Understanding the Placebo Effect in Complementary Medicine: Theory, Practice, and Research

By David Peters | Go to book overview

3
A critical reanalysis of the concept,
magnitude and existence of placebo
effects
Gunver S. Kienle and Helmut Kiene
An analysis of research findings
The dilemma of the placebo concept
Factors that can create false
impressions of placebo effects
Natural, spontaneous improvement of a disease
Spontaneous fluctuation of symptoms or disease course
Regression to the mean
Additional treatment
Conditional switching of treatment
Irrelevant or questionable response variables
Answer of politeness and experimental subordination
Conditioned answers
Neurotic or psychotic misjudgement
The placebo is not a placebo
Uncritical reporting of anecdotes
Misquotations
Side-effects, toxic reactions
Conclusion

Editor's note

Having so long emphasised technical effectiveness, modern medicine is beginning to understand just how important as yet poorly defined human factors can be. As practitioners we usually take our clinical impressions of treatment outcomes as the measure of our effectiveness. Yet though we say these everyday experiences justify the way we treat patients, our results may have less to do with specific treatments than with these non‐ specific factors. Calling them 'placebo effect' just creates a rag-bag category; nor is labelling something the same as understanding it - or how it works. For nearly 50 years since Beecher's classic research, the myth of the 30% placebo response has persisted. Dr Kienle takes it apart and criticises subsequent studies that appear to show even higher rates of placebo response. In doing this she highlights many of the non-specific factors that influence treatment outcome, and asks whether the placebo response (in its narrow sense of mere imitation therapy) exists at all. By re-examining these studies she has been able to identify in every case, significant non-pharmacological factors at work. Her chapter makes us more aware of what they might be. She introduces the term 'patient self-healing' and implies that it is right and proper for practitioners to encourage these processes.

Since 1955, when H. K. Beecher published his classic 'The powerful placebo', it has been generally accepted that 35% of patients with any of a wide variety of disorders can be treated with placebos alone. In recent

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