The Placebo Effect: Illness and Interpersonal Healing

Department of Bioethics, National Institutes of Health, Bethesda, MD 20892-1156, USA.
Perspectives in Biology and Medicine (Impact Factor: 0.48). 09/2009; 52(4):518-39. DOI: 10.1353/pbm.0.0115
Source: PubMed


The placebo effect has been a source of fascination, irritation, and confusion within biomedicine over the past 60 years. Although scientific investigation has accelerated in the past decade, with particular attention to neurobiological mechanisms, there has been a dearth of attention to developing a general theory of the placebo effect. In this article, we attempt to address this gap. To set the stage, we review evidence relating to the reality and clinical significance of the placebo effect. Next we investigate the scope and limits of the placebo effect by examining the hypothesis that the placebo effect operates predominantly by modifying the experience and perceptions of illness symptoms, such as pain, anxiety, and fatigue, rather than by modifying the pathophysiology of disease. Based on this background, we characterize the placebo effect as a form of interpersonal healing, as distinct from spontaneous natural healing and from technological healing dependent on physiologically active pharmaceuticals or procedures. Finally, we argue that research on the placebo effect has the potential to revitalize the art of medicine.

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Available from: Luana Colloca, Feb 27, 2014
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    • "Broadly, psychosocial cues and the entire set of interpersonal interactions (eg, parents, peers, or proxy) contribute to induce expectations and potentially recall memories of analgesia. Although placebo effects by proxy are based on reports of parents and may reflect report bias rather than real benefit in the children, the phenomenon by which physician– child–parent interactions triggers placebo mechanisms is relevant for clinical outcomes [17] [49] [4]. "
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    ABSTRACT: Pain modulation by placebo mechanisms is one of the most robust and best-studied phenomena, yet almost all research investigating the mechanisms and implications of the placebo analgesia are based on adult research. After highlighting crucial aspects that need to be considered in studying pain modulation in children, this comprehensive review examines studies related to pain modulation with an emphasis on factors such as age, neural development and pain measures. Psychological mechanisms underlying placebo effects including: 1) verbally-induced expectations; 2) conditioning and learning mechanisms; 3) child-parent-physician interactions are critically discussed. Taken together, research suggests that placebo mechanisms can impact therapeutic outcomes and potentially be exploited clinically to improve clinical outcomes in pediatric population. Recommendations for further investigating the mechanistic bases and harnessing placebo effects for supportive therapeutic applications are given.
    Full-text · Article · Aug 2014 · Pain
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    • "The somewhat atheoretical approach in the placebo literature (Miller, et al., 2009) may also be hindering progress. Personality measures, rather than personality theory, appears to be driving research. "
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    ABSTRACT: The placebo effect is now recognised as a genuine psychobiological phenomenon; however, the question of how it can be systematically harnessed to improve health outcomes is not yet clear. One issue that remains unresolved is why some respond to placebos and others do not. A number of traits have been linked to responding, but findings are scattered. In extending prior work, this paper offers three considerations. First, attempts to describe the placebo responder via a single personality trait may be limiting. A synthesis of findings to date suggest placebo responsiveness may reflect a two faceted construct, with ‘inward’ and ‘outward’ orientation representing the different but related facets of placebo responsiveness. Second, the lack of theoretically driven research may be hindering progress. Personality measures rather than personality theory appear to be driving research and higher order traits are descriptive tools with limited use in predicting behaviour. A biologically based stimulus-response model of personality that considers how individuals respond to certain environmental cues may be more appropriate. Third, a transactional model of placebo responding in which dispositional characteristics interact with environmental contingencies is presented. Responsiveness may manifest in placebo environments where there is a match between an individual’s biological trait-like response systems and environmental contingencies. This type of model may be useful in both research and clinical settings. Systematic consideration of how different individuals might respond to different placebo environments might facilitate identification of stable individual characteristics predictive of responding. The ability to determine who is responsive to placebo treatments, and in what context, may enable the matching of individual to treatment, thereby maximising the effectiveness of treatment and minimizing possible iatrogenic harm. In the increasingly overtaxed modern healthcare industry non-pharmacological treatment alternatives are of critical importance.
    Full-text · Article · Jun 2014 · Psychology Health and Medicine
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    • "‘We are inclined to attribute recovery from disease to the ministrations of healers when, in point of fact, it is often due to self-limiting diseases and the automatic natural healing of the organism.’9 "
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    ABSTRACT: Placebo appears to be a real neurobiological phenomenon that has evolved through the selection pressure to be able to heal ourselves. The complex language and social structures of humans means that we can attribute meaning to therapeutic encounters with culturally sanctioned authority figures and we can use our attachment to such figures to generate hope for recovery. Different mechanisms may be involved in the neurobiological aspect of placebo including anxiety, learning, conditioning as well as individual genetic variation. Examination of the published work shows that while some trials do seem to indicate a specific mode of action for homeopathic remedies other trials do not and this is an issue that needs to be addressed at the trial design stage. A clinical trial that includes both a placebo group and a non-participating control arm is the most powerful design for separating the non-specific and polymorphic placebo effect from the specific effects of trial medication. The control variables in a trial of homeopathic medication should also include the process of consultation as this may assume a meaning for the individual that can also be associated with a placebo effect.
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