Placebo, Are You There?
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Harriet Hall translated this French article on placebo for ScienceBasedMedicine.org, calling it “the best explanation of placebo that I had ever read.” (I was quite involved editorially, and in particular spent a bunch of time on producing shinier, translated diagrams.) I’m not quite sure it’s the best placebo explanation I’ve ever read, but on the other hand I can’t point to a better one, and it is certainly chock-a-block with historical context, effectively cited science, and little gems of clarity on this tricky topic.
The gist of the article is that “placebo” is an imprecise term and we need to distinguish placebo objects (essential for research), the effect of placebo (“that doesn’t exist,” because placebo objects inert), and contextual effects (which go beyond a response to a placebo object but are not “powerful”). Brissonnet concludes:
So, then! Placebo, are you there? The placebo object is certainly there! It will be irreplaceable for the foreseeable future in carrying out the controlled clinical studies that are essential to medical research. As for the effect of the placebo, that doesn’t exist. As for the effect “called” placebo, if its existence is undeniable albeit limited, it would be better to simply name it “contextual effect” in order to better understand its true nature and to make its magical connotations disappear.
~ Paul Ingraham, PainSci Publisher
- “The powerful placebo,” Beecher, J Am Med Assoc, 1955.
- “The powerful placebo effect: fact or fiction?,” Kienle et al, J Clin Epidemiol, 1997.
- “Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment,” Hróbjartsson et al, New England Journal of Medicine, 2001.
- “Is the placebo powerless? Update of a systematic review with 52 new randomized trials comparing placebo with no treatment,” Hróbjartsson et al, J Intern Med, 2004.
One article on PainScience.com cites this item as a source: