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Placebo precision 

 •  • by Paul Ingraham
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Harriet Hall translated a French article on placebo by Jean Brissonnet 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. For example:

There are many arguments against its use in healthcare practice. Do we have the right to fool the patient? Do we have the right to act without his consent? Can we risk permanently damaging the doctor/patient relationship if the patient finds out that he has been deceived? A better understanding of the phenomenon makes such questions obsolete. To the extent that the “placebo effect” is only a contextual effect that doesn’t depend on the use of an inactive object, it can and should be used in healthcare practice. It can probably be used instead of a prescription in certain functional diseases, and it certainly can potentiate the effect of prescribed drugs in many cases.

The gist of the article is that what we usually refer to as “the” placebo effect is a category of phenomena, many of them clinically meaningless, and we truly need to learn and use more precise terminology. It’s not just word-nerd nitpickery! Speaking only of “placebo” is about as useful as saying only “furniture” when you mean “chaise longue” or “credenza” or “futon.”

Placebo, Are You There?
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