GOLDEN OLDIE EDITORIAL - THE PLACEBO EFFECT: POWERFUL, POWERLESS OR REDUNDANT?

Review written by Steve Kamper info

INTRODUCTION

Placebos are one of those things that almost everyone has an opinion on, but relatively few people have actually invested much thought into. Colleagues and I have invested some thought into placebos. This article is a summary of an editorial we published in the British Journal of Sports Medicine in 2013. It’s certainly not the definitive word on the topic, but our position on the issue.

A BRIEF HISTORY

Placebos appeared in the field of medicine around the 1700s, and were a relatively accepted part of medical practice for hundreds of years. During this time, opinion was that placebos had no effect on pathophysiology; they were a sort of benign comfort to the patient while nature took its course – one way or the other. In 1955, an influential article titled ‘The Powerful placebo’ (1) encapsulated a view that there was a ‘placebo effect’ responsible for important therapeutic benefits. This coincided with increase in use of placebo interventions in medical research. Placebos established a place in practice and research in the medical field. Around the turn of this century, researchers began asking questions about the importance (and indeed existence) of placebo effects, exemplified in the publication of a large systematic review titled ‘Is the placebo powerless?’ (2). A major advance was to highlight that factors such as natural history, regression to the mean, and polite patient effects are not placebo effects; they represent completely distinct concepts.

PLACEBO PARADOX

In the last 50 years, numerous attempts were made to propose a universal definition for placebos and placebo effects. Failure to agree upon a widely accepted definition led to some researchers questioning the logical underpinning of the placebo concept itself.

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