Placebos in medicine: Placebo use is well known, placebo effect is not

doi:10.1136/bmj.330.7481.45

BMJ 2005;330:45 (1 January), doi:10.1136/bmj.330.7481.45

Letter

Placebos in medicine

Placebo use is well known, placebo effect is not

The first 150 words of the full text of this article appear below.

EDITOR—In their paper on the use of placebos in clinicalpractice, Nitzan and Lichtenberg say that they were unable tofind more than one other study on the use of placebos in a clinicalcontext.^{1 2} Eight similar studies are indexed in PubMed (seebmj.com).

In the accompanying editorial, Spiegel points out that the Cochranereview on the placebo effect probably underestimated the placeboeffects of treatments.^{3 4} Spiegel gave some methodological explanationsfor this underestimation but did not mention a much more importantreason.

A problem with the Cochrane review, as mentioned in three lettersby Lilford and Braunholtz, Kuppers, and Shrier,⁵ is that theincluded studies were done in a setting completely differentfrom the situation in clinical practice. The included studiesare three armed studies, in which patients are randomly allocatedto a supposedly active treatment, to a placebo, or to no treatment.The placebo effect . . . [Full text of this article]

Toke S Barfod, clinical researcher

Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark Toke.barfod@dadlnet.dk