Implementing placebo

doi:10.1136/bmj.39577.537778.3A

BMJ 2008;336:1087 (17 May), doi:10.1136/bmj.39577.537778.3A

Letters

Placebo effect

Implementing placebo

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

Pittrof and Rubinstein make the important point that the "placeboeffect" is actually an effect—people often do get betteron placebo.¹ However, most, if not all, of the evidence forplacebo effects comes from studies where patients expected tohave a reasonable chance (generally 0.5) of receiving the activetreatment. There is therefore no evidence base for prescribingplacebos in a standard clinical setting, which is what the authorsseem to advocate.

We do not know whether placebos will have an effect if patientsare aware of what they are receiving. The most likely explanationfor the placebo effect, particularly in mental disorders, isthat it works as a proto-psychotherapy, using the patients’conviction that they are being helped and mobilising their ownpositive resources. We know very little about the brain mechanismsof the placebo response, but the available evidence suggeststhat, like psychotherapy, it partly operates through the . . . [Full text of this article]

David E Linden, professor of biological psychiatry

¹ School of Psychology, Bangor University and North Wales Clinical School, Bangor LL572AS

d.linden@bangor.ac.uk