Published 12 May 2009, doi:10.1136/bmj.b1898
Cite this as: BMJ 2009;338:b1898

Letters

Placebo misery

Escaping from placebo prison

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

Nunn is correct: there is no such thing as the placebo.¹ People slap the label placebo on treatments that have a host of distinct factors with potentially therapeutic effects, including:

• Hawthorne effects (potential therapeutic benefit resulting simply from participants’ knowing that they are taking part in a trial)²
  
• Effects of empathetic patient-doctor interaction³
  
• Effects of a patient’s belief that a treatment is powerful, expensive, or has a brand name³
  
• Other features, including colour, method of administration,⁴ and content.⁵
  

Thinking in terms of the all inclusive placebo blurs the distinction between these very different factors, which, in turn, blinds researchers to how to maximise therapeutic benefits.

Worse, placebos are rarely described in sufficient detail, and they might contain ingredients that are clearly non-placebogenic. One example is olive oil used as a bulking agent in placebo controls for cholesterol lowering drugs.⁶

It is time to recognise placebos as treatments in their own . . . [Full text of this article]

¹ Centre for Evidence-Based Medicine, University of Oxford, Oxford OX3 7LF

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