Spirituality and clinical careBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7394.881 (Published 19 April 2003) Cite this as: BMJ 2003;326:881
Placebo or not—we may never know
- Daniel R Nethercott, senior house officer, palliative medicine (firstname.lastname@example.org)
- Holme Tower, Marie Curie Centre, Penarth, South Glamorgan CF64 3YR
- Worcestershire Acute Hospitals NHS Trust, Worcester WR5 1DD
- Addictive Behaviours Centre, Birmingham B4 6SX
EDITOR—I agree with Culliford that knowing your patients better makes for a better therapeutic relationship.1 Often—for example, in terminal care or when physical measures do not have an impact on any disease—being able to relate in “wider” terms can increase the potential for healing. But I disagree with Culliford on the question of methodology.
Most religions and other arenas of spirituality use ritualised gestures, incantations, prayers, symbolism, and rites. Unless you believe that these processes have effects through a perceived extracorporeal being, power, or energy, the effect is presumed to come from within patients themselves. But the placebo effect is inherently based on its own camouflage. Once you know you're taking placebo then the magic is lost.
The entire effect is dependent on your “faith” in the procedure. Although I might deliberately use the placebo effect in my pharmacological treatment of patients, is it not an unethical deceit for me to portray a facade of spirituality for their benefit when …
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