Editorials

What is the placebo worth?

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39535.344201.BE (Published 01 May 2008) Cite this as: BMJ 2008;336:967
  1. David Spiegel, Willson professor 1,
  2. Anne Harrington, professor and chair2
  1. 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5718, USA
  2. 2Department of the History of Science, Science Center 371, Harvard University, Cambridge, MA 02138, USA
  1. dspiegel{at}stanford.edu

    The doctor-patient relationship is a crucial part of its value

    George Bernard Shaw described a miracle as “an event that creates faith.” Belief is a powerful tool, and many factors influence it. A recent study testing pain relief from analgesics showed that merely telling people that a novel form of codeine they were taking (actually a placebo) was worth $2.50 (£1.25; €1.58) rather than 10 cents increased the proportion of people who reported pain relief from 61% to 85.4%.1 When the “price” of the placebo was reduced, so was the pain relief. A meta-analysis of decades of clinical trials proposed that the placebo effect was more hype than reality.2 However, the resulting backlash against it has had the implicit effect of clarifying what is best practice with regard to the placebo.3

    Hovering over much of the research is a practical question for clinicians—what does all this mean for patient care? In the accompanying randomised controlled trial, Kaptchuk and colleagues undertake a dismantling approach to the examination of placebo effects.4 In 262 adults with irritable bowel syndrome, they examined the effects …

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