The Dangerous Side of Placebo Research: Is Hard Science Boosting Pseudoscience?

Hacking the Predictive Mind

According to active inference, constantly running prediction engines in our brain play a large role in delivering all human experience. These predictions help deliver everything we see, hear, touch, and feel. In this paper, I pursue one apparent consequence of this increasingly well-supported view. Given the constant influence of hidden predictions on human experience, can we leverage the power of prediction in the service of human flourishing? Can we learn to hack our own predictive regimes in ways that better serve our needs and purposes? Asking this question rapidly reveals a landscape that is at once familiar and new. It is also challenging, suggesting important questions about scope and dangers while casting further doubt (as if any was needed) on old assumptions about a firm mind/body divide. I review a range of possible hacks, starting with the careful use of placebos, moving on to look at chronic pain and functional disorders, and ending with some speculations concerning the complex role of genetic influences on the predictive brain.

What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus

INTRODUCTION

Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments.

OBJECTIVE

There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information.

METHODS

Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients.

RESULTS

There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities.

CONCLUSIONS

The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.

Thirty Years of Neuroscientific Investigation of Placebo and Nocebo: The Interesting, the Good, and the Bad

Over the past 30 years there has been a surge of research on the placebo effect using a neuroscientific approach. The interesting aspects of this effort are related to the identification of several biological mechanisms of both the placebo and nocebo effects, the latter of which is defined as a negative placebo effect. Some important translational implications have emerged both in the setting of clinical trials and in routine medical practice. One of the principal contributions of neuroscience has been to draw the attention of the scientific and medical communities to the important role of psychobiological factors in therapeutic outcomes, be they drug related or not. Indeed, many biological mechanisms triggered by placebos and nocebos resemble those modulated by drugs, suggesting a possible interaction between psychological factors and drug action. Unfortunately, this new knowledge regarding placebos has the potential of being dangerously exploited by pseudoscience. Expected final online publication date for the Annual Review of Pharmacology and Toxicology, Volume 62 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

[Homeopathy-a therapeutic option for medical practice? : An evaluation from the perspective of evidence-based medicine]

Many publications declare homeopathy to be "controversial." However, based on the findings of extensive research on homeopathy, there has long been a broad scientific consensus that there is no reliable evidence of specific medical effectiveness. Overall, the evidence clearly denies effects beyond those of placebo and context. All the more must it be seen as a phenomenon that homeopathy is still the subject of medical and therapeutic practice. This may lie largely in the fact that the homeopathic scene appropriates medical research and the concept of evidence in a way that is suitable to maintain the appearance that there is still a scientifically relevant discourse to dispute. The following article aims to justify that this is not the case, and that homeopathy is, therefore, obsolete as a therapeutic option, even according to the principles of contemporary medical ethics.

Placebos and Movies: What Do They Have in Common?

Placebos are fake therapies that can induce real therapeutic effects, called placebo effects. It goes without saying that what matters for inducing a placebo effect is not so much the fake treatment itself, but rather the therapeutic ritual that is carried out, which is capable of triggering psychobiological mechanisms in the patient’s brain. Both laypersons and scientists often accept the phenomenon of the placebo effect with reluctance, as fiction-induced clinical improvements are at odds with common sense. However, it should be emphasized that placebo effects are not surprising after all if one considers that fiction-induced physiological effects occur in everyday life. Movies provide one of the best examples of how fictitious reality can induce psychological and physiological responses, such as fear, love, and tears. In the same way that a horror movie induces fear-related physiological responses, even though the viewer knows everything is fake, so the sight of a syringe may trigger the release of pain-relieving chemicals in the patient’s brain, even if the patient knows there is a fake painkiller inside. From this perspective, placebos can be better conceptualized as rituals, actions, and fictions within a more general framework that emphasizes the power of psychological factors in everyday life, including the healing context.