Placebo Economics: A Systematic Review About the Economic Potential of Utilizing the Placebo Effect

The impact of green credit legislation on business financing: Insights from Chinese polluting firms

Introducing sustainable credit protection by companies depends on eco-friendly funding that accelerate businesses' technical development and transformation. This study investigates the sustainable financing roles through green credit legislation which impacted state owned enterprises and non state owned enterprises. We have investigated our hypothesis using the Propensity Score Matching Difference-in-Differences (PSM-DID) model. For this purpose we collected data of businesses listed on the Shanghai and Shenzhen stock exchanges that are country's most polluting publicly listed enterprises between 2009 and 2021. The results of the study reveals that liquid Finance and industrial Credit experienced a meteoric rise while the use of illiquid debt financing has dropped significantly among highly polluting organizations. This pattern has intensified after China introduced its "sustainable credit guidelines." Additionally, businesses in areas with lower sustainable development indices are more likely to feel the consequences of sustainable credit programs. However, there is still a need for prudent capital flow allocation in response to the personalized financing preferences resulting from the sustainable credit policy at the business level, even if China's sustainable credit rules have unquestionably reduced the use of illiquid debt financing by severely polluting enterprises. Policy implications include improving the direction signalled to these businesses via sustainable funding.

White patients' physical responses to healthcare treatments are influenced by provider race and gender

The healthcare workforce in the United States is becoming increasingly diverse, gradually shifting society away from the historical overrepresentation of White men among physicians. However, given the long-standing underrepresentation of people of color and women in the medical field, patients may still associate the concept of doctors with White men and may be physiologically less responsive to treatment administered by providers from other backgrounds. To investigate this, we varied the race and gender of the provider from which White patients received identical treatment for allergic reactions and measured patients' improvement in response to this treatment, thus isolating how a provider's demographic characteristics shape physical responses to healthcare. A total of 187 White patients experiencing a laboratory-induced allergic reaction interacted with a healthcare provider who applied a treatment cream and told them it would relieve their allergic reaction. Unbeknownst to the patients, the cream was inert (an unscented lotion) and interactions were completely standardized except for the provider's race and gender. Patients were randomly assigned to interact with a provider who was a man or a woman and Asian, Black, or White. A fully blinded research assistant measured the change in the size of patients' allergic reaction after cream administration. Results indicated that White patients showed a weaker response to the standardized treatment over time when it was administered by women or Black providers. We explore several potential explanations for these varied physiological treatment responses and discuss the implications of problematic race and gender dynamics that can endure "under the skin," even for those who aim to be bias free.

The influence of price and funding source disclosure on medication labels: Implications for intended adherence, perceived value and efficacy, and feelings of burden and guilt

OBJECTIVES

To examine if informing people in free-at-the-point-of-use medical systems of the financial value of medicines, and priming them with the fact that the medication is funded by taxation, influences people's perceived value and efficacy of the medicines, feelings of burdensomeness and guilt, and intended adherence.

DESIGN

An experiment was implemented to examine the impact of medication labelling featuring the presence (vs. absence) of the phrase 'funded by UK the taxpayer' and pricing information (absent vs. £20 vs. £200) on outcome measures.

METHODS

A total of 257 UK participants (age: M = 29.10 years, SD = 9.15; 89 males, 167 females, one undisclosed) who were currently taking medication were recruited from an online participant pool (prolific academic). Participants viewed an image of a medication with the manipulated price and taxation message on the label. They then completed a number of measures to gauge perceived value and efficacy of the medicines, feelings of burdensomeness and guilt, and intended adherence.

RESULTS

Findings point to both positive and negative consequences of such labelling of medication, with the taxpayer label increasing perceptions of value but also increasing feelings of guilt. The price labels demonstrated a positive effect on perceived value and intended adherence.

CONCLUSIONS

Discussion of results is centred on potential policy implications, applied recommendations, and future directions for study.

Acupuncture for post-stroke depression: a systematic review and meta-analysis

Background

Acupuncture for post-stroke depression (PSD) has been evolving, but uncertainty remains. To assess the existing evidence from randomized clinical trials (RCTs) of acupuncture for PSD, we sought to draw conclusions by synthesizing RCTs.

Methods

An exhaustive literature search was conducted in seven electronic databases from their inception dates to April 19, 2020, to identify systematic reviews (SRs) and meta-analyses (MAs) on this topic. The primary RCTs included in the SRs/MAs were identified. We also conducted a supplementary search for RCTs published from January 1, 2015, to May 12, 2020. Two reviewers extracted data separately and pooled data using RevMan 5.3 software. The quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system.

Results

A total of 17 RCTs involving 1402 patients were included. Meta-analysis showed that participants who received a combination of acupuncture and conventional treatments exhibited significantly lower scores on the HAM-D₁₇, HAM-D₂₄ and HAM-D (MD, − 5.08 [95% CI, − 6.48 to − 3.67], I² = 0%), (MD, − 9.72 [95% CI, − 14.54 to − 4.91], I² = 65%) and (MD, − 2.72 [95% CI, − 3.61 to − 1.82], respectively) than those who received conventional treatment. However, there was no significant difference in acupuncture versus antidepressants in terms of the 17-item, 24-item and HAM-D scales (MD, − 0.43 [95% CI, − 1.61 to 0.75], I² = 51%), (MD, − 3.09 [95% CI, − 10.81 to 4.63], I² = 90%) and (MD, − 1.55 [95% CI, − 4.36 to 1.26], I² = 95%, respectively). For adverse events, acupuncture was associated with fewer adverse events than antidepressants (RR, 0.16 [95% CI, 0.07 to 0.39], I² = 35%), but there was no significant difference in the occurrence of adverse events between the combination of acupuncture and conventional treatments versus conventional treatments (RR, 0.63 [95% CI, 0.21 to 1.83], I² = 38%). The quality of evidence was low to very low due to the substantial heterogeneity among the included studies.

Conclusions

The current review indicates that acupuncture has greater effect on PSD and better safety profile than antidepressants, but high-quality evidence evaluating acupuncture for PSD is still needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-021-03277-3.

Effects of open-label placebos in clinical trials: a systematic review and meta-analysis

Open-label placebos (OLPs) are placebos without deception in the sense that patients know that they are receiving a placebo. The objective of our study is to systematically review and analyze the effect of OLPs in comparison to no treatment in clinical trials. A systematic literature search was carried out in February 2020. Randomized controlled trials of any medical condition or mental disorder comparing OLPs to no treatment were included. Data extraction and risk of bias rating were independently assessed. 1246 records were screened and thirteen studies were included into the systematic review. Eleven trials were eligible for meta-analysis. These trials assessed effects of OLPs on back pain, cancer-related fatigue, attention deficit hyperactivity disorder, allergic rhinitis, major depression, irritable bowel syndrome and menopausal hot flushes. Risk of bias was moderate among all studies. We found a significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I² = 76%) of OLP. Thus, OLPs appear to be a promising treatment in different conditions but the respective research is in its infancy. More research is needed, especially with respect to different medical and mental disorders and instructions accompanying the OLP administration as well as the role of expectations and mindsets.

Maximizing placebo response in neurological clinical practice

The placebo effect is a widely recognized phenomenon in clinical research, with a negative perception that it could hide the "true" drug effect. In clinical care its positive potential to increase known drug effects has been neglected for too long. The placebo and nocebo responses have been described in many neurologic disorders such as Parkinson's, Huntington's and Alzheimer's diseases, restless leg syndrome, tics, essential tremor, dystonia, functional movement disorders, neuropathic pain, headaches, migraine, amyotrophic lateral sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, multiple sclerosis and epilepsy. Knowledge regarding placebo mechanisms and their consequences on clinical outcome have greatly improved over the last two decades. This evolution has led to reconsiderations of the importance of placebo response in the clinic and has given several clues on how to improve it in daily practice. In this chapter, we first illustrate "why," e.g. the reasons (relevance to clinical practice, help in differential diagnosis/treatment of psychogenic movements, clinical impact, proven neurobiological grounds, health economic potential), and "how," e.g. the means (increase patients' knowledge, increase learning, improve patient-doctor relationship, increase Hawthorne effect, increase positive/decrease negative expectations (the Rosenthal effect), personalize placebo response), the placebo should be maximized (and nocebo avoided) in neurological clinical practice. Future studies regarding more specific neurobiological mechanisms will allow a finer tuning of placebo response in clinical practice. The use of placebo in clinical practice raises ethical issues, and a recent expert consensus regarding placebo use in the clinic is a first step to future guidelines necessary to this field.