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Blease C, Colagiuri B, Locher C. Replication crisis and placebo studies: rebooting the bioethical debate. JOURNAL OF MEDICAL ETHICS 2023; 49:663-669. [PMID: 36609361 DOI: 10.1136/jme-2022-108672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
A growing body of cross-cultural survey research shows high percentages of clinicians report using placebos in clinical settings. One motivation for clinicians using placebos is to help patients by capitalising on the placebo effect's reported health benefits. This is not surprising, given that placebo studies are burgeoning, with increasing calls by researchers to ethically harness placebo effects among patients. These calls propose placebos/placebo effects offer clinically significant benefits to patients. In this paper, we argue many findings in this highly cited and 'hot' field have not been independently replicated. Evaluating the ethicality of placebo use in clinical practice involves first understanding whether placebos are efficacious clinically. Therefore, it is crucial to consider placebo research in the context of the replication crisis and what can be learnt to advance evidence-based knowledge of placebos/placebo effects and their clinical relevance (or lack thereof). In doing so, our goal in this paper is to motivate both increased awareness of replication issues and to help pave the way for advances in scientific research in the field of placebo studies to better inform ethical evidence-based practice. We argue that, only by developing a rigorous evidence base can we better understand how, if at all, placebos/placebo effects can be harnessed ethically in clinical settings.
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Affiliation(s)
- Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Psychology, Plymouth University, Plymouth, UK
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Druart L, Bailly-Basin E, Dolgopoloff M, Rossettini G, Blease C, Locher C, Kubicki A, Pinsault N. Using contextual factors to elicit placebo and nocebo effects: An online survey of healthcare providers' practice. PLoS One 2023; 18:e0291079. [PMID: 37656736 PMCID: PMC10473518 DOI: 10.1371/journal.pone.0291079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
Contextual factor use by healthcare professionals has been studied mainly among nurses and physiotherapists. Preliminary results show that healthcare professionals use contextual factors without specifically labelling them as such. The main objective of this study was to evaluate knowledge and explore voluntary contextual factor use among various healthcare professions. The results aim to facilitate hypothesis-generation, to better position further research to explain and characterise contextual factor use. We conducted a web-based questionnaire cross-sectional observational study on a non-probabilistic convenience sample. Face and content validity were tested through cognitive interviews. Data were analysed descriptively. The target population was the main healthcare profession, or final year students, defined by the French public health law. The countries of distribution of the questionnaire were the French-speaking European countries. Among our 1236 participants, use of contextual factors was widespread. Those relating to the therapeutic relationship (e.g., communication) and patient characteristics (e.g., past experiences) were reportedly the most used. Meanwhile, contextual factors related to the healthcare providers' characteristics and their own beliefs were reported as less used. Despite high variability, respondents suggested contextual effects contribute to approximately half of the overall effect in healthcare and were perceived as more effective on children and elderly adults. Conceptual variations that exist in the literature are also present in the way healthcare providers consider contextual effects. Interestingly, there seems to be common ground between how physiotherapists, nurses and physicians use different contextual factors. Finally, in the present study we also observed that while there are similarities across usage, there is lack of both an epistemological and ethical consensus among healthcare providers with respect to contextual factors.
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Affiliation(s)
- Leo Druart
- Univ. Grenoble Alpes, CNRS, VetAgro Sup, Grenoble INP, Grenoble, France
- Department of Physiotherapy University Grenoble Alpes, Grenoble, France
| | - Emilie Bailly-Basin
- Univ. Grenoble Alpes, CNRS, VetAgro Sup, Grenoble INP, Grenoble, France
- Department of Rehabilitation, Franche-Comté University, Montbéliard, France
| | - Maïa Dolgopoloff
- Department of Physiotherapy University Grenoble Alpes, Grenoble, France
| | | | - Charlotte Blease
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Digital Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Switzerland
- Faculty of Health, University of Plymouth, United Kingdom
| | - Alexandre Kubicki
- Department of Rehabilitation, Franche-Comté University, Montbéliard, France
- Laboratoire de neurosciences intégratives, Besançon, France
| | - Nicolas Pinsault
- Univ. Grenoble Alpes, CNRS, VetAgro Sup, Grenoble INP, Grenoble, France
- Department of Physiotherapy University Grenoble Alpes, Grenoble, France
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Smits RM, Veldhuijzen DS, van Middendorp H, van der Heijden MJE, van Dijk M, Evers AWM. Integrating Placebo Effects in General Practice: A Cross-Sectional Survey to Investigate Perspectives From Health Care Professionals in the Netherlands. Front Psychiatry 2021; 12:768135. [PMID: 35095592 PMCID: PMC8790122 DOI: 10.3389/fpsyt.2021.768135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Placebo effects, beneficial treatment outcomes due to non-active treatment components, play an important role in the overall treatment response. To facilitate these beneficial effects it is important to explore the perspectives of health care professionals (HCPs) on the integration of placebo effects in clinical care. Three themes were investigated: knowledge about placebo effects and factors that contribute to these, frequency of placebo use, and attitudes toward acceptability and transparency of placebo use in treatment. Methods: A cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was conducted in the Netherlands in 2020. The survey was conducted in two samples: a (nested) short survey in 78 nurses during working shifts (sample 1) and an extended online survey in 47 general HCPs e.g., medical psychologists, oncologists, surgeons (sample 2). Results: Respondents from both samples reported to be somewhat or quite familiar with placebo effects (24.0 and 47.2%, respectively). From the six placebo mechanisms that were presented, mind-body interaction, positive expectations, and brain activity involved in placebo effects were rated as the most influential factors in placebo effects [F(5,119) = 20.921, p < 0.001]. The use of placebo effects was reported in 53.8% (n = 42) of the nurses (e.g., by inducing positive expectations), and 17.4% of the HCPs (n = 8 reported to make use of pure placebos and 30.4% of impure placebos (n = 14). Attitudes toward placebo use in treatment were acceptant, and transparency was highly valued (both up to 51%). Conclusions: The findings from this study address knowledge gaps in placebo effects in practice and provide insights in attitudes toward the integration of placebo effects from HCPs. Altogether, integrating these findings may potentially optimize treatment outcomes.
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Affiliation(s)
- Rosanne M Smits
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Marianne J E van der Heijden
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
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