Nocebo

In this article we explore the ethics of manipulating verbal information for the sake of influencing health-outcomes through placebo and nocebo responses. Recent scientific research on placebo and nocebo effects has drawn attention to the ways in which communication by health professionals may modulate the symptoms of patients across an array of highly prevalent conditions such as pain, depression, anxiety, insomnia, irritable bowel syndrome, migraine and Parkinson’s disease. The positive and negative effects of clinicians’ communication on patient outcomes pose important ethical issues, which we describe in this article under the label of “the ethics of therapeutic communication” (TC). We begin by reviewing available evidence supporting the claim that doctor-patient communication has therapeutic effects. We then identify in truthfulness, helpfulness and pragmatism three morally relevant considerations that can guide clinicians in therapeutic communication with their patients. Finally, we examine the ethics of using TC to enhance the effectiveness of proven medical interventions and open-label placebos.

As old as healing itself, the placebo effect is an important yet seemingly misunderstood phenomenon in conventional medical science. In a broad sense it occurs when patients experience positive results more from psychological rather than chemical origins. Much of antidepressants hidden efficacy has been found to be attributed to this effect, conversely, alternative medicine has embraced the notion and calls it self-healing. There is a major correlation between the placebo effect and the doctor-patient relationship. The placebo is more than just a control tool, it has the ability to be a positive force in the conventional medical understanding of the power of mind over body.

A nocebo effect hypothesis has been proposed to explain variations in where small minorities of exposed residents complain about noise and health effects said to be caused by wind farm turbines. The hypothesis requires that those complaining have been exposed to negative, potentially frightening information about the impact of proposed wind farms on nearby residents, and that this information conditions both expectations about future health impacts or the etiology of current health problems where wind farms are already operational. This hypothesis has been confirmed experimentally under laboratory conditions, but case studies of how this process can operate in local communities are lacking. In this paper, we present a case study of the apparent impact of an anti-wind farm public meeting on the generation of negative news media and the subsequent expression of concerns about anticipated health and noise impacts to a planning authority approval hearing in Victoria, Australia. We present a content analysis of the negative claims disseminated about health and noise in the news media and available on the internet prior to the hearing, and another content analysis of all submissions made to the planning authority by those opposing the development application.

The placebo effect is a somewhat well known phenomenon. The nocebo effect is its evil twin and produces the opposite results.
Studies on the placebo and nocebo effect suggest that perception is not merely a result of external stimuli, but it is not yet clear how exactly our beliefs or expectations alter our perceptions.

The use of placebos in clinical settings raises a host of important ethical issues. On the one hand, ethical guidelines tend to categorically prohibit the clinical use of placebos because they require deception. On the other hand, a growing series of empirical studies has revealed that placebos can be clinically effective and are still widely used by health professionals. In this article we provide a synthetic overview of the ethical debate discussing (i) the ethics of deceptive placebos, (ii) the ethics of placebos without deception, and (iii) the ethics of eliciting placebo responses without administering a traditional placebo.

Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. There was consensus that maximizing placebo effects and minim...

Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. There was consensus that maximizing placebo effects and minim...

Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. There was consensus that maximizing placebo effects and minim...

ITA: In questo breve commento all'articolo di Sara Palermo mi propongo di rilevare alcune critici-tà relative al metodo di indagine e alla solidità dell'ipotesi suggerita dall'autrice. In seguito mi concentrerò sulla rilevanza dello studio del nocebo/placebo nell'ambito del dibattito sul rapporto mente/corpo e su come questi fenomeni mettano in discussione approcci dualisti e neurocentrici ancora pervasivi soprattutto in campo filosofico. In conclusione, mi soffermerò sul ruolo delle aspettative nella costruzione del mo-dello del nocebo/placebo, riprendendo un contesto particolarmente promettente per l'inquadramento teorico del fenomeno: il cervello predittivo.

ENG: In this brief commentary on Sara Palermo’s article, I highlight several methodological criticisms of the data analysis and hypotheses proposed by the author. I then  focus  on  the  relevance  of  nocebo/placebo  studies  for  the  contemporary  debate  on  the  mind/body problem.  In  particular,  I  show  how  these  phenomena  raise  questions  for  dualistic  and  neurocentric  approaches that are still prevalent in philosophy. Finally, I stress the role of expectations in nocebo/placebo models, with reference to a promising theoretical framework: the predictive brain.