Bennett is questioning our usage of the term placebo in research. In this article the author is advocating for a change in terminology to phrases that will appropriately set expectations:
"The foregoing discussion leads to an obvious recommendation for clinical trials procedure. The word “placebo” should be avoided in all information and instructions given to the patients. Patient instructions should have the goal of forcing the patient’s expectations to the form: ‘I may receive pain relief’ vs. ‘I will not obtain pain relief’. Thus, for example, patients should be told that they will be randomly assigned to receive pills (tablets, capsules, etc.) that contain ‘a drug that might relieve their pain’ (the treatment group) or ‘pills that do not contain any medicine and will not affect their pain’ (the control group). If the patient were to ask if he might receive a placebo, he should be told ‘No, the pills will contain a medicine or no medicine’.”
The authors advocate for phrases such as:
“medicine vs sham-medicine” or “treatment vs sham-treatment”.
Ultimately, the authors are arguing the usage of the term placebo has been incorrect for some time and we need to shift away from the term.
This is a really good article. What i have to say about this research and what i saw in my clinical practice is that sometimes it’s okay to tell the patient that he was receiving a placebo. I particularly use this modality when I want the patient to understand that a large part of the pain regulation is in his mind.
I understand that the study indicates not telling the patient that he is taking a placebo at that time. But I consider, taking as a reference my clinical practice and understanding the low level of evidence that this has, that maybe in some situations it is helpful for pain education.
I look forward to read other colleagues experiences about this topic.
This is an interesting take rise of a very hot buzzword in medicine and how it has grown over the years. I think it is important for our terminology to be used correctly, and I honestly didn’t know about the history of the word. I can appreciate the movement for proper use of the word, especially as much as it is being used in current academic and non-academic literature.
Although…
I’m not sure I agree with the research implications the authors mention. They are saying that doing any intervention with the guise of positive expectations will create a positive effect. We know this to be true from previous studies. Although, as long as the expectations are equal, does it matter when testing an intervention? They are inferring that a belief in placebo intervention has and will skew results, but don’t we want our sham interventions to be perceived as effective to reduce the risk of expectation bias or ruining the blinding?
If someone believes in my placebo/sham solely because they think placebos are effective, and the results show it to be equal to/better than my treatment, I think that still says a lot about my treatment. I think the study would still prove that my intervention is no better than someone’s belief. So, I agree with the correct use of the word, I am just skeptical to believe that the misuse of this word is the cause of previous type II errors.
I would love to hear some other perspectives on this!
I’ve long felt that we needed a different word than placebo as per the definition I always knew (inert substance), this was not accurate. Something is happening, just not always due to the narrative given. It’s interesting to learn the original working definition as a well intentioned deceit. Using this definition, ethics definitely come into play. Repeating studies to use medicine vs not medicine groups would be interesting or this may or may not work.
I work with a variety of athletes and we talk about the placebo effect all the time. Most of them don’t seem to care that something is placebo as long as it makes them feel better. One high level powerlifter told me that if he sees his competition and other high level lifters getting a certain treatment, he wants it to even though it may not be supported by research. He wants to know that he did everything possible to be his best.
Another thought I had after reading this article is why can’t placebo be seen as part of the treatment? If the placebo itself and then the patient expectation of the placebo (or specific treatment) produces analgesia, is that such a bad thing? Is it not better than swallowing pills (if the treatment is manual therapy)? I understand and support the argument of condition, self-efficacy etc but I try to see from both sides of the aisle and questions my own thoughts and beliefs.
I’m mhm own opinion, I like the term Placebo in place of sham treatments but as far as the field would go, I agree that we need to move away from placebo.
I wonder though, would you need to tell the patient what sort of treatment they’re receiving? Where it’s sham or Placebo, I know it would make a difference but if you told both groups that they were getting the actual treatment, what level of significance would it have?