In what ways can a medical practitioner use the placebo effect on patients in order to ensure the best outcome? Would it be ethical to strongly support a treatment that might just have mediocre results to a patient in order to get the most robust placebo response possible? I can see this backfiring in a case where the patient doesn’t show great improvement and then the patient-clinician relationship is damaged. What would the furthest extent, as far as implications and language use, be of using the placebo effect on a patient?
Kaptchuk, in his article “The placebo effect in alternative medicine” implies that the clear diagnosis of alternative medicine, whether or not it is an accurate diagnosis, gives patients participating in alternative medicine a larger placebo response as compared to conventional medicine. In what ways do you think a medical practitioner can use this information to better treat their patients?
Yeah, active debate is the understatement of the century. I personally think (and hope) we will see a semantic shift away from placebo response and towards contextual factors over the next few years. The truth is the response is multifactorial and often knowing (or just being aware of) those factors can help strengthen the response. Things like building a therapeutic alliance, possessing clinical equipoise in your treatment paradigm, and motivational interviewing all have some place in eliciting the response. If you are working towards maximizing those variables, it is hard to argue that it is just a general placebo response. The key when it comes to issues like equipoise is being able to have absolute faith in what you’re doing, mixed with a profound uncertainty of your method. This is more of a paradox than a placebo effect in my opinion. Keith Waldron, speaking at the San Diego Pain Summit last weekend summed this up better than anyone I have ever heard when he said “consider all that might be possible. Then do your damndest to not be an asshole to your patient.” I’m contemplating getting that crocheted for the back office at work.