Original ArticlesThe Powerful Placebo Effect: Fact or Fiction?
Section snippets
Definition and methods
It seems easy to define placebos: They are imitations of specific treatments, with the absence of the specific therapeutic constituents. However, defining placebos is a very controversial topic 22, 23, 24. Gøtzsche even concluded, “The placebo concept as presently used cannot be defined in a logically consistent way and leads to contradictions” [25]. From reading Beecher's own article, he refers to “pharmacologically inert substances” [1], the administration of which he considers can have “real
Result
For 14 out of the 15 trial publications 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16detailed analysis was possible. (One publication [4]did not give account of the study design.) The overall result was that for none of these trials was there any reason to assume the existence of the slightest placebo effect. These studies were placebo-controlled drug trials. Although they were not carried out in order to investigate placebo effects, Beecher retrospectively attributed the improvements in
Spontaneous Improvement
Spontaneous improvement of a disease does not occur as a result of a placebo administration; it is not an effect of a placebo. This often seems to be disregarded in placebo literature.
In a placebo-controlled drug trial on acute common cold, described as mild and of short duration, 35% of the patients receiving placebos felt better within 6 days (2 days after the onset of placebo administration) [2]Beecher interpreted these improvements as an effect of the placebo administration [1]. However, he
Discussion
Beecher's “The Powerful Placebo,” published in 1955, has been a seminal and most influential paper. It is still the most frequently cited placebo reference. This is amazing, as none of the original trials cited by Beecher gave grounds to assume the existence of placebo effects. The reanalysis of a similar classic German placebo survey [17]gave the same results. No placebo effects could be found [21].
The conceptual and methodological mistakes of Beecher's classic paper are still prevalent today.
Acknowledgements
We are indebted to Prof. Joachim Hornung, Dr. Gerben ter Riet, Dr. Klaus Linde, Dr. Harald Walach, Dr. Michael Evans, Dr. Gerald Karnow, Dr. Lou Aventuro, Dr. Frank Mulder, and Dr. Peter van Leeuwen for their critical commentary on the manuscript.
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