In the field of placebo studies residual disagreement about the terminology ‘placebo’ and ‘placebo effect’ still persists. We differentiate between the conceptualization of placebos in clinical trials; and placebo effects understood as a psychobiological phenomenon. With respect to the latter, we argue that a scientific ‘placebo paradigm’ has emerged, indicating that—at least among placebo scientists—there exists relatively stable consensus about how to conceive of placebo effects. We claim that existence of a placebo paradigm does not protect concepts from revision; nonetheless, (...) we argue that scientific progress is dependent on, and guided by relative conceptual stability. Therefore, to mount persuasive arguments for conceptual revision in respect of ‘placebo effects’ we argue, critics either need to defend the claim that a placebo paradigm is not underway, or that there are major scientific failings in respect of it. With these considerations in mind we examine three alternative proposals for conceptual reform: Grünbaum/Howick’s relativity models of placebo concepts; Moerman/Brody’s meaning response; and Nunn/Turner’s proposal for conceptual eliminativism. We derive two conclusions from this evaluation. First, we conclude that no convincing arguments have so far been presented for conceptual overhaul of ‘placebo effects.’ Notwithstanding this analysis, we conclude that refinement of this concept is likely. Second, we agree with Turner and Nunn that the term ‘placebo’ in the context of randomized controlled trials remains a source of confusion for many researchers, risking the design and scientific integrity of clinical findings. Therefore, in these contexts, replacing the term ‘placebo’ with ‘control’ is justified. (shrink)

Shamans, healers, and doctors have always known that patients may improve even if no real therapy is administered. In the Charmides, Plato noted that to soothe a headache, one needed "a kind of leaf, which required to be accompanied by a charm, and if a person would repeat the charm at the same time he used the cure, he would be made whole; but that without the charm would be of no avail". Similarly, more than two millennia later, Thomas Jefferson (...) observed, "One of the most successful physicians I have even known has assured me that he used more bread pills, drops of colored water, and powder of hickory ashes, than of all other medication put together"; Jefferson famously labeled this... (shrink)

In this article, Charlotte Blease argues that patient access to online shared clinical notes (also called ‘open notes’) may cause or exacerbate nocebo effects in two ways. 1 First, open notes may enhance patient understanding about the adverse effects of medications and treatments. However, reading information about adverse effects may lead patients to form negative expectations that, in turn, may cause or worsen symptoms via nocebo mechanisms. Second, open notes may paradoxically lower the quality of the therapeutic relationship by allowing (...) patients to detect signs of discrimination and stigma in clinical notes. By accessing their shared notes, patients may identify (or think that they are identifying) signs of stigmatisation and discrimination in clinicians’ words. This may diminish their trust while increasing their anxieties and fears, all factors that have been associated with enhanced nocebo effects. The article then suggests different strategies to mitigate nocebo effects while using open... (shrink)

Doctor–patient communication is a crucial component in any therapeutic encounter. Physicians use words to formulate diagnoses and prognoses, to disclose the risks and benefits of medical interventions, and to explain why, how, and when a therapy will be administered to a patient. Likewise, patients communicate to describe their symptoms, to make sense of their conditions, to report side effects, to explore other therapeutic options, and to share their feelings. Throughout the history of medicine, the ethics of the doctor–patient communication has (...) been traditionally grounded on considerations of paternalistic beneficence and nonmaleficence. In this respect, it was no different from the ethics regulating.. (shrink)

Discussions about the merits and shortcomings of non-inferiority trials are becoming increasingly common in the medical community and among regulatory agencies. However, criticisms targeting the ethical standing of non-inferiority trials have often been mistargeted. In this article we review the ethical standing of trials of non-inferiority. In the first part of the article, we outline a consequentialist position according to which clinical trials are best conceived as epistemic tools aimed at fostering the proper ends of medicine. According to this view, (...) clinical trials are means to ends, and thus their moral status depends both on how well they perform as means to reach desired ends and on which ends they are meant to achieve. Building upon this normative framework in the next two sections we analyze the specific ethical issues raised by non-inferiority trials. By making it clear that clinical trials are just epistemic tools – i.e. means to certain ends – it is possible not only to clarify the conceptual debate over a fundamental issue in clinical research, but also to identify which ethically relevant considerations ought to be addressed in setting up a non-inferiority trial. (shrink)

The genealogy of lexicography represents an ideal standpoint to reveal how sign-making practices may shape cultural objects. In this paper I discuss the revolution that lexicography undertook during the nineteenth century, showing why this process required the availability of a specific set of concepts, and then how it led up to the emergence of new social techniques, to the coming into being of a new kind of people, and to the introduction of new practices of sign-manipulation. Finally, I confront the (...) historical development of lexicography with the project of the dictionary of Newspeak that Orwell envisioned in 1984. (shrink)

Over 200 years ago, doctors' most effective tools were typically not found in their medical bags. Indeed, most treatments in the history of medicine have, until relatively recently, caused more harm than good. Prior to the biomedical revolution in the late 19th century, doctors' most reliable and effective instruments of healing were their skills of communication with patients and an aptitude for a positive and supportive bedside manner. Bearing out this portrait of medicine, Thomas Jefferson, writing in 1807, noted that (...) "one of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, and powers of hickory ashes, than of all other medicines put together"... (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 55-57, September 2012.