Background: 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. Methods: 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. Results: There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. Conclusions: The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.

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Background The potential for machine learning to disrupt the medical profession is the subject of ongoing debate within biomedical informatics and related fields. Objective This study aimed to explore general practitioners’ (GPs’) opinions about the potential impact of future technology on key tasks in primary care. Methods In June 2018, we conducted a Web-based survey of 720 UK GPs’ opinions about the likelihood of future technology to fully replace GPs in performing 6 key primary care tasks, and, if respondents considered replacement for a particular task likely, to estimate how soon the technological capacity might emerge. This study involved qualitative descriptive analysis of written responses (“comments”) to an open-ended question in the survey. Results Comments were classified into 3 major categories in relation to primary care: (1) limitations of future technology, (2) potential benefits of future technology, and (3) social and ethical concerns. Perceived limitations included the beliefs that communication and empathy are exclusively human competencies; many GPs also considered clinical reasoning and the ability to provide value-based care as necessitating physicians’ judgments. Perceived benefits of technology included expectations about improved efficiencies, in particular with respect to the reduction of administrative burdens on physicians. Social and ethical concerns encompassed multiple, divergent themes including the need to train more doctors to overcome workforce shortfalls and misgivings about the acceptability of future technology to patients. However, some GPs believed that the failure to adopt technological innovations could incur harms to both patients and physicians. Conclusions This study presents timely information on physicians’ views about the scope of artificial intelligence (AI) in primary care. Overwhelmingly, GPs considered the potential of AI to be limited. These views differ from the predictions of biomedical informaticians. More extensive, stand-alone qualitative work would provide a more in-depth understanding of GPs’ views.

Background:Futurists have predicted that new autonomous technologies, embedded with artificial intelligence (AI) and machine learning (ML), will lead to substantial job losses in many sectors disrupting many aspects of healthcare. Mental health appears ripe for such disruption given the global illness burden, stigma, and shortage of care providers.Objective: To characterize the global psychiatrist community's opinion regarding the potential of future autonomous technology (referred to here as AI/ML) to replace key tasks carried out in mental health practice.Design: Cross sectional, random stratified sample of psychiatrists registered with Sermo, a global networking platform open to verified and licensed physicians. Main outcome measures:We measured opinions about the likelihood that AI/ML tools would be able to fully replace -not just assist -the average psychiatrist in performing 10 key psychiatric tasks. Among those who considered replacement likely, we measured opinions about how many years from now such a capacity might emerge. We also measured psychiatrist's perceptions about whether benefits of AI/ML would outweigh the risks.Results: Survey respondents were 791 psychiatrists from 22 countries representing North America, South America, Europe and Asia-Pacific. Only 3.8% of respondents felt it was likely that future technology would make their jobs obsolete and only 17% felt that future AI/ML was likely to replace a human clinician for providing empathetic care. Documenting and updating medical records (75%) and synthesizing information (54%) were the two tasks where a majority predicted that AI/ML could fully replace human psychiatrists. Female-and US-based doctors were more uncertain that the benefits of AI would outweigh risks than male-and non-US doctors, respectively. Around one in 2 psychiatrists did however predict that their jobs would be substantially changed by AI/ML. Conclusions:To our knowledge, this is the first global survey to seek the opinions of physicians on the impact of autonomous AI/ML on the future of psychiatry. Our findings provide compelling insights into how physicians think about AI/ML which in turn may help us better integrate technology and reskill doctors to enhance mental health care.