BackgroundPlacebo treatment can significantly influence subjective symptoms. However, it is widely believed that response to placebo requires concealment or deception. We tested whether open-label placebo (non-deceptive and non-concealed administration) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome (IBS).MethodsTwo-group, randomized, controlled three week trial (August 2009-April 2010) conducted at a single academic center, involving 80 primarily female (70%) patients, mean age 47±18 with IBS diagnosed by Rome III criteria and with a score ≥150 on the IBS Symptom Severity Scale (IBS-SSS). Patients were randomized to either open-label placebo pills presented as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes” or no-treatment controls with the same quality of interaction with providers. The primary outcome was IBS Global Improvement Scale (IBS-GIS). Secondary measures were IBS Symptom Severity Scale (IBS-SSS), IBS Adequate Relief (IBS-AR) and IBS Quality of Life (IBS-QoL).FindingsOpen-label placebo produced significantly higher mean (±SD) global improvement scores (IBS-GIS) at both 11-day midpoint (5.2±1.0 vs. 4.0±1.1, p<.001) and at 21-day endpoint (5.0±1.5 vs. 3.9±1.3, p = .002). Significant results were also observed at both time points for reduced symptom severity (IBS-SSS, p = .008 and p = .03) and adequate relief (IBS-AR, p = .02 and p = .03); and a trend favoring open-label placebo was observed for quality of life (IBS-QoL) at the 21-day endpoint (p = .08).ConclusionPlacebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using placebos consistent with informed consent.Trial RegistrationClinicalTrials.gov NCT01010191

A comprehensive methodology has been created to quantify the degree of criticality of the metals of the periodic table. In this paper, we present and discuss the methodology, which is comprised of three dimensions: supply risk, environmental implications, and vulnerability to supply restriction. Supply risk differs with the time scale (medium or long), and at its more complex involves several components, themselves composed of a number of distinct indicators drawn from readily available peer-reviewed indexes and public information. Vulnerability to supply restriction differs with the organizational level (i.e., global, national, and corporate). The criticality methodology, an enhancement of a United States National Research Council template, is designed to help corporate, national, and global stakeholders conduct risk evaluation and to inform resource utilization and strategic decision-making. Although we believe our methodological choices lead to the most robust results, the framework has been constructed to permit flexibility by the user. Specific indicators can be deleted or added as desired and weighted as the user deems appropriate. The value of each indicator will evolve over time, and our future research will focus on this evolution. The methodology has proven to be sufficiently robust as to make it applicable across the entire spectrum of metals and organizational levels and provides a structural approach that reflects the multifaceted factors influencing the availability of metals in the 21st century.

Because modern technology depends on reliable supplies of a wide variety of materials, and because of increasing concern about those supplies, a comprehensive methodology has been created to quantify the degree of criticality of the metals of the periodic table. In this paper, we apply this methodology to the elements of the geological copper family: Cu, As, Se, Ag, Te, and Au. These elements are technologically important, but show a substantial variation in different factors relating to their supply risk, vulnerability to supply restriction, and environmental implications. Assessments are made on corporate, national, and global levels for year 2008. Evaluations of each of the multiple indicators are presented and the results plotted in "criticality space", together with Monte Carlo simulation-derived "uncertainty cloud" estimates for each of the aggregated evaluations. For supply risk over both the medium term and long term, As is the highest risk of the six metals, with Se and Ag nearly as high. Gold has the most severe environmental implications ranking. Vulnerability to supply restriction (VSR) at the corporate level for an invented solar cell manufacturing firm shows Se, Te, and Cu as approximately equal, Cu has the highest VSR at the national level, and Cu and Au have the highest VSRs at the global level. Criticality vector magnitudes are greatest at the global level for As (and then Au and Ag) and at the national level for As and Au; at the corporate level, Se is highest with Te and Cu lower. An extension of this work, now in progress, will provide criticality estimates for several different development scenarios for the period 2010-2050.