Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.

Howe, Lauren; Goyer, J. Parker; Crum, Alia J.

doi:10.1037/hea0000499

Cited by 147 publications

(180 citation statements)

References 35 publications

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“…Experts agreed that a good patient-clinician relationship is essential to make optimal use of placebo effects to increase therapeutic efficacy (D2). Indeed, evidence is mounting that characteristics such as trust, warmth, and empathy are helpful in medical communication to foster placebo effects [38, 39]. In addition, there was clear consensus that clinicians should receive regular education and training about how to make optimal use of placebo effects in their treatments (D6 and D7).…”

Section: Resultsmentioning

confidence: 99%

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Evers

Colloca

Blease

et al. 2018

Psychother Psychosom

385

420

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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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Section: Resultsmentioning

confidence: 99%

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Evers

Colloca

Blease

et al. 2018

Psychother Psychosom

385

420

View full text Add to dashboard Cite

show abstract

“…Investigators found that perceived physician warmth and competence, along with positive expectations of treatment, boosted placebo responses that ameliorated skin allergic reactions resulting from a histamine skin prick with the subsequent application of a cream with no active ingredients (Howe, Goyer, & Crum, 2017). Although these physician characteristics relate more to perceived likeability and credibility rather than empathy itself, they form part of the contextual psychosocial factors that help establish rapport with patients (see also Sussex, 2018).…”

Section: The Patient–practitioner Interaction: a Sociobiological Apprmentioning

confidence: 99%

“…Interactions that hold a business-like character and that create doubt and uncertainty around the practitioner’s skills and competence could lead to nocebo effects or to a reduction of placebo effects (Howe et al, 2017). HPA axis activation, anxiety, and the activity of the cholecystokinin system have been associated to the occurrence of nocebo effects (Benedetti, Amanzio, Casadio, Oliaro, & Maggi, 1997; Benedetti, Amanzio, Vighetti, & Asteggiano, 2006; Blasini et al, 2017).…”

Section: Connecting the Dots: A Clinical Approachmentioning

confidence: 99%

The Role of Patient–Practitioner Relationships in Placebo and Nocebo Phenomena

Blasini

Peiris

Wright

et al. 2018

International Review of Neurobiology

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Introduction: Placebo and nocebo effects form part of all therapeutic environments and play a significant role in the effectiveness of treatment outcomes. Patient expectancies drive these phenomena, which can be shaped through contextual factors including verbal suggestions, conditioning, and social observation. Objectives: This review seeks to identify the biopsychosocial factors of the patient– practitioner interaction that play a role in the development of placebo and nocebo effects, as well as the anthropological elements of the biodynamic process of relating that are meaningful in the development of expectancies. Methods: We conducted a narrative review of frameworks of the placebo and nocebo effect, including the impact of expectancies and interpersonal relationships in the context of healing and the clinical setting. Results: Expectancies leading to placebo and nocebo effects can be modified by macro and micro factors, such as culture and society, as well as individual psychobiological traits, respectively. The developmental sociobiological adaptations that form and consolidate mindsets and meaningful contexts play an important role in shaping patient expectancies, as well as patients’ conscious and subconscious reactions to signs and actions taking place within the clinical environment. Practitioner characteristics, like empathy, friendliness, and competence, favor the formation of positive expectancies. Caring and warm patient–practitioner interactions can enhance the therapeutic value of clinical encounters when patients’ positive expectancies are actively encouraged and engaged. Conclusion: A patient-centered approach rooted in demonstrating care and empathy can positively enhance a patient’s experience within the clinical environment and activate psychosociobiological adaptations associated with the placebo phenomenon. Pain patients could particularly benefit from non-invasive approaches for improving treatment effectiveness and quality-of-life.

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“…Howe et al 25 found that after inducing an allergic reaction in participants, those who had both positive expectations of allergy relief and who interacted with a provider who demonstrated high warmth and high competence displayed the largest reduction in their allergic reaction (as measured by the size of the weal) compared with other groups who had negative expectations and/or providers with low warmth and competence. Similarly, in an experiment involving patients with a common cold, it was found that 48 hours after the clinical encounter, those who rated their clinician as high in empathy had higher measures of interleukin 8 (an immune biomarker) and reported that their cold lasted on average 1 day less than those who rated their clinician as low on empathy 26.…”

Section: Evidence For Placebo Effects In the Clinical Encountermentioning

confidence: 99%

Placebo effects and racial and ethnic health disparities: an unjust and underexplored connection

Friesen

Blease

2018

J Med Ethics

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While a significant body of bioethical literature considers how the placebo effect might introduce a conflict between autonomy and beneficence, the link between justice and the placebo effect has been neglected. Here, we bring together disparate evidence from the field of placebo studies and research on health inequalities related to race and ethnicity, and argue that, collectively, this evidence may provide the basis for an unacknowledged route by which health disparities are exacerbated. This route is constituted by an uneven distribution of placebo effects, resulting from differences in expressions of physician warmth and empathy, as well as support and patient engagement, across racial and ethnic lines. In a discussion of the ethical implications of this connection, we argue that this contribution to health disparities is a source of injustice, consider ways in which these disparities might be ameliorated and suggest that this conclusion is likely to extend to other realms of inequality as well.

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Harnessing the placebo effect: Exploring the influence of physician characteristics on placebo response.

Abstract: This study suggests that placebo effects should be construed not as a nuisance variable with mysterious impact but instead as a psychological phenomenon that can be understood and harnessed to improve treatment outcomes. (PsycINFO Database Record

Cited by 147 publications

References 35 publications

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

The Role of Patient–Practitioner Relationships in Placebo and Nocebo Phenomena

Placebo effects and racial and ethnic health disparities: an unjust and underexplored connection

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