Open versus hidden medical treatments: The patient's knowledge about a therapy affects the therapy outcome.

Abstract

Any medical treatment has 2 components, the first being the specific effects of the treatment itself, the second, the knowledge that the treatment is being performed (the placebo effect). So far, the placebo effect has been studied by eliminating the specific effects of the therapy through the administration of a dummy treatment. In this study, the authors reversed this experimental approach. In fact, whereas the specific effects of the treatment were maintained constant, the patient's knowledge that the therapy was being performed was done away with. To do this, the authors performed hidden medical treatments and compared these with the open ones. The results show that the hidden administrations of pharmacological and nonpharmacological therapies are less effective than the open ones.

Placebo Effects: From the Neurobiological Paradigm to Translational Implications

“…For example, the effectiveness of diazepam, one of the most frequently used benzodiazepines for treating anxiety, is reduced or completely abolished when diazepam is administered unbeknownst to the patient (Benedetti et al, 2003a(Benedetti et al, , 2011cColloca et al, 2004). In postoperative anxiety ( Figure 5A), there is a clear-cut decrease of anxiety in those patients who receive an overt administration of diazepam, as routinely done in clinical practice, whereas diazepam is totally ineffective if given covertly, which indicates that anxiety reduction after the open diazepam is a psychological effect (or placebo response).…”

Agreement and meaning: Rethinking consensus analysis

“…Post-surgical patients were randomized to receive their analgesics in the ordinary fashion from a clinician, or secretly by computer controlled infusion through an intravenous line. The clinicians' presence increased the effectiveness of the treatment (as reported on a standard 10-point pain scale) by about a third (Benedetti et al, 2003). This study -employing no placebos -demonstrates (as do several others) that these effects are not only associated with inert treatments, but also with active treatments.…”

Klinische Bedeutung des Placeboeffektes

“…B. AlzheimerDe menz; [12]) zu sein. Die versteckte Verab reichung eines Placebos führt zu keiner Placeboantwort [16,17]. Daher erscheint die Wahrnehmung (und Bedeutungsge bung) der Behandlung ("therapeutischer Akt") wichtig zu sein, die als facetten reiches Symbol fungiert.…”

“…Hierbei wird das Verumpräparat zu unterschied lichen Zeitpunkten entweder angekündi gt ("Open"Komponente) oder versteckt ("Hidden"Komponente) appliziert. Aus der jeweils resultierenden Wirkung (Ant wort) kann zwischen dem spezifischen Verumeffekt (bei versteckter Gabe) und der Kombination aus spezifischem Ver um sowie Placeboeffekt (Gesamtthera pieeffekt) der tatsächliche Placeboeffekt abgeleitet werden (s. weiter unten; [3,16,17,31,98]; . Abb.…”