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Der Placeboeffekt in der Medizin

  • P. EnckEmail author
  • S. Zipfel
  • S. Klosterhalfen
Leitthema
  • 876 Downloads

Zusammenfassung

Placebos sind Medikamentensurrogate, die bei Verabreichung durch einen Arzt bei einem Patienten Symptombesserungen auslösen können, die sich nicht durch einen Wirkstoff erklären lassen. Sogenannte Placeboeffekte machen in klinischen Tests und vermutlich auch in der klinischen Praxis wiederum einen großen Teil der Wirksamkeit von Medikamenten aus, zumindest bei alltäglichen Erkrankungen und Beschwerden. Placebos beziehungsweise die Wirkmechanismen der Placeboantwort haben nicht nur die Entwicklung neuer Medikamente erschwert. Sie haben auch zur verstärkten wissenschaftlichen Erforschung der Placebowirkungen geführt und das öffentliche Interesse an der klinischen Nutzung des vermeintlichen Potenzials von Placebos geweckt. Gegenwärtig wird der Wissensbestand jedes Jahr um ca. 10.000 placebokontrollierte Studien und etwa 100 Arbeiten zum Placeboeffekt selbst erweitert. Die Geschichte der Placebonutzung in der Medizin, ethische Aspekte ihres Einsatzes, Methodenprobleme placebokontrollierter Medikamentenstudien und deren Alternativen sowie Mechanismen der Placeboantwort in klinischen und experimentellen Studien (zum Beispiel Art, Größe, Dynamik, Determinanten, Prädiktoren der Placeboresponse) sind vier Aspekte, die im vorliegenden Beitrag anhand exemplarischer Arbeiten diskutiert werden.

Schlüsselwörter

Placebo Nocebo Ethik Kontrollierte Studie 

The placebo effect in medicine

Abstract

Placebos are medication surrogates that are able to improve symptoms in patients when prescribed by a doctor and for a patient, and that cannot be explained by a drug. In clinical testing and presumably also in clinical routine, placebo effects contribute substantially to the efficacy of medicines, at least with every-day diseases and complaints. Placebos on the one hand, and the mechanisms the response on the other, have not interfered with the development on novel drugs in past years, but have also brought about research that investigates its mechanisms and public interest in its clinical use in everyday medicine. Current knowledge grows by about 10.000 publications per year on placebo-controlled studies, and by nearly 100 papers on the placebo effect itself. This review will focus on the history of placebo use in medicine, on ethical issues related to the use of placebos, on methodological problems in placebo-controlled trials and their alternatives, and on mechanisms of the placebo response in clinical and experimental research, e.g. on type, size, dynamics, determinants, and predictors of the placebo response in the literature.

Keywords

Placebo Nocebo Ethics Controlled trial 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Medizinische Universitätsklinik VI, Psychosomatische Medizin und Psychotherapie, ForschungsbereichUniversitätsklinikum TübingenTübingenDeutschland
  2. 2.Institut für klinische Neurobiologie und Medizinische PsychologieUniversität DüsseldorfDüsseldorfDeutschland

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