Summary
The hypothesis that clinical improvement would be significantly correlated with number of daily placebo pills prescribed was supported for clinic and general practice patients but not for private psychiatric practice patients. Patients in the 3 treatment settings differed in other ways, particularly in treatment orientation, i.e., their awareness of having emotional problems and the most suitable treatment recommended for them by their physicians, as well as in social class. Treatment orientation was found not to account for the demonstrated “pill effect”, and social class differences, seen only in general practice, also did not appear to modify the relationship between pills and improvement within the entire patient sample.
Our findings in this study have methodological as well as clinical implications. The fact that higher placebo intake levels resulted in reduced drug-placebo differences in improvement poses a practical problem for the clinical researcher, while the lack of placebo improvement observed at lower placebo intake levels indicates that 1 placebo pill per day is not a very effective agent in the symptomatic treatment of neurotic outpatients. Further research is needed to determine the optimal dosage for placebo therapy. Perhaps dosage intake norms, which probably vary within different treatment settings and social classes, represent a major factor influencing the “pill effect” on placebo response.
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This work was supported in full by USPHS Grants MH-08957-8.
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Rickels, K., Hesbacher, P.T., Weise, C.C. et al. Pills and improvement: A study of placebo response in psychoneurotic outpatients. Psychopharmacologia 16, 318–328 (1970). https://doi.org/10.1007/BF00404738
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DOI: https://doi.org/10.1007/BF00404738