Résumé
La perception du placebo et de l’effet placebo chez les soignants éclaire les conceptions du phénomène douloureux et sa prise en charge. Un tel sujet est souvent perçu comme «embarrassant», peu d’auteurs publient sur ce thème, mais il se transment plusieurs idées préconçues et persistantes sur le placebo qui peuvent être critiquées. Par exemple, si le placebo est efficace, la douleur est fausse, ou bien, donner un placebo équivaut à ne rien faire. De même, l’idée qu’il existe une possible sous-population de sujets placebo répondeurs semble tenace. Pourtant, plusieurs études ont montré qu’une même expérience pouvait transformer un non répondeur en répondeur.
Nous pouvons par contre nous interroger sur l’existence d’une population de placebo-prescripteurs car la conviction du médecin dans l’efficacité du traitement qu’il prescrit augmente la probabilité de son efficacité. A cela, se mêlent les «effets non spécifiques» d’un traitement et l’attitude du soignant, qui, si elle est bienveillante et rassurante, génère une réponse placebo importante: ce qui est en jeu est bien la relation médecinmalade. Prescrire un placebo lorsque cette relation s’inscrit dans la confiance présente-t-il un intérêt? Par ailleurs, le problème éthique soulevé lors d’une telle prescription est le mensonge altérant cette relation. Ce placebo serait alors utilisé dans une relation médecin malade déficiente.
En revanche, l’effet placebo pourrait-il être mis à profit pour potentialiser les effets spécifiques d’une véritable alliance thérapeutique? Mais le terme «placebo» est-il bien adapté dans le contexte d’une utilisation intentionnelle d’une attitude psychothérapeutique?
S’interroger sur le placebo permet d’appréhender la nature des liens qui s’établissent dans les relations médecin-malade et l’importance de l’intentionnalité de la prescription.
Summary
The perception of the placebo and of the placebo effect by healthcare professionals clarifies the conception of pain phenomenon and the way to take care of it. Such a subject is often perceived as «embarrassing«, few authors publish on this topic but they are still transmitting misconceptions about placebo which can be criticized: Thus, the idea that, if the placebo is effective, the pain is false or the one that to give a placebo is equivalent of making nothing always persist. In the same way, the idea that there is a possible subpopulation of subjects that are placebo-responders seems frequent. However, several studies showed that the same experiment could transform a non responder into a responder.
We can, on the other hand question us on the existence of a population of placebo-prescribers because the conviction of the doctor in the effectiveness of the treatment which he prescribes increases the probability of an effectiveness. It can be combined with the attitude of healthcare professionals, which, if it is a kindness and reassuring attitude generates an important placebo-response: what is concerned here is the doctor-patient relationship. Let us then wonder about the prescription of a placebo in the doctor-patient relationship and its interest. Several authors reproach to the placebo that it involves necessarily a deceit at the origin of an ethical problem. They criticize the cases where the use of placebo can be presented as legitimate but which replace only an insufficient doctor-patient relationship. Could the placebo effect then be used in order to potentiate the specific effects of the treatment? But is the term «placebo» well adapted when it concerns the intentional use of a psychotherapeutic attitude?
To wonder about the placebo helps us to apprehend the nature of the bonds which are established in the doctor-patient relationship and the importance of the intentionnality of the prescription.
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Bloch, F., Abitbol, G., Le Nouvel, B. et al. Placebo et effet placebo dans la prise en charge de la douleur: sa perception par les soignants. Doul. et Analg. 17, 25–32 (2004). https://doi.org/10.1007/BF03014534
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DOI: https://doi.org/10.1007/BF03014534