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Impure placebo is a useless concept

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Abstract

Placebos are allegedly used widely in general practice. Surveys reporting high level usage, however, have combined two categories, ‘pure’ and ‘impure’ placebos. The wide use of placebos is explained by the high level usage of impure placebos. In contrast, the prevalence of the use of pure placebos has been low. Traditional pure placebos are clinically ineffective treatments, whereas impure placebos form an ambiguous group of diverse treatments that are not always ineffective. In this paper, we focus on the impure placebo concept and demonstrate problems related to it. We also show that the common examples of impure placebos are not meaningful from the point of view of clinical practice. We conclude that the impure placebo is a scientifically misleading concept and should not be used in scientific or medical literature. The issues behind the concept, however, deserve serious attention in future research.

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References

  1. Howick, Jeremy, Felicity L. Bishop, Carl Heneghan, Jane Wolstenholme, F.D. Sarah Stevens, Richard Hobbs, and George Lewith. 2013. Placebo use in the United Kingdom: results from a national survey of primary care practitioners. PLoS One 8(3): e58247.

    Article  Google Scholar 

  2. Cheng, Maria. 2013. Many UK doctors give useless drugs, treatments. Associated Press, March 21. http://www.newsvine.com/_news/2013/03/21/17396948-many-uk-doctors-give-useless-drugs-treatments. Accessed July 13, 2015.

  3. Philby, Charlotte. 2013. The placebo effect: doctors admit prescribing unproven treatments, unnecessary tests and pills with no active ingredient. The Independent, March 20. http://www.independent.co.uk/life-style/health-and-families/health-news/the-placebo-effect-doctors-admit-prescribing-unproven-treatments-unnecessary-tests-and-pills-with-no-active-ingredient-8542666.html. Accessed July 13, 2015.

  4. Grünbaum, Adolf. 1986. The placebo concept in medicine and psychiatry. Psychological Medicine 16: 19–38.

    Article  Google Scholar 

  5. Louhiala, Pekka, and Raimo Puustinen. 2008. Rethinking the placebo effect. Medical Humanities 34: 107–109.

    Article  Google Scholar 

  6. Moerman, Daniel E. 2002. Meaning, medicine and the ‘placebo effect’. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  7. Fässler, Margrit, Markus Gnadinger, Thomas Rosemann, and Nikola Biller-Andorno. 2009. Use of placebo interventions among Swiss primary care providers. BMC Health Services Research 9: 144.

    Article  Google Scholar 

  8. Meissner, Karin, Lisa Höfner, Margrit Fässler, and Klaus Linde. 2012. Widespread use of pure and impure placebo interventions by GPs in Germany. Family Practice 29: 79–85.

    Article  Google Scholar 

  9. Fässler, Margrit, Karin Meissner, Antonius Schneider, and Klaus Linde. 2010. Frequency and circumstances of placebo use in clinical practice—a systematic review of empirical studies. BMC Medicine 8: 15.

    Article  Google Scholar 

  10. Gold, Harry, David B. Barr, McKeen Cattell, et al. (eds.). 1947. The use of placebos in therapy. In Cornell Conferences on Therapy: use of placebos in therapy, 1–26. New York: MacMillan.

  11. Louhiala, Pekka. 2012. What do we really know about the deliberate use of placebos in clinical practice? Journal of Medical Ethics 38: 403–405.

    Article  Google Scholar 

  12. Gøtzsche, Peter. 1995. Placebo effects: concept of placebo should be discarded. BMJ 311: 1640–1641.

    Article  Google Scholar 

  13. Leslie, Alan. 1954. Ethics and practice of placebo therapy. American Journal of Medicine 16: 854–862.

    Article  Google Scholar 

  14. Shapiro, Arthur, and Louis A. Morris. 1978. The placebo effect in medical and psychological therapies. In Handbook and psychotherapy and behavior change: an empirical analysis, 2nd ed, ed. S.L. Garfield, and A.E. Bergin, 369–410. New York: Wiley.

    Google Scholar 

  15. Hróbjartsson, Asbjörn, and Michael Norup. 2003. The use of placebo interventions in medical practice—a national questionnaire survey of Danish clinicians. Evaluation and the Health Professions 26: 153–165.

    Article  Google Scholar 

  16. Fent, Rahel, Thomas Rosemann, Margrit Fässler, Oliver Senn, and Carola A. Huber. 2011. The use of pure and impure placebo interventions in primary care—a qualitative approach. BMC Family Practice 12: 11.

    Article  Google Scholar 

  17. Kermen, Rachel, John Hickner, Howard Brody, and Irma Hasham. 2010. Family physicians believe the placebo effect is therapeutic but often use real drugs as placebos. Family Medicine 42: 636–642.

    Google Scholar 

  18. Altman, Douglas G., and J. Martin Bland. 1995. Absence of evidence is not evidence of absence. British Medical Journal 311: 485.

    Article  Google Scholar 

  19. Kaiser, Laurent, Daniel Lew, Bernard Hirschel, et al. 1996. Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions. Lancet 347: 1507–1510.

    Article  Google Scholar 

  20. Louhiala, Pekka. 2009. The ethics of the placebo in clinical practice revisited. Journal of Medical Ethics 35: 407–409.

    Article  Google Scholar 

  21. Young, Jim, An De Sutter, Dan Merenstein, et al. 2008. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: A meta-analysis of individual patient data. Lancet 371: 908–914.

    Article  Google Scholar 

  22. Linde, Klaus, Michael M. Berner, and Levente Kriston. 2008. St. John’s wort for major depression. Cochrane Database of Systematic Reviews (4): CD000448, doi: 10.1002/14651858.CD000448.pub3.

  23. Novella, Steven. 2013. Do 97% of UK doctors prescribe placebos? Neurologica Blog, March 28. http://theness.com/neurologicablog/index.php/do-97-of-uk-doctors-prescribe-placebos/. Accessed July 13, 2015.

  24. Holley, A.D., E. Osland, J. Barnes, A. Krishnan, and J.F. Fraser. 2011. Scurvy: historically a plague of the sailor that remains a consideration in the modern intensive care unit. Internal Medicine Journal 41: 283–285.

    Article  Google Scholar 

  25. Raynaud-Simon, A., J. Cohen-Bittan, A. Gouronnec, E. Pautas, P. Senet, M. Verny, and J. Boddaert. 2010. Scurvy in hospitalized elderly patients. Journal of Nutrition, Health, and Aging 14: 407–410.

    Article  Google Scholar 

  26. Zhang, Michelle, Line Robitaille, Shaun Eintracht, and L. John Hoffer. 2011. Vitamin C provision improves mood in acutely hospitalized patients. Nutrition 27: 530–533.

    Article  Google Scholar 

  27. Wang, Yifan, Xing J. Liu, Line Robitaille, Shaun Eintracht, Elizabeth MacNamara, and L. John Hoffer. 2013. Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients. American Journal of Clinical Nutrition 98: 705–711.

    Article  Google Scholar 

  28. Padayatty, Sebastian J., Hugh D. Riordan, Stephen M. Hewitt, L. Arie Katz, John Hoffer, and Mark Levine. 2006. Intravenously administered vitamin C as cancer therapy: Three cases. CMAJ 174: 937–942.

    Article  Google Scholar 

  29. Hemilä, H., and Elizabeth Chalker. 2013. Vitamin C for preventing and treating the common cold. Cochrane Database Systematic Reviews (1): CD000980, doi: 10.1002/14651858.CD000980.pub4.

  30. Hemilä, Harri. 2013. Vitamin C may alleviate exercise-induced bronchoconstriction: A meta-analysis. BMJ Open 3: e002416.

    Article  Google Scholar 

  31. Juraschek, Stephen P., Eliseo Guallar, Lawrence J. Appel, and Edgar R. Miller III. 2012. Effects of vitamin C supplementation on blood pressure: A meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition 95: 1079–1088.

    Article  Google Scholar 

  32. Tilburt, Jon C., Ezekiel J. Emanuel, Ted J. Kaptchuk, and Farr A. Curlin. 2008. Prescribing ‘placebo treatments’: Results of national survey of US internists and rheumatologists. British Medical Journal 337: a1938.

    Article  Google Scholar 

  33. U.S. doctors regularly prescribe real drugs as placebo treatments, study claims. 2008. ScienceDaily, October 25. http://www.sciencedaily.com/releases/2008/10/081023195216.htm. Accessed July 13, 2015.

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Correspondence to Pekka Louhiala.

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Louhiala, P., Hemilä, H. & Puustinen, R. Impure placebo is a useless concept. Theor Med Bioeth 36, 279–289 (2015). https://doi.org/10.1007/s11017-015-9336-6

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