The Placebo Effect And Health

by Thompson, W. Grant

• ISBN13: 9781591022756
• ISBN10: 1591022754
• Format: Trade Paper
• Copyright: 2005-06-03
• Publisher: Prometheus Books

Summary

Since the days when doctors routinely made house calls and sat by the bedside offering comforting words along with medical care, the doctor-patient relationship has become increasingly impersonal and superficial. As medical technology and treatment have improved, and time constraints have become more demanding, the beneficial effects of meaningful doctor-patient interactions have too often been overlooked. Nonetheless, objective clinical trials have repeatedly shown that real, measurable benefits to the patient occur through the "placebo effect," the positive effects of the doctor's presence and personality plus the patient's belief in the efficacy of the treatment. Dr. W. Grant Thompson, a frequent consultant on the design of clinical trials, reviews the history of the placebo effect and the evidence of its benefits to health in this lively, informative, and scientifically rigorous book. He looks at both the planned use of placebos in blind clinical trials, and the unplanned placebo effects arising out of the doctor-patient relationship, the passage of time, and the perceptions of the patient. Dr. Thompson emphasizes that placebos in themselves have no intrinsic benefit; what matters is how the treatment is provided and under what circumstances. He argues that understanding the placebo effect is important for the care of the ill, the design of clinical trials, and for healthcare policy planning. He contends that we should be using judiciously the best medical evidence, but even that can be undermined by insensitive delivery. Healthcare policy can only gain from taking both vital components of medical care into consideration. Praised by the New England Journal of Medicine as "a giftedteacher and clinician with a talent for clear exposition," Dr. Thompson has written an important, accessible, and interesting work that deepens our understanding of both the tangible and intangible factors that affect health. He convincingly demonstrates that patients need the best that science has to offer combined with kind and compassionate caregiving by doctors in order for a treatment to be its most effective.

Author Biography

W. Grant Thompson is professor emeritus of medicine at the University of Ottawa, where he served as chief of the Division of Gastroenterology from 1980 to 1997.

Table of Contents

INTRODUCTION	11	(4)
PART 1: THE PLACEBO EFFECT	15	(68)
Chapter 1 What Is a Placebo?	17	(12)
Chapter 2 History of Placebos	29	(8)
Chapter 3 Placebo Research: Some Facts and Myths	37	(12)
Chapter 4 The Placebo Effect	49	(10)
Chapter 5 Elements of the Placebo Effect	59	(12)
Chapter 6 The Nocebo Effect	71	(12)
PART 2: PLACEBO EFFECT, MEDICAL EVIDENCE, AND THE DOCTOR/PATIENT RELATIONSHIP	83	(132)
Chapter 7 Randomized Clinical Trials	85	(26)
Chapter 8 Evidence-Based Medicine	111	(16)
Chapter 9 Can Surgery Be a Placebo?	127	(16)
Chapter 10 Placebo Effects and Psychotherapy	143	(10)
Chapter 11 Complementary and Alternative Medicine	153	(26)
Chapter 12 The Doctor as Placebo	179	(14)
Chapter 13 The Placebo Responder	193	(10)
Chapter 14 The Ethics of Using Placebos	203	(12)
PART 3: DOCTOR/PATIENT RELATIONSHIP, EVIDENCE-BASED MEDICINE, AND HEALTH CARE	215	(64)
Chapter 15 Strangers in the Consulting Room	217	(12)
Chapter 16 The Burden of Proof	229	(14)
Chapter 17 Health-Care Systems and the Placebo Effect	243	(22)
Chapter 18 Physicians, Heal Yourselves	265	(14)
CONCLUSION	279	(6)
GLOSSARY	285	(10)
NOTES	295	(38)
INDEX	333