Implications of Placebo and Nocebo Effects for Clinical Practice
A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts.
Expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice
Do's
- Consider placebo effects as part of regular treatment
- Inform patients about placebo and nocebo effects in such a way that treatment effects are maximized and side effects are minimized
- Ensure a patient-clinician relationship that is characterized by trust, warmth and empathy in order to maximize placebo effects and minimize nocebo effects
- Train health-care providers in patient-clinician communication to maximize placebo effects and minimize nocebo effects
- Prefer open-label rather than hidden placebo prescription in those cases where there is evidence for efficacy and where prescribing a placebo is legal
Don'ts
- Do not take risks (e.g., prescribing invasive treatments) to maximize placebo effects
- Do not consider deception a necessary component of placebo effects