Influence of the therapeutic environment
Placebo effects are ubiquitous in the context of medication therapies. In spite of this fact, they are mostly accepted tacitly within clinical practice. A factual debate of the origin and realization of placebo effects enables their inclusion into orthodox medicine, for the benefit of our patients. In addition to the history and mechanisms of action, one might have wished for the authors to include in their article a practice related listing of medication uses that are particularly susceptible to the influences of the therapeutic environment. Quantitative data are available from meta-analyses of placebo controlled studies. Instead of the otherwise customary difference between pharmacologically active drug (“verum”) and placebo, the relation of the effect sizes of the two treatment arms should be assessed. Such results for 10 typical medication uses in complementary phytotherapy have recently been presented in a journal (1). Under optimal conditions, 60–100% of the effect sizes for the active drug were also achieved under placebo, for symptomatic medication treatments of dysmenorrhea, acute upper respiratory tract infections, anxiety states, symptoms of benign prostatic hyperplasia, irritable bowel symptoms, depression, varicose veins, sleep disorders, pain disorders, and dementias. Statistical data comparisons of this kind are mostly not included in clinical trials, primarily because they would be counterproductive for the purposes of drug licensing. To assess the three influencing variables “pharmacologically related effectiveness,” “innocuousness,” and “cost of treatment” are of major importance for such analyses. The two latter variables gain in importance to the degree that the first variable assumes a marginal importance.
Prof. Dr. med. Volker Schulz
Oranienburger Chaussee 25
13465 Berlin, Germany
|1.||Schulz V, Kraft K: Phytotherapie – Eine erhaltenswerte Alternative. Dtsch Arztebl 2009; 106: 21–3. VOLLTEXT|
|2.||Breidert M, Hofbauer K: Placebo: Missunderstandings and prejudices [Placebo: Missverständnisse und Vorurteile]. Dtsch Arztebl Int 2009; 106(46): 751–5. VOLLTEXT|