Thompson W G
University of Ottawa, Ontario, Canada.
Am J Gastroenterol. 2000 Jul;95(7):1637-43. doi: 10.1111/j.1572-0241.2000.02179.x.
Placebos have been a component of healing since the beginning. Whether consciously or unconsciously given, they are largely responsible for the success of medicine before randomized trials. Yet, even in this era of "evidence-based medicine," placebos remain enigmatic, and elicit mixed attitudes from divers disciplines. However, our ignorance is not total. There are a few facts to cling to and old myths to dispel. The effect of placebos seems to encompass such disparate elements as anxiety, conditioning, expectation, the healer's persona, and the attachment of meaning to illness. Placebos may obscure as well as illuminate the truth about treatment effectiveness. Moreover, it is easy to confuse their effect with the natural progression of the disease being treated. Those engaged in treatment trials must recognize and manage the reality of placebos rather than attempt to eliminate or disparage them. Factors that might influence the placebo effect such as age, gender, and social circumstances need prospective study. Meanwhile doctors, through honest and compassionate interactions with patients, should strive to maximize their treatments' benefits. This implies confident reassurance and the provision of some meaning to the person's symptoms.
从一开始起，安慰剂就是治疗的一个组成部分。无论给予安慰剂是有意识还是无意识的，在随机试验之前，医学的成功很大程度上要归功于它们。然而，即使在这个“循证医学”时代，安慰剂仍然神秘莫测，并在不同学科中引发了复杂的态度。不过，我们并非一无所知。有一些事实可供把握，也有一些旧观念需要破除。安慰剂的效应似乎涵盖了焦虑、条件作用、期望、治疗者的形象以及对疾病意义的赋予等如此不同的因素。安慰剂可能会掩盖也可能会揭示关于治疗效果的真相。此外，很容易将它们的效应与所治疗疾病的自然病程相混淆。参与治疗试验的人员必须认识并应对安慰剂的实际情况，而不是试图消除或贬低它们。诸如年龄、性别和社会环境等可能影响安慰剂效应的因素需要进行前瞻性研究。与此同时，医生通过与患者进行诚实且富有同情心的互动，应努力使治疗效果最大化。这意味着要给予患者坚定的安慰，并对其症状作出一定解释。
