Kaptchuk Ted J, Kelley John M, Deykin Aaron, Wayne Peter M, Lasagna Louis C, Epstein Ingrid O, Kirsch Irving, Wechsler Michael E
Osher Research Center, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA.
Contemp Clin Trials. 2008 Jul;29(4):587-95. doi: 10.1016/j.cct.2008.02.002. Epub 2008 Feb 23.
The placebo effect has been the subject of much controversy. For a scientific investigation of placebo effects to advance it is important to establish whether a placebo response in any particular illness is reliable - i.e., if there is a response to a single placebo administration there will also be a placebo response to the repeated administration of a similar placebo in similar conditions. A positive answer would allow more sophisticated clinical trial designs and more precise basic research experiments on the placebo effect. This article reviews experiments that used multiple administrations of placebo to answer the question "do reliable placebo responders exist?" This paper also examines the evidence for the existence of a consistent placebo responder, i.e. a person who responds to placebo in one situation will respond in another condition or using a different type of placebo ritual. Much of the existing evidence for these two questions was performed before 1967. This early evidence is contradictory, methodologically weak and is sufficiently old to be considered medical history. Since 1969, at least eight experiments exposed asthma patients to multiple administrations of placebo given with deceptive suggestions that the "treatment" was an active medication. While the results of this research are not unequivocal, and may not be equivalent to non-deceptive conditions, this line of inquiry suggests that if a reliable and consistent placebo response exists it could be detected within this population. Finally, this paper proposes one model to rigorously investigate the stability of placebo responses.
安慰剂效应一直备受争议。为推动对安慰剂效应的科学研究,确定在任何特定疾病中安慰剂反应是否可靠至关重要——也就是说,如果对单次给予安慰剂有反应,那么在相似条件下重复给予类似安慰剂时也会有安慰剂反应。肯定的答案将允许采用更复杂的临床试验设计以及针对安慰剂效应进行更精确的基础研究实验。本文回顾了使用多次给予安慰剂来回答“是否存在可靠的安慰剂反应者?”这一问题的实验。本文还考察了是否存在持续的安慰剂反应者的证据,即一个人在一种情况下对安慰剂有反应,在另一种情况下或使用不同类型的安慰剂程式时也会有反应。关于这两个问题的现有证据大多是在1967年之前获得的。这些早期证据相互矛盾,在方法上存在缺陷,而且年代久远,可被视为医学史。自1969年以来,至少有八项实验让哮喘患者多次接受安慰剂治疗,并伴有欺骗性暗示,称“治疗”是一种活性药物。虽然这项研究的结果并不明确,可能也不等同于非欺骗性条件下的结果,但这条研究思路表明,如果存在可靠且持续的安慰剂反应,那么在这一人群中有可能检测到。最后,本文提出了一个模型来严格研究安慰剂反应的稳定性。