Institute of General Practice, Technische Universität München, 81667 Munich, Germany.
Philos Trans R Soc Lond B Biol Sci. 2011 Jun 27;366(1572):1905-12. doi: 10.1098/rstb.2010.0383.
This article reviews the role of placebo interventions and placebo effects in clinical practice. We first describe the relevance of different perspectives among scientists, physicians and patients on what is considered a placebo intervention in clinical practice. We then summarize how placebo effects have been investigated in randomized controlled trials under the questionable premise that such effects are produced by placebo interventions. We further discuss why a shift of focus from the placebo intervention to the overall therapeutic context is necessary and what research methods can be used for the clinical investigation of the relevance of context effects. In the last part of the manuscript, we discuss why placebo or context effects are seen as positive in clinical practice when they are associated with active treatments, while placebo interventions pose major ethical and professional problems and have to be avoided.
本文回顾了安慰剂干预和安慰剂效应在临床实践中的作用。我们首先描述了科学家、医生和患者对临床实践中什么是安慰剂干预的不同看法之间的相关性。然后，我们总结了在随机对照试验中如何研究安慰剂效应，这些试验的前提是安慰剂干预会产生这种效应。我们进一步讨论了为什么有必要将重点从安慰剂干预转移到整体治疗环境，以及可以使用哪些研究方法来临床研究背景效应对的相关性。在本文的最后一部分，我们讨论了当安慰剂或背景效应与积极治疗相关联时，为什么在临床实践中被视为积极的，而安慰剂干预则带来重大的伦理和专业问题，必须避免。
