Langer G
Psychiatrische Universitätsklinik, Wien.
Wien Klin Wochenschr Suppl. 1987;175:1-20.
In this theoretical paper the concept of placebo is being investigated within a field of tension: on one side the conventional understanding of "placebo", that is empirically inconsistent and scientifically and ethically unsatisfactory, and on the other side the upgraded concept of "aura curae" as suggested by the author, that appears to be less contradictory and also richer in heuristic potential and, conceivably, may be closer to the essence of "placebo" itself. This statement is being corroborated by six main arguments. The first three arguments are meant to weaken the conventional concept of "placebo": The first argument deals with the empirical inconsistencies of the traditional placebo concept; the second addresses the possible distortion of scientific conclusions drawn from a conventional "placebo-controlled" trial; the third argument deals with the ethical problems of "pretense" and of "withholding adequate medication". The following three corresponding arguments are put forward in support of the upgraded placebo-concept of "aura curae" (Latin: "air of care"; "unspecific healing context"). The fourth argument introduces the concept of "aura curae" itself; the fifth argument deals with two alternatives to the conventional placebo-controlled trial, namely the "placebo-integration" and the "value added efficacy"; the sixth argument concludes with a discussion of the ethical advantages of implementing the concept of "aura curae" in clinical and research practice. The purpose of this paper is to contribute to a comprehensive "healing context", that would better fit the patient's needs; i.e., in addition to the various traditional "therapies" of specific influence (biological and psychosocial), the "protherapeutic" and unspecific effects of the "aura curae" should be integrated into a systemic patient care.
在这篇理论性论文中，安慰剂的概念是在一个张力场中进行研究的：一方面是对“安慰剂”的传统理解，这种理解在经验上不一致，在科学和伦理上也不能令人满意；另一方面是作者提出的“治愈氛围”的升级概念，它似乎矛盾较少，启发潜力更大，并且可以想象，可能更接近“安慰剂”本身的本质。这一观点得到了六个主要论据的支持。前三个论据旨在削弱“安慰剂”的传统概念：第一个论据涉及传统安慰剂概念在经验上的不一致性；第二个论据讨论了从传统“安慰剂对照”试验得出的科学结论可能存在的扭曲；第三个论据涉及“伪装”和“ withhold adequate medication”（此处原文有误，推测可能是“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ withholding adequate treatment”，意为“ withholding adequate treatment”，即“ 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