Can we create placebo responders and non-responders in the lab?

摘要

The recent advances in placebo research have uncovered many mechanisms through both the psychological and neurobiological approach, with a number of important clinical implications (Benedetti, 2008; Price et al., 2008; Enck et al., 2008; Finniss et al., 2010). Indeed, some of these mechanisms can be exploited in clinical trials as well as in medical practice, although the objectives are certainly opposite in the two situations. In fact, whereas placebo responses need to be reduced in clinical trials, their increase is desirable in routine medical practice. With this in mind, today we are in a good position to consider the possibility to manipulate placebo responses in both directions in order to create either placebo responders or non-responders in the laboratory. However, it is important to remember that the improvement that may take place in a patient who has received a placebo may depend on plenty of factors, such as spontaneous remission, regression to the mean, experimenter's and patient's biases, and the like. By keeping all these factors constant, the real placebo response, i.e. the real psychobiological phenomenon, can be manipulated and/or controlled in a number of ways.