Questioning the Consensus on Placebo and Nocebo Effects.
Questioning the Consensus on Placebo and Nocebo Effects.
复制标题
质疑安慰剂和反安慰剂效应的共识。
DOI：
10.1159/000513466
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发表时间：
2021
影响因子：
22.8
通讯作者：
Hardman D
中科院分区：
文献类型：
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作者：
Hardman D
我们饶有兴趣地阅读了最近发表在《心理治疗与心身医学》上的一篇文章，该文章报道了27位专家就安慰剂和反安慰剂效应应该向患者传达什么以及应该如何培训临床医生来提供这些信息达成的共识[1]。作者提出，向患者传达有关安慰剂和反安慰剂效应的一般信息是有益的，但应根据具体情况进行调整。他们进一步建议，培训临床医生沟通安慰剂和反安慰剂效应应该是医学教育的常规和综合部分。这些建议建立在早期关于在临床实践中最大化安慰剂效应和最小化反安慰剂效应的共识声明上[2]。作为回应，我们认为，最新的共识声明是概念模糊，并不雅阁与最近的研究对病人和临床医生的意见。此外，这些共识陈述的呈现掩盖了安慰剂研究中的激烈辩论和分歧，包括关于安慰剂和反安慰剂效应的认知主义解释的主导地位等基本问题[3，4]。正如作者所指出的那样，他们的方法并不能让他们得出关于可以最大化安慰剂效应和最小化反安慰剂效应的具体策略的结论。当然，这是因为“安慰剂”和“反安慰剂”只是总括性术语，尽管对协调研究很有用，包括各种各样的情况依赖的做法太多了，无法提及-患者和临床医生参与和谈论的实践，而不需要抽象的总括术语。正如前一位
We read with interest a recent article in Psychotherapy and Psychosomatics reporting the consensus of 27 experts on what should be communicated to patients about placebo and nocebo effects and how clinicians should be trained to deliver this information [1]. The authors propose that communicating general information to patients about placebo and nocebo effects is beneficial but should be adjusted to the context. They further propose that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education. These recommendations build on an earlier consensus statement regarding maximizing placebo effects and minimizing nocebo effects in clinical practice [2]. In response, we argue that the latest consensus statement is conceptually ambiguous and does not accord with recent research on the views of patients and clinicians. Furthermore, the presentation of these consensus statements belies lively debates and disagreements in placebo study research, including on fundamental issues such as the dominance of cognitivist accounts of placebo and nocebo effects [3, 4]. As the authors note, their method did not allow them to draw conclusions about specific strategies that can maximize placebo effects and minimize nocebo effects.This is, of course, because “placebo” and “nocebo” are merely umbrella terms that, though useful for coordinating research, encompass a diverse array of situation-dependent practices too numerous to mention–practices that patients and clinicians engage in and talk about without the need for abstract umbrella terms. As a previous