Does the model of additive effect in placebo research still hold true? A narrative review.
Does the model of additive effect in placebo research still hold true? A narrative review.
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DOI：
10.1177/2054270416681434
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发表时间：
2017-03-01
期刊：
影响因子：
--
通讯作者：
Heusser, Peter
中科院分区：
文献类型：
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作者：
Boehm, Katja;Berger, Bettina;Heusser, Peter
个性化和情境化护理已成为参与医疗保健的人们的主要需求，建议转向以人为本的医学。以人为本的医学评估可以最有效地实现，如果治疗研究使用“与不”的人为中心或综合研究设计。然而，这是假设综合或以人为本的干预措施的组成部分具有累加关系，以产生总效果。比彻的加和模型假设安慰剂和药物效应之间存在加和关系，因此呈现算术求和。到目前为止，还没有进行审查评估的有效性的添加剂模型，这是质疑和更密切的调查，在这次审查。2016年7月，使用Pubmed和Google Scholar对主要研究进行了初步检索。为了找到与本综述的比较部分相似的相似规模的匹配出版物，对所有纳入的综述进行了相应的匹配。共有22篇综述和3项临床和实验研究符合纳入标准。结果指出，以下因素积极质疑加性模型：各种影响的相互作用，试验设计，条件反射，背景效应和因素，神经生物学因素，作用机制，统计因素，干预特定因素（酒精，咖啡因），副作用和干预类型。除了一个被仔细评估的出版物之外，所有出版物都对加性模型提出了质疑。有必要对研究设计进行更仔细的检查。尝试采用一种更系统的方法来解决问题，可以为这一领域今后的研究提出建议。
Personalised and contextualised care has been turned into a major demand by people involved in healthcare suggesting to move toward person-centred medicine. The assessment of person-centred medicine can be most effectively achieved if treatments are investigated using 'with versus without' person-centredness or integrative study designs. However, this assumes that the components of an integrative or person-centred intervention have an additive relationship to produce the total effect. Beecher's model of additivity assumes an additive relation between placebo and drug effects and is thus presenting an arithmetic summation. So far, no review has been carried out assessing the validity of the additive model, which is to be questioned and more closely investigated in this review. Initial searches for primary studies were undertaken in July 2016 using Pubmed and Google Scholar. In order to find matching publications of similar magnitude for the comparison part of this review, corresponding matches for all included reviews were sought. A total of 22 reviews and 3 clinical and experimental studies fulfilled the inclusion criteria. The results pointed to the following factors actively questioning the additive model: interactions of various effects, trial design, conditioning, context effects and factors, neurobiological factors, mechanism of action, statistical factors, intervention-specific factors (alcohol, caffeine), side-effects and type of intervention. All but one of the closely assessed publications was questioning the additive model. A closer examination of study design is necessary. An attempt in a more systematic approach geared towards solutions could be a suggestion for future research in this field.