Placebos Without Deception: Outcomes, Mechanisms, and Ethics.

Placebos Without Deception: Outcomes, Mechanisms, and Ethics.
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DOI:
10.1016/bs.irn.2018.01.005
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发表时间:
2018
影响因子:
--
通讯作者:
Howick J
Howick J
中科院分区:
医学3区
文献类型:
--
作者:
Colloca L;Howick J

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科学研究表明,开放标签和剂量延长的安慰剂(患者知道是安慰剂)可以引起行为、生物学和临床结果的变化。在这一章中,我们介绍了关于开放标签和延长剂量安慰剂的最新证据和伦理考虑,讨论了给予安慰剂合理的、作为活性药物剂量延长或预期助推剂的观点。以前对安慰剂使用的全面审查考虑了如何在医学上利用安慰剂效应,以及需要关注临床接触的因素以及患者与临床医生的关系。在这里,我们说明了标准(欺骗性)安慰剂、开放标签安慰剂和剂量延长安慰剂之间的异同。我们的结论是,没有欺骗的安慰剂将超越临床使用的伦理障碍。这为未来的大规模、务实的随机试验铺平了道路,这些试验调查了伦理开放标签和延长剂量的安慰剂在改善患者结局和减少副作用方面的潜力。
Scientific research indicates that open-label and dose-extending placebos (that patients know are placebos) can elicit behavioral, biological, and clinical outcome changes. In this chapter, we present the state-of-the-art evidence and ethical considerations about open-label and dose-extending placebos, discussing the perspective of giving placebos with a rational, as dose extension of active drugs, or expectancy boosters. Previous comprehensive reviews of placebo use have considered how to harness placebo effects in medicine and the need to focus on elements of the clinical encounter as well as patient–clinician relations. Here, we illustrate the similarities and differences between standard (deceptive) placebos, open-label placebos and dose-extending placebos. We conclude that placebos without deception would override ethical barriers to their clinical use. This paves the way to future large-scale, pragmatic randomized trials that investigate the potential of ethical open-label and dose-extending placebos to improve patients’ outcomes, and reduce side effects.
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