Placebo effects and racial and ethnic health disparities: an unjust and underexplored connection
Placebo effects and racial and ethnic health disparities: an unjust and underexplored connection
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DOI：
10.1136/medethics-2018-104811
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发表时间：
2018-11-01
影响因子：
4.1
通讯作者：
Blease, Charlotte
中科院分区：
文献类型：
--
作者：
Friesen, Phoebe;Blease, Charlotte
虽然大量的生物伦理学文献认为安慰剂效应可能会导致自主性和善行之间的冲突，但正义和安慰剂效应之间的联系却被忽视了。在这里，我们汇集了来自安慰剂研究领域和与种族和民族有关的健康不平等研究的不同证据，并认为，总的来说，这些证据可能为一种未被承认的途径提供了基础，这种途径加剧了健康差距。这条路线是由安慰剂效应的不均匀分布构成的，这是由于医生的温暖和同情，以及支持和患者参与的表达在种族和民族界线上的差异造成的。在讨论这种联系的伦理含义时，我们认为，这种对健康差距的贡献是不公正的根源，考虑这些差距可能得到改善的方式，并建议这一结论也可能延伸到其他不平等领域。
While a significant body of bioethical literature considers how the placebo effect might introduce a conflict between autonomy and beneficence, the link between justice and the placebo effect has been neglected. Here, we bring together disparate evidence from the field of placebo studies and research on health inequalities related to race and ethnicity, and argue that, collectively, this evidence may provide the basis for an unacknowledged route by which health disparities are exacerbated. This route is constituted by an uneven distribution of placebo effects, resulting from differences in expressions of physician warmth and empathy, as well as support and patient engagement, across racial and ethnic lines. In a discussion of the ethical implications of this connection, we argue that this contribution to health disparities is a source of injustice, consider ways in which these disparities might be ameliorated and suggest that this conclusion is likely to extend to other realms of inequality as well.