The placebo response in medicine: minimize, maximize or personalize?
Nat Rev Drug Discov. 2013 Mar;12(3):191-204.
Enck P, et al.
Our understanding of the mechanisms mediating or moderating the placebo response to medicines has grown substantially over the past decade and offers the opportunity to capitalize on its benefits in future drug development as well as in clinical practice. In this article, we discuss three strategies that could be used to modulate the placebo response, depending on which stage of the drug development process they are applied. In clinical trials the placebo effect should be minimized to optimize drug-placebo differences, thus ensuring that the efficacy of the investigational drug can be truly evaluated. Once the drug is approved and in clinical use, placebo effects should be maximized by harnessing patients’ expectations and learning mechanisms to improve treatment outcomes. Finally, personalizing placebo responses – which involves considering an individual’s genetic predisposition, personality, past medical history and treatment experience – could also maximize therapeutic outcomes.
From the perspective of a patient and the physician, maximal drug efficacy is desirable irrespective of whether the improvements are based on specific pharmacological effects, placebo mechanisms or a combination of both.
the verbal induction of negative expectations can abolish the effect of potent drugs such as opioids.
Therefore optimizing patients’ expectations before and during medical interventions may contribute to improved clinical outcomes.
Brief psychological interventions are promising tools that could be used by medical personnel in daily routine scenarios to optimize patients’ expectations.
Patients with inadequate treatment expectations (that is, overly negative or over-optimistic cognitions) should undergo re‑attribution training to develop more positive and realistic expectations.
in the United States 50% of patients do not have an adequate understanding of what their physician has told them following a visit
in addition to merely providing information, manipulation of patients’ treatment expectations is considered to be most effective if patients develop a ‘mental map’ that clearly and adequately promotes an optimistic perspective regarding the treatment outcome.