Abstract
In 1955, Henry K. Beecher published the classic work entitled “The Powerful Placebo.”
Since that time, 40 years ago, the placebo effect has been considered a scientific
fact. Beecher was the first scientist to quantify the placebo effect. He claimed that
in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved
by a placebo alone. This publication is still the most frequently cited placebo reference.
Recently Beecher's article was reanalyzed with surprising results: In contrast to
his claim, no evidence was found of any placebo effect in any of the studies cited
by him. There were many other factors that could account for the reported improvements
in patients in these trials, but most likely there was no placebo effect whatsoever.
False impressions of placebo effects can be produced in various ways. Spontaneous
improvement, fluctuation of symptoms, regression to the mean, additional treatment,
conditional switching of placebo treatment, scaling bias, irrelevant response variables,
answers of politeness, experimental subordination, conditioned answers, neurotic or
psychotic misjudgment, psychosomatic phenomena, misquotation, etc.
These factors are still prevalent in modern placebo literature. The placebo topic
seems to invite sloppy methodological thinking. Therefore awareness of Beecher's mistakes
and misinterpretations is essential for an appropriate interpretation of current placebo
literature.
Keywords
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Article info
Publication history
Accepted:
August 20,
1997
Identification
Copyright
© 1997 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
