CEO Talk Series: Placebo Meaning and Context:
In June 2013, President and Chief Executive Officer Wayne Jonas gave a talk at the Samueli Institute on “The P Word”. The talk consisted of exploring “meaning and context” effects or MAC, which are the non-specific effects typically referred to as “placebo”. However, Dr. Jonas addresses how these effects go beyond placebo and how meaning and context play a role as part of the treatment in something such as a clinical encounter. This ties into another center at Samueli, the Center for Optimal Healing Environments, through how the environment plays a role in meaning and context.
2012 Placebo Conference:
In January 2012, Samueli Institute, along with Theophrastus-Stiftung, gathered leading experts for two conferences on placebo effects.
The first conference, on January 18th, in collaboration with Uniformed Services University (USU), Human Performance Resource Center (HPRC) and Consortium for Health and Military Performance (CHAMP), focused primarily on placebo and performance in the military and sports medicine.
The second, on January 19th and 20th, in collaboration with National Institute on Drug Abuse (NIDA), National Center for Complementary and Alternative Medicine (NCCAM) and the Agency for Healthcare Research and Quality (AHRQ), sought to determine what are the key issues and next steps associated with placebo research. Specific topics included opportunities and challenges in the areas of: placebo conditioning, beliefs and expectations, the patient-practitioner relationship, nocebo and ethics.
2012 Placebo Conference Reports:
Placebo Response in Clinical Practice Summary
Placebo Response in Clinical Practice Full Report
Placebo and Performance Summary
Placebo and Performance Full Report
Samueli Institute Placebo Research Summary:
When we think of medical treatment we often think of a pill, injection or surgery, but recent research suggests healing also takes place at a deeper level. The medical encounter between patient and practitioner plays a significant role in the effects of healing. Placebos (a biomedically inert substance) can bring significant relief to patients suffering from pain, mild depression and even Parkinson’s disease. Because by definition the placebo is not an active agent, their effects are thought to be impacted by the meaning and context (MAC) of the therapeutic encounter. Other elements that mediate the placebo response include expectancy, classical conditioning and social learning.
Placebo Research
Goals:
The goal is to develop a new conceptualization and approach to healing with a summary of the current evidence for the effects of MAC, placebo and placebo-related effects. This will elucidate the cognitive and socio-contextual processes that underlie placebo and nocebo responses. This research will hopefully impact the way placebo is administered and used in clinical practice.
This program has supported and been a part of collaborations with Harvard, Theophrastus-Stiftung, Ludwig-Maximilian University of Munich and National Institutes of Health. The program's efforts have been featured in high-profile communications such as the New Yorker, and NPR's KoJo Namdi Show.
Projects:
Placebo Effects in Medicine
Meissner K, Kohls N, Colloca L, ed. Placebo effects in medicine: mechanisms and clinical implications. Philosophical Transactions of the Royal Society B 2011.
This special issue of “Philosophical Transactions of the Royal Society B” focuses on how the psychobiological and behavioral changes caused by placebo can facilitate the development of personal well-being. Topics covered in this special issue include:
- various kinds of placebo mechanisms across medical fields, accounting not only expectation and conditioning, but also empathy, social learning, emotion and motivation, spirituality and healing rituals;
- translating knowledge from placebo research into clinical practice;
- implications for the design and interpretation of clinical trials;
- therapeutic settings in patient care; and future translation of placebo research.
Placebo, Meaning and Context Issues
Vase L, Jonas WB, Walach H, Placebo, Meaning and Context Issues in Research, in Clinical Research in Complementary Therapies: Principles, Problems and Solutions, G. Lewith, W. Jonas, and H. Walach, Editors. 2011, Churchill Livingstone, Elsevier: Edinburgh. p. 313-332.
This book chapter reviews the literature discussing the impact of MAC on healing, the psycho-neuro-physiological mechanisms of the placebo effect, and how to exploit theses effects to enhance our well-being. It explores the following aspects of MAC: patient-practitioner interactions, Conditioning, and Expectation and emotions. Mechanisms for placebo analgesia include endogenous opioids, whereas diseases such as depression and Parkinson’s disease also include placebo responses involving serotonin and dopaminergic systems respectively.
Spirituality and Placebo
Kohls N, Sauer S, Offenbacher M, Giordano J, Spirituality: an overlooked predictor of placebo effects? Philosophical Transactions of The Royal Society B, 2011. 366(1572): p. 1838-1848.
Ongoing studies suggest that spiritual experiences and practices involve a variety of neural systems that may facilitate neural ‘top-down’ effects that are comparable, if not identical to, those present in placebo responses. 'Meaning' may be an overarching psychological construct that is important to facilitating the psycho-physiological mechanisms that are involved in the health-related effects of spirituality and the placebo response. Empirical evidence suggests that under certain conditions, spirituality may be a predictor of placebo response and effects.
A research agenda addressing responses and effects of both placebo and spirituality could be (i) synergistic, (ii) valuable to each individual phenomenon and (iii) contribute to an extended placebo paradigm that focuses on the concept of meaningfulness.