Choice as a Moderator of Placebo Expectation Effects: Additional Support From Two Experiments

Two experiments investigated the hypothesis that treatment choice enhances placebo treatment efficacy. In Experiment 1, prior to a pain task, participants were given either an expectation that two (inert) products could reduce pain or no expectation. In addition, participants either selected between the two products or were assigned a product to use. Participants given both the placebo expectation and treatment choice reported the lowest pain. Experiment 2 conceptually replicated this finding using a placebo paradigm with aversive auditory stimuli. Additional control conditions indicated that a choice availability (rather than choice restriction) explanation best accounted for these results.     

Placebo Effects and Informed Consent

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice.     

The Power of Expectation – Understanding the Placebo and Nocebo Phenomenon

Although placebo pills are supposed to have no pharmacological activity, people taking placebo pills describe a variety of positive (i.e., placebo phenomenon) and negative (i.e., nocebo phenomenon) reactions. This has major clinical implications. Placebo reactions account for a substantial part of improvement when treating patients with hypertension, mental disorders, and even after surgical procedures. The nocebo phenomenon on the other hand is responsible for non‐compliance and discontinuation of many pharmaceutical interventions. Mechanisms that underlie the placebo and nocebo effects may be related to expectation and/or classical conditioning, but some methodological issues should also be considered. Most experimental studies investigating the placebo effect have used paradigms to induce ‘placebo analgesia’, the reduction of pain perception after receiving an inert substance and an instruction that this medication would relieve pain. This paradigm allows investigators to examine the neurobiological circuitry of the placebo response using neuroimaging techniques.     

The Neural Bases of Placebo Effects in Pain

Abstract— Placebo effects are beneficial effects of treatment caused not by the biological action of the treatment but by one's response to the treatment process itself. One possible mechanism of placebo treatments is that they create positive expectations, which change one's appraisal of the situation and may thereby shape sensory and emotional processing. Recent brain-imaging evidence suggests that placebo-induced expectations of analgesia increase activity in the prefrontal cortex in anticipation of pain and decrease the brain's response to painful stimulation. These findings suggest that placebo treatments can alter experience, not just alter what participants are willing to report about pain. To the extent that they involve neural systems mediating expectancy and appraisal, placebo effects in pain may share common circuitry with placebo effects in depression, Parkinson's disease, and other disorders.     

薪酬预期与选择:基于三参照点理论的验证与探讨

两项实验研究对新近提出的风险决策的三参照点(TRP)理论进行了验证.实验就大学生对就业的薪酬制度的偏好和选择对三参照点理论的独特推断进行了检验.三参照点理论强调决策参照点对预期结果分布的界定作用.人们在决策时不仅会考虑现状(SQ)还会考虑最低要求(MR)和目标(G).MR,SQ和G三个参照点把结果空间分成了四个功能区域:成功、获益、损失和失败.根据三参照点理论,参照点的心理效应为MR＞>G＞SQ.当预期结果的平均值低于MR(或者G)的时候,人们会偏好风险高的选择以增加达到或者超过参照点的可能性;而当预期结果的平均值高于MR(或者G)的时候,人们会偏好风险低的选择以减少低于MR(或者(G)的可能性.实验1中,根据预先测定的大学生群体对第一份工资的最低要求,准确地预测了参与者在高稳定型、高弹性型和中间型三种工资类型的风险偏好和取舍.实验2进一步探讨了MR和G之间的权衡:实验发现当弹性型工资的浮动范围双向超出MR和G(而不是双向非临界)时,人们会优先考虑MR从而使超过G的可能性的吸引力相对降低;而不会为了追求达到G而忽略低于MR的风险.     

面对临床无效治疗:思考与抉择

对于没有临床救治意义的病人 ,要不要继续治疗 ?这既是临床医疗问题 ,又是一个涉及社会、伦理、法规的问题。在社会多元化发展的今天 ,对于临床无效治疗无论放弃与否 ,都应当把维护病人的利益作为医疗活动的出发点。在此基础上 ,知情同意和尊重病人自主权是医务人员必须遵循的基本道德原则 ,同时也应当考虑卫生资源的有效分配和社会公众的健康利益     

Genre of Music and Lyrical Content: Expectation Effects

This study was designed to examine whether people's expectations differ regarding how music lyrics affect individual behavior as a function of music genre. Because legislative attention and media publicity have been biased against certain types of popular music (i.e., heavy metal and rap), the authors expected that those genres of music would be viewed more negatively than other genres of popular music, for which there has been little or no negative publicity (i.e., pop and country). Participants (N = 160 college students) rated their perceptions of how the lyrical content of a song would affect listeners' behavior. The authors presented prosocial or antisocial lyrical passages to students (N = 160) under the guise of four musical genres (heavy metal, rap, pop, and country). Participants rated the potential impact of the lyrics on listeners' behavior. Findings indicated that lyrics labeled as heavy metal or rap were perceived as less likely to inspire prosocial behavior but not more likely to inspire antisocial behavior than the same lyrics labeled as country or pop.     

对骨折治疗"优化选择"与"合理选择"的理解和思考

从合理化角度回顾了当前几种重要的骨折治疗理论体系的发展与演变,认为骨折治疗的最优原则是一种理想状态,现实中没有绝对最优只有相对合理.只有建立以患者为中心的思维体系,加强医疗逻辑思维能力,用多维思考的方式寻找矛盾的合理平衡点,始终坚守医学伦理道德底线,才能真正做到为每一位骨折患者进行最合理的治疗.     

对骨折治疗“优化选择”与“合理选择”的理解和思考

从合理化角度回顾了当前几种重要的骨折治疗理论体系的发展与演变,认为骨折治疗的最优原则是一种理想状态,现实中没有绝对最优只有相对合理。只有建立以患者为中心的思维体系,加强医疗逻辑思维能力,用多维思考的方式寻找矛盾的合理平衡点,始终坚守医学伦理道德底线,才能真正做到为每一位骨折患者进行最合理的治疗。     

Placebo and criminal law

This article considers issues concerning cases where the use of placebo is lawful or is not lawful under aspects of German criminal law. It will differentiate between cases of individual therapy and cases of supervised experiments within the scope of medical tests. Thereby, it reveals that a medication of placebo with regard to an individual patient seems to be lawful if there is no alternative possibility of a better treatment using a chemically effective medicine and if the limits of presumed consent are complied with. On the other hand, in the context of the supervised experiment, the assignment of a patient to a group treated with placebo is only lawful if the patient has been fully informed about the possibilities of a treatment and if the patient has given consent to it. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003. The author’s interests include International Criminal Law, Comparative Criminal Law and Philosophy of Law.     

State-Dependent Memory Effects Using Caffeine and Placebo Do Not Extend to Metamemory

The authors examined the impact of caffeine on human memory and predictions of memory (i.e., metamemory). On Day 1, 83 college students drank a sweetened beverage containing either caffeine (4 mg/kg body weight) or a placebo before they studied 40 pairs of words. While the participants studied, they predicted their future memory performance for each word pair. On Day 2, the participants again received caffeine or a placebo before the memory test. The participants who drank the same beverage on both days (either caffeine or a placebo) recalled more word pairs than did those who drank different beverages (caffeine on 1 day and a placebo on the other day). In contrast, memory predictions were more accurate when the beverages did not match on both days. These data provide evidence for state-dependent memory when caffeine is used, but not for state-dependent metamemory. People's memory and their predictions of memory can be influenced in different ways if they drink caffeine before they study or take a test.     

Exposition Effects on Decision Making: Choice and Confidence in Choice

Many of us believe that, after writing about a subject, we understand it more deeply. Studies in education indicate that writing does indeed enhance comprehension. Three experiments examined whether similar “exposition effects” exist for decision making. In these experiments, subjects were confronted with standard framing problems. Positive exposition effects would require that the influence of alternative frames on subjects' choices be diminished by exposition demands. Control subjects made choices under customary, non-exposition instructions. Others chose after writing rationales for their selections (exposition), after explicitly planning to write such rationales, or merely in anticipation of writing the rationales. Exposition reduced framing effects in each of the experiments. The magnitudes of the effects were greatest for subjects who wrote before choosing. Also, exposition markedly increased subjects' confidence that their choices were appropriate. Theoretical and practical implications are discussed.     

A Negotiation Approach to Intake and Treatment Choice

Treatment choice is the decision process whereby the psychotherapeutic methods and the psychotherapist are determined when psychotherapy is recommended for a specific client. In this article the problem of treatment choice is situated within an integrative view of psychotherapy. A review of the literature confirms the usefulness of the following concepts for treatment choice: client preferences, client control of the situation of choice, and the mutual acceptability of differing views of therapists and clients. These research findings reveal the importance of four elements in the psychotherapeutic intake strategy: exploration of the client's perspective, informing the client, negotiation as a process of confrontation between the client's and the clinician's perspective, and the client's ultimate choice between alternative treatment proposals.     

脑损伤新生儿救治的选择

脑损伤是婴儿死亡、儿童残疾的主要原因之一。关于有严重脑损伤新生儿（包括脑瘫、智能精神发育落后等）是否该救治,牵涉到很多矛盾的思想观点。通过分析新生儿期脑损伤发生的高危因素,且提出相应的综合处置意见,认为要和谐地解决此矛盾,需要医院、家庭和社会有关部门的共同努力。     

Expectation and autokinesis

The reported direction of autokinesis for naive observers is not biased by gaze deviations of 22.5 deg of arc. However, instructions to expect either “inward” or “outward” movement produce reports of autokinetic movement that are progressively biased in the expected direction. Instructions to expect “more” or “less” movement resulted in a decrease in the reported duration of apparent movement for the “less” group but no change for the “more” group. Response bias is not considered to play a role in these results. The results are discussed in terms of fixational bias and selective attention mechanisms of autokinesis.     

Need for Cognition and Choice Framing Effects

Two experiments tested the hypothesis that framing biases in decision making would affect more strongly individuals with relatively low levels of need for cognition (NC). Participants were classified as high or low NC based on responses to a standard scale and subsequently were exposed to one of two framings of a choice problem. Different choice problems were used in each experiment, modeled after those developed by Kahneman and Tversky. Experiment 1 employed a monetary task and Experiment 2 a medical decision-making task. Consistent with expectations, framing effects on choice were observed in both experiments, but only for low NC participants. High NC participants were unaffected by problem framing, showing that they were less susceptible to attempts to alter their frame of reference.     

What You Don't Know Can Help You: The Ethics of Placebo Treatment

Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be administered in an honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment. While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive.     

肝癌综合治疗的发展与展望

原发性肝癌是我国最常见的恶性肿瘤之一,预后较差,病死率较高。经过多年的探索与努力,人们利用辩证思维的方法,在总结了各种治疗方法的优、缺点后,取长补短兴起了肝癌的综合治疗。包括手术治疗、化疗、放疗、导向治疗、局部治疗、中医治疗、免疫治疗、基因治疗的综合治疗,成为进一步提高肝癌疗效的新途径。