The use of the placebo effect in clinical medicine — ethical blunder or ethical imperative?

The current debate in medical ethics on placebos focuses mainly on their use in health research. Whereas this is certainly an important topic the discussion tends to overlook another longstanding but nevertheless highly relevant question, namely if and how the placebo effect should be employed in clinical practice. This paper describes the way the placebo effect is perceived in modern medicine and offers some historical reflections on how these perceptions have developed; discusses elements of a definition of the placebo effect; and suggests some conditions under which making use of the therapeutic potential of the placebo effect can be ethically acceptable, if not warranted. 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. Nikola Biller-Andorno, MD, PhD, is Assistant Professor in the Dept. of Medical Ethics and History of Medicine, University of Goettingen, Germany. Dr. Biller-Andorno also serves as an ethicist for the World Health Organization (WHO). This paper does not necessarily reflect the views of the World Health Organization.     

Effect of visual experience on face processing: a developmental study of inversion and non-native effects

In adults, three phenomena are taken to demonstrate an experience effect on face recognition: an inversion effect, a non-native face effect (so-called 'other-race' effect) and their interaction. It is crucial for our understanding of the developmental perception mechanisms of object processing to discover when these effects are present in childhood. Three- to 5-year-old Caucasian children (N = 64) were asked to recognize upright and inverted Caucasian and Asian faces. Recognition was tested with a forced-choice procedure. Overall performance improved with age. However, there was an interaction between the inversion and non-native effects that did not change with age between ages 3 and 5: (a) the inversion effect with native (Caucasian) faces was larger than with non-native (Asian) faces, and (b) upright native faces were recognized better than upright non-native faces. These results show that face orientation and morphology constrain face processing in 3- to 5-year-olds. The first 3 years of life during which the brain and the environment interact are sufficient to build a face-processing system that constrains recognition.     

Psychosozialer Versorgungsbedarf bei Arbeitnehmern

Zusammenfassung  Untersuchungen zu Häufigkeit, Verlauf und Ursachen psychischer Erkrankungen bei Arbeitnehmern sind rar. Die Gründe hierfür liegen sowohl auf Seiten der Arbeitsmedizin, die psychosoziale Aspekte wenig berücksichtigt, als auch bei der Psychotherapie, die zu wenig auf die Arbeitssituation eingeht. Die wenigen aussagekräftigen Untersuchungen legen bei Arbeitnehmern eine ähnlich hohe Prävalenz und Behandlungsbedürftigkeit nahe wie in der Allgemeinbevölkerung. Von den Folgen einer störungsinadäquaten Therapie psychischer Erkrankungen sind Arbeitnehmer in besonderem Maße betroffen, da die Erkrankungen nicht nur zu erheblichem persönlichem Leid führen, sondern durch Chronifizierung zu enormen Kosten in der medizinischen Versorgung beitragen. Außerdem sind sie durch krankheitsbedingte Fehlzeiten und (Früh-)Berentungen auch die Ursache weit reichender Produktionsausfälle in der Wirtschaft. Obwohl eine Reihe von Maßnahmen der betrieblichen Gesundheitsförderung zur Besserung der psychischen Befindlichkeit von Arbeitnehmern verfügbar sind, werden sie gegenwärtig noch zu selten eingesetzt und noch weniger evaluiert.

Valence of distractor words increases the effects of irrelevant speech on serial recall

Participants memorized target words in silence or while ignoring neutral or valent (positive or negative) distractor words that could be either possessor-relevant or other-relevant. Distractor words impaired recall performance, but valent distractor words caused more disruption than neutral distractors, and negative distractors caused more disruption than positive distractors. The results are problematic for explanations of the irrelevant speech effect within working memory models that do not specify an explicit role of attention in the maintenance of information for immediate serial recall.     

On doing two things at once: Temporal constraints on actions in language comprehension

In two experiments, we investigated how text comprehension is influenced by the interaction between the properties of actions and the temporal relations specified by adverbs. Participants read short narratives describing a protagonist who performed two actions that involved similar sensorimotor systems (e.g., chopping wood and painting a fence) or different ones (e.g., whistling a melody and painting a fence). The actions were described as simultaneous or successive by means of the temporal adverbs while and after, respectively. Comprehension, both in Spanish and in English, was markedly impaired (longer reading times and lower subjective coherence) for sentences including the adverb while and actions involving the same sensorimotor system. However, when one of the same sensorimotor system actions was described as a mental plan (e.g., chopping wood and thinking of painting a fence), comprehension was equally easy with the adverbs while and after. These results are compatible with a revised version of the indexical hypothesis that specifies how comprehension is guided by syntax and embodied constraints within multiple noninteracting mental spaces.     

Coping assessment in adolescents

The aim of this work was to obtain an abridged form of the Adolescent Coping Scale (Spanish version) that included items representative of the various factorial dimensions identified as stable. The scale (80 items) was administered to 800 Argentine adolescents. Factor analyses, principal axes and oblimin solution, were performed. An abridged scale was obtained, consisting of 46 items that were grouped into 11 dimensions: Cognitive Redefinition, Self-Blame, Fatalism, Evasion Through Amusement, Problem-Focused Coping (which includes requests for information and action), Evasion Through Physical Activity, Emotional Support, Emotional Discharge and Somatization, Anxiety, Isolation, and No Action. The reliability coefficients were found to be satisfactory.     

Processing of temporal information: Evidence from eye movements

In two experiments, we recorded eye movements to study how readers monitor temporal order information contained in narrative texts. Participants read short texts containing critical temporal information in the sixth sentence, which could be either consistent or inconsistent with temporal order information given in the second sentence. In Experiment 1, inconsistent sentences yielded more regressions to the second sentence and longer refixations of it. In Experiment 2, this pattern of eye movements was shown only by readers who noticed the inconsistency and were able to report it. Theoretical and methodological implications of the results for research on text comprehension are discussed.     

Imagery and rehearsal as study strategies for written or orally presented passages

In the present research, we studied the influence of text presentation modality on recall under imagery, rehearsal, and no strategy instructions. It was hypothesized that imagery is a more effective recall strategy for an oral presentation and rehearsal for a written presentation, and that imagery and rehearsal are effective study strategies. One hundred twenty participants participated, 80 of whom were trained in the use of imagery or rehearsal in the study of passages and 40 of whom made up the control group. A text was presented orally or in writing; the trained participants were to memorize it using the strategy taught, and the participants in the control group were to memorize it using a freely chosen strategy. They were then asked for free written recall. The results confirmed that the participants using imagery recalled the oral presentation better than the written one, and those using rehearsal recalled the written presentation better than the oral one. The discussion focuses on a selective-interference explanation of the presentation modality effects. Practical suggestions are given, and implications for future research are discussed.