Abstract

RODRIGUEZ MARTIN, Boris C  and  RIVAS SUAREZ, Saira R. Placebo: the brightest «spot» in medicine. Rev Cubana Invest Bioméd [online]. 2013, vol.32, n.3, pp. 366-378. ISSN 0864-0300.

Introduction: no term has probably been as misused and has caused so much confusion as the term `placebo'. Its effects have strengthened medical treatments throughout history without receiving due recognition. Understood as events attributable to the significance acquired by an intervention in a given therapeutic context, it takes on a new dimension, detaching from the prevailing tautological definitions. Objective: analyze the challenges posed by this theoretical stand, as well as its potential for research and clinical practice. Method: an analysis is conducted of the limitations of its use in randomized clinical trials, among them the efficacyparadox. A contrast is made of evidence of its effectiveness generated in various contexts. A description is provided of placebos available in clinical practice and situations of use, as well as doctors' and patients' opinions. Its effect is presented from a biopsychosocial perspective, within the framework of Lifestyle Medicine. An outline is provided of the factors preventing alternative medicines from being «better than a placebo». Finally, its place in clinical practice is identified and exemplified. Conclusions: the placebo effect should be understood as an effect from the context, structured on the basis of the individual significance assigned to the intervention by a specific culture and historical development, which is significant for a large number of diseases, through the activation and modification of psychological and physiological variables. Conceived of as an Optimal Healing Environment, it acquires the «active principle» required to act by itself (when the alternative is doing nothing), or strengthen the effect of conventional treatments.

Keywords : placebo; placebo effect; efficacyparadox; optimal healing environment (OHE); alternative and complementary therapies.

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