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. (shrink)

Is there a response, which is not accounted for by regression to the mean, natural history, the Hawthorne effect?The term placebo comes to us from the Latin for "I shall please," indicating that the phenomenon known as the "placebo effect" or "placebo response" has been familiar to medical practitioners for a number of centuries, at least. As we reached the mid-20th century and randomized controlled trials became a central feature of medical research, the use of controls and blinding in those (...) trials allowed for the isolation of the placebo effect in ways that made it much clearer that there... (shrink)

Despite the conceptual problems in identifying the placebo effect, an increasing number of multidisciplinary inquiries rest on the assumption that there is a distinct class of effects, placebo effects. In this chapter, I argue against this assumption. I present cases and characterizations of the placebo effect as offered in the literature, and argue that the latter are subject to insurmountable problems. Moreover, I argue that identification of placebo effects as such is not useful for the three main purposes offered in (...) the literature. I then offer suggestions for why it may remain intuitive that some effects are placebo effects and close by noting the potential benefits of ultimately explaining away these intuitions. (shrink)

Care theorists have made significant gains over the past twenty-five years in establishing caring as a viable moral and political concept. Nonetheless, the concept of caring remains underdeveloped as a basis for a moral and political philosophy, and there is no fully developed account of our moral obligation to care. This article advances thinking about caring by developing a definition of caring and a theory of obligation to care sufficient to ground a general moral and political philosophy.

In this paper it is suggested that Freud's 'tally argument' (Grunbaum 1984) is not best interpreted as a risky claim concerning the efficacy of psychoanalytic therapy, but as a risky claim concerning the implications of theoretical psychoanalytic explanations of the efficacy of psychoanalytic therapy. Despite the fact that Freud never empirically established that these implications hold, the 'tally argument' does draw attention to a critical distinction that is too often neglected in contemporary empirical studies of psychoanalysis and other forms of (...) psychotherapy: between empirical evaluations of the efficacy of psychotherapy and empirical evaluations of theoretical explanations of the efficacy of psychotherapy, and the different forms of comparative enquiry relevant to each. It is argued that the contemporary neglect of this critical distinction, in conjunction with the common negative conception of placebo control treatments in psychotherapy research, has led to the epistemic impoverishment of experimental studies of the various professional psychotherapies. In consequence, although there is good empirical evidence for the efficacy of psychoanalysis and other forms of professional psychotherapy, there is no good empirical evidence for theoretical psychoanalytic explanations of the efficacy of psychoanalysis, or for traditional theoretical explanations of the efficacy of other forms of professional psychotherapy. (shrink)