Placebos: Their Underappreciated Impact in Pharmaceutical Trials

In conclusion, placebo effects are experienced as real by patients, and further understanding of the impact of placebos in clinical research and care appears integral to optimal management of rheumatic diseases. New views of clinical trials are emerging (e.g., the Oxford Centre for Evidence-Based Medicine comments that “early hierarchies that placed randomized trials categorically above observational studies were criticized for being simplistic. In some cases, observational studies give us the ‘best’ evidence”).¹⁰ Recognition of these new views may be helpful in further understanding and harnessing the placebo effect to improve patient care and outcomes.²¹

Terence Starz, MD, is a clinical professor of medicine in the Division of Rheumatology at the University of Pittsburgh School of Medicine and is in practice at Arthritis and Internal Medicine Associates–UPMC in the Western Pennsylvania area.

Theodore Pincus, MD, is a professor of medicine at Rush University Medical Center in Chicago.

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