Placebo effects: a new paradigm and relevance to psychiatry

Systematic evaluations show that placebo treatments can have large effects, sometimes larger than those of ‘evidence-based treatments’. This is the ‘efficacy paradox’. The neurobiology of placebo effects is being mapped out. Placebo effects are no less real or, in some illnesses, clinically important than the effects of direct biomechanical or pharmacological interventions. The technical model of medicine seeks impersonal technologies that can be applied independently of context and person. This approach has had spectacular success in the treatment of disease but meaning, cultural context, interpersonal effects, personal preferences and values are enormously important in the treatment of illness. The study of placebo reveals aspects of the biology of interpersonal relationships and the social environment. The evidence demonstrates that interpersonal healing (sometimes called placebo) in illness is just as real, scientific and biological as technological healing. This is a paradigm shift.