International Society for History, Philosophy, and Social Studies of Biology


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Program

MONDAY, JULY 6  /  09:00 - 10:30  /  DS-1545
Organized session / standard talks
Randomized controlled trials : The placebo perspective
Organizer(s):

Jean-Felix Gross (Université Jean Moulin Lyon 3, France); Hajime Fujimori (IHPST/ Université Paris 1 Panthéon-Sorbonne, France)

Randomized Controlled Trials (RCTs) are generally considered as the most reliable form of trial design for assessing the efficacy of a medical intervention. A crucial component of such trials is the use of a placebo-control group. In this session, each presenter will challenge the sufficiency of our understanding of placebos and in turn, the way they are implemented in assessing medical treatments. Conservatively, it can be shown that placebos often fail to play the role they are intended to play in the logic of RCT experimentation. This is shown empirically and compensatory alterations to our concept of a placebo and statistical practices are proposed. More fundamentally, in violation of the dominant understanding of placebos, recent research into placebo effects shows they have distinct neurobiological underpinnings and that they can be produced without deception. This raises the possibility that rather than being a sham treatment suitable for control, the (so-called) placebo effect may be a legitimate treatment in and of itself. Accordingly, it would be inappropriate to regard treatments that are especially effective at harnessing such effects (e.g. acupuncture) as ineffective rather than a legitimate treatment in its own right.


Why most sugar pills are not placebos

Bennett Holman (University of California, Irvine, United States)

The standard philosophical definition of placebos offered by Grünbaum is incompatible with the experimental role they must play in randomized clinical trials as articulated by Cartwright. I offer a modified account of placebos that respects this role and clarifies why many current medical trials fail to warrant the conclusions they are typically seen as yielding. I then consider recent changes to guidelines for reporting medical trials and show that pessimism over parsing out the cause “unblinding” is premature. Specifically, using a trial of antidepressants, I show how more sophisticated statistical analyses can parse out the source of such effects and serve as an alternative to placebo control.


Placebo effect and randomized controlled trials on acupuncture

Wenbo Liang (IHPST/ Université Paris 1 Panthéon-Sorbonne, France)

In this talk I consider the placebo effect concept as it has been employed by a large quantity of randomized controlled trials (RCTs) in clinic studies. After reviewing the history of RCTs and its application to acupuncture studies, I argue that applying RCTs to acupuncture requires a double evaluation, both of the standards of RCTs and of traditional Chinese medicine, rather than a simple confirmation via RCTs . I suggest that the abstract debates about placebo effect should be set aside, a more practical question is how can acupuncture leads to successful treatments with “specific effects” in the framework of RCTs.


Do we learn from history?

Jean-Felix Gross (Université Jean Moulin Lyon 3, France)

The standard history of the development of the placebo traces the use of placebos from the Bible through its employment in modern medical trials. This narrative is repeated not just in the work of English-speaking authors (e.g. Kaptchuk and Shapiro), but in French-speaking authors as well (e.g. Lemoine, Maire and Boussageon). I will argue that this uniformity in historical accounts stresses a dated vision of the concept of a placebo. Specifically, the standard history paints a placebo as an agent of suggestion, deception with poor biological grounding. In contrast, recent research has showed (e.g. Benedetti, Kaptchuk) that placebos can trigger very specific neurobiological pathways and in some cases (e.g. analgesia) that the effect can be produced without deception. The ability to evoke such a response in absence of deception would seem to be a troubling case to fit into our standard notion of placebo effects. However, I will argue that this impulse to incorporate such diverse phenomena under the umbrella of “placebo” unintentionally reifies a multifarious concept under a single label and thus inhibits research by demanding a single unified account for a diverse set of neuro-pharmacological phenomena.