Harnessing placebo: Lessons from psychedelic science.

The randomized controlled trial (RCT) design assumes a drug's specific effect can be separated from nonspecific context and person effects, but ample evidence shows that physical, social, and cultural variables not only add to but also shape drug effects. Harnessing these placebo effects for patient benefit is challenging due to conceptual and normative obstacles. A new framework inspired by psychedelic science's 'set and setting' concept acknowledges that drug and nondrug factors interact synergistically, suggesting ways to reintegrate nondrug variables into biomedical practice to ethically use placebo effects for improved clinical care.

Study at a glance

Abstract

The randomized controlled trial (RCT) research design assumes that a drug's "specific" effect can be isolated, added, and subtracted from the "nonspecific" effect of context and person. While RCTs are helpful in assessing the added benefit of a novel drug, they tend to obscure the curative potential of extra-pharmacological variables, known as "the placebo effect." Ample empirical evidence suggests that person/context-dependent physical, social, and cultural variables not only add to, but also shape drug effects, making them worth harnessing for patient benefits. Nevertheless, utilizing placebo effects in medicine is challenging due to conceptual and normative obstacles. In this article, we propose a new framework inspired by the field of psychedelic science and its employment of the "set and setting" concept. This framework acknowledges that drug and nondrug factors have an interactive and synergistic relationship. From it, we suggest ways to reintegrate nondrug variables into the biomedical toolbox, to ethically harness the placebo effect for improved clinical care.