The relativity of ‘placebos’: defending a modified version of Grünbaum’s definition

Synthese 194 (4):1363-1396 (2017)

Authors
Jeremy Howick
Oxford University
Abstract
Debates about the ethics and effects of placebos and whether ‘placebos’ in clinical trials of complex treatments such as acupuncture are adequate rage. Yet there is currently no widely accepted definition of the ‘placebo’. A definition of the placebo is likely to inform these controversies. Grünbaum’s characterization of placebos and placebo effects has been touted by some authors as the best attempt thus far, but has not won widespread acceptance largely because Grünbaum failed to specify what he means by a therapeutic theory and because he does not stipulate a special role for expectation effects. Grünbaum claims that placebos are treatments whose ‘characteristic features’ do not have therapeutic effects on the target disorder. I show that with four modifications, Grünbaum’s definition provides a defensible account of placebos for the purpose of constructing placebo controls within clinical trials. The modifications I introduce are: adding a special role for expectations, insisting that placebo controls control for all and only the effects of the incidental treatment features, relativizing the definition of placebos to patients, and introducing harmful interventions and nocebos to the definitional scheme. I also provide guidance for classifying treatment features as characteristic or incidental
Keywords Philosophy of science  Methodology  Placebo  Randomized trial  Grünbaum  Philosophy of medicine  Ethics
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DOI 10.1007/s11229-015-1001-0
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References found in this work BETA

The Philosophy of Evidence-Based Medicine.Jeremy Howick - 2011 - Wiley-Blackwell, Bmj Books.
The Cement of the Universe.J. L. Mackie - 1974 - Oxford, Clarendon Press.
What Evidence in Evidence-Based Medicine?John Worrall - 2002 - Proceedings of the Philosophy of Science Association 2002 (3):S316-S330.
What Evidence in Evidence‐Based Medicine?John Worrall - 2002 - Philosophy of Science 69 (S3):S316-S330.
A Duty to Deceive: Placebos in Clinical Practice.Bennett Foddy - 2009 - American Journal of Bioethics 9 (12):4-12.

View all 15 references / Add more references

Citations of this work BETA

In Defense of Meta-Analysis.Bennett Holman - 2019 - Synthese 196 (8):3189-3211.
Problematic Placebos in Physical Therapy Trials.Matthew Maddocks, Roger Kerry, Andrew Turner & Jeremy Howick - 2016 - Journal of Evaluation in Clinical Practice 22 (4):598-602.

View all 6 citations / Add more citations

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