AlainBraillon, Senior consultant, University hospital. 8000 Amiens. Francebraillon.alain@gmail.com
Submitted February 10, 2015
Espay et al. evaluated the short term effect (4 hours) of "cheap" or "expensive" subcutaneous "novel injectable dopamine agonist" placebo (normal saline) in patients with Parkinson disease and concluded "The potentially large benefit of placebo, with or without price manipulations, is waiting to be untapped for patients ..." [1] They only confirmed, with a costly imaging technique, that cognitive information (conditioning and expectation) produces a response in the brain. However, there is no evidence yet, whatever the disease could be, that placebos can have long lasting and powerful objective clinical effects.
Patients deserve clear and evidence based information about benefit or harm of treatments, with empathy. Placebo only strengthens medical arrogance and infantilizes people. Accordingly, the backlash can be damaging. [2]
1. Espay AJ, Norris MM, Eliassen JC et al. Placebo effect of medication cost in Parkinson disease: A randomized double-blind study. Neurology 2015 Epub Jan 28.
2. Braillon A. Placebo is far from benign: it is disease-mongering. Am J Bioeth 2009;9:36-38.
For disclosures, contact the editorial office at journal@neurology.org.
Espay et al. evaluated the short term effect (4 hours) of "cheap" or "expensive" subcutaneous "novel injectable dopamine agonist" placebo (normal saline) in patients with Parkinson disease and concluded "The potentially large benefit of placebo, with or without price manipulations, is waiting to be untapped for patients ..." [1] They only confirmed, with a costly imaging technique, that cognitive information (conditioning and expectation) produces a response in the brain. However, there is no evidence yet, whatever the disease could be, that placebos can have long lasting and powerful objective clinical effects.
Patients deserve clear and evidence based information about benefit or harm of treatments, with empathy. Placebo only strengthens medical arrogance and infantilizes people. Accordingly, the backlash can be damaging. [2]
1. Espay AJ, Norris MM, Eliassen JC et al. Placebo effect of medication cost in Parkinson disease: A randomized double-blind study. Neurology 2015 Epub Jan 28.
2. Braillon A. Placebo is far from benign: it is disease-mongering. Am J Bioeth 2009;9:36-38.
For disclosures, contact the editorial office at journal@neurology.org.