Public and professional attitudes towards deceptive and open-label placebo in [FND] and wider neurological practice 2025 Huys et al

Andy

Andy

Senior Member (Voting rights)

Abstract​

Background Placebo effects are powerful and have been suggested to be particularly relevant in certain neurological conditions, including functional neurological disorder (FND).

Methods A survey on attitudes towards and current practice of deceptive placebo treatments and ethical alternatives, notably positive suggestion, trust and open-label placebo was performed among health professionals and lay people with and without neurological diagnoses.

Results 116 healthcare professionals and 631 lay people (176 FND, 332 with other neurological diagnoses, 61 with medical diagnoses, 62 healthy controls) completed the survey. 71% of lay people but only 46% of healthcare professionals were in favour of deceptive placebo treatments. Among lay people, healthy individuals were most in favour (87%), and people with FND were least in favour (62%). All groups were sceptical towards open-label placebo, yet neurologists were most open to this practice. Placebo was considered more effective for functional than non-functional disorders by healthcare professionals, but not by patients. Healthcare professionals reported only rarely using placebo in clinical practice, and if so, mainly in the diagnosis or treatment of FND.

Conclusions This is the first survey on opinions and current practice of placebo treatments in neurological practice. The results show a mixed picture, with deceptive placebos being perceived as effective and acceptable by most lay people (though strongly opposed by some, particularly by some patients with FND) and mostly considered more negatively by healthcare professionals. Ethically acceptable alternatives of harnessing the power of placebo without deception were considered with scepticism by all respondents, but least so by neurologists.

What is already known on this topic​

  • Placebo effects are genuine, potent and share pathophysiological mechanisms with some neurological conditions, including functional neurological disorder, indicating a potential special relevance.

What this study adds​

  • This is the first survey in neurological illness on opinions and clinical practice regarding placebo treatments. It shows an openness towards deceptive placebo treatments in most lay people, but less so in people with functional neurological disorder and healthcare professionals. Importantly, a significant minority strongly opposes deceptive placebo even when presented as a potentially curative intervention. There is widespread scepticism towards open-label placebo.

How this study might affect research, practice or policy​

  • When debating policies surrounding deceptive placebo treatments, given their associated risks, those in strong opposition deserve particular consideration.
  • A stronger focus, both in terms of education and clinical practice, on ethically viable alternative ways of harnessing the power of placebo, such as open-label placebo, enhancing treatment effects through positive reinforcement and strengthening trust in doctors is less contentious, but currently viewed with scepticism by lay people and most health professionals.

Open access
 
Sean said:
Placebo effects are powerful​
​
Wrong from the opening statement, and just gets worse.
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Remarkable, isn't it? By definition it is the least impactful anything, every single treatment that works a little, and many treatments that don't work, have to do better than this fake effect, so every single treatment, even those that only do very little, are more effective. By definition it cannot be powerful, but it's just an affirmation based on faith, so it does not matter.

And the fact that this is even discussed is just more "medicine in crisis". It's as absurd as discussing the healing power of prayer or rituals to some deity or another. It is patently absurd that this is even taken seriously. Especially when you consider the 'deceptive' qualifier, on issues where deceit is the standard. Medicine is already massively deceitful, the idea of deceptive placebo being any more deceitful than an entirely fraudulent construct they are pondering to apply it onto is straight up satirical.

I'm mostly puzzled by this difference:
71% of lay people but only 46% of healthcare professionals were in favour of deceptive placebo treatments
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But frankly I'm assuming that if you removed 'deceptive' you would get results more aligned with reality. Medicine has clearly made belief in this *cebo stuff a core aspect of their profession, so most probably don't see it as deceptive, even though it's as deceitful as anything can be.

And that is not surprising at all:
Ethically acceptable alternatives of harnessing the power of placebo without deception were considered with scepticism by all respondents, but least so by neurologists.
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Ethics. What an idea. I hope they try that some day. It would be very important to apply this concept to health care.

Humanity has never stopped believing in gods, fairies and demons, we just keep giving them a different form. The ideas are all the same regardless.
 
Sean said:
Placebo effects are powerful​
​
Wrong from the opening statement, and just gets worse.
Click to expand...
indeed.

For what they are doing as experiments it is actually:

being openly deceitful as an HCP, gaslighting/invalidating, or lying about something that won't work leads to almost guaranteed likelihood that patients won't return. And that isn't because they recovered.

Plus

Except if they are forced to fill out a survey and you have made it clear what the correct answers are they must put and you are aware of or perceive they have significant power over you that could affect your future if it were wielded then that need to negotiate said risk is also a powerful effect in coercing/forcing/giving no option other than to provide what said HCP desires 'on the form' in order to escape and minimise notes on medical records etc.



It's also funny when people are asked about soemthing they think will be applied to 'others' and whether they think it is either a good idea or believe the spiel on what they'll actually do (just trying to help lies) vs if there is a likelihood it's them getting it no matter what they have/think they have.

SOme of these people with other conditions need to start getting themselves up to speed with the mission of these people and believing the story of those diagnosed with supposed 'functional' conditions but without necessarily having full investigation. They are just like Joe Blogs with something serious, that has just as barn-door symptoms as Jo Bloggs thinks excludes himself from being likely to be dumped into said treatment, and are no more hysterical or susceptical to making themselves ill with worry and all those 'exceptionalist' assumptions people tell themselves. They just came across the wrong, bad people via bad luck.

And the system or their support system or both might have made them low hanging fruit obvious those people could get away with it in their eyes, or not. But I'm not sure that anyone currently could successfully survive fighting it, or indeed not fighting it given what they are doing is so harmful as the main aim and clever tactic is to provide a label currently that removes their voice and suggests lies about that person which means 'noone will listen or hear you' inappropriately, from the start, based on nothing to cover that possibility. And for some reason there is no law to either stop that or ensure repurcussions for those who cotton-on to using that for their own personal mixture of reasons
 
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