Describing placebo phenomena in medicine: a linguistic approach

The present paper reviews how language and communication are used to describe placebo phenomena in medicine, with particular reference at key points to the question of pain. Selected aspects of placebo language are submitted to lexical, grammatical and semantic analysis. We distinguish three uses of placebo, with three semantic components: “pleasing,” inert medication or procedure, and what is often called “deception.” The three uses of placebo are: PLACEBO-TREATMENT, which combines all three semantic components: “pleasing” patients with inert treatments, and possibly with “deception.” PLACEBO-TRIAL, which refers to the closely defined inert control in Randomized Controlled Trials. PLACEBO-RAPPORT, which covers all aspects of the health care encounter, excluding therapeutic interventions, but including psychosocial factors which can have a beneficial effect on the patient. Three key conclusions emerge from this analysis. First, the “deception” connotation of placebo found in PLACEBO-TREATMENT can contaminate the use of PLACEBO-TRIAL and especially PLACEBO-RAPPORT. Second, the enlarged “pleasing” framework of PLACEBO-RAPPORT, which includes the benefits of quality appropriate and helpful medical care, forces us to ask whether PLACEBO-TRIAL in Randomized Controlled Trials has in fact been a neutral baseline control. Biopsychosocial and other factors in PLACEBO-RAPPORT may have influenced the outcomes of many trials in medicine and pharmacology. And third, extending PLACEBO-RAPPORT to embrace all aspects of clinical care (except specific medication or procedural interventions) and psychosocial factors of the health care encounter engages patient beliefs, mindsets and interpersonal dynamics, as well as values and contextual and cultural issues. These take PLACEBO-RAPPORT substantially beyond what is currently seen as its identity and modes of operation