The art of medicine in treating osteoarthritis: I will please

Abstract

Many factors, some expected and others unexpected, play an important role in the placebo effect. Placebo responses on pain are among the most studied, and usually found to be considerable. The placebo effect is something we not only have to live with and control for in clinical studies, but something that we can optimise in the care of our patients. Some of these insights might long be used implicitly or explicitly and conscious or unconscious by complementary medicine practitioners and in this respect we might learn from them. How to incorporate the findings of Zhang et al in our daily clinical practice? First, we should realise that placebo effect is not a negative effect. We should realise that the effect of a "real" intervention is the result of the "active" treatment plus the placebo effect, although it has been challenged whether the effects are in fact additive.14 We should make proper use of that finding. Clearly, the doctor-patient relationship is a very powerful tool in the art of medicine, and is probably a cost effective part of the placebo effect. Primum nil nocere (in the first place, do not do any harm) is also a powerful adagium of the art of medicine; making optimal use of the placebo effect is in line with this statement. So our conclusion would be: there is no need to use actual placebos, but there is nothing wrong in using the placebo effect in treating patients. Patients with OA, in whom pain plays a crucial role, will benefit from doctors who are able to use the placebo effect in a respectable way, "to please the patient".