Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-12-03T20:28:13.009Z Has data issue: false hasContentIssue false
  • English
  • Français

Why Most Sugar Pills Are Not Placebos

Published online by Cambridge University Press:  01 January 2022

Bennett Holman
Get access Rights & Permissions [Opens in a new window]

Abstract

The standard philosophical definition of placebos offered by Grünbaum is incompatible with Cartwright’s conception of randomized clinical trials. I offer a modified account of placebos that respects this role and clarifies why many current medical trials fail to warrant the conclusions they are typically seen as yielding. I then consider recent changes to guidelines for reporting medical trials and show that pessimism over parsing out the cause of “unblinding” is premature. Specifically, using a trial of antidepressants, I show how more sophisticated statistical analyses can parse out the source of such effects and serve as an alternative to placebo control.

Type
Medicine
Information
Philosophy of Science , Volume 82 , Issue 5 , December 2015 , pp. 1330 - 1343
Copyright
Copyright © The Philosophy of Science Association

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

In memory and appreciation of my father, who encouraged my pursuit of philosophy even when he didn’t understand it and who read no fewer than seven versions of this paper, never failing to find a way to make it better. Any remaining errors are his fault.

References

Cartwright, Nancy. 2010. “What Are Randomized Controlled Trials Good For?” Philosophical Studies 147:59–70.CrossRefGoogle Scholar
Cartwright, Nancy, and Hardie, Jeremy. 2012. Evidence-Based Policy. Oxford: Oxford University Press.CrossRefGoogle Scholar
Elkin, Irene, et al. 1989. “National Institute of Mental Health Treatment of Depression Collaborative Research Program: General Effectiveness of Treatments.” Archives of General Psychiatry 46:971–82.CrossRefGoogle ScholarPubMed
Freedman, Laurence, and Schatzkin, Arthur. 1992. “Sample Size for Studying Intermediate Endpoints within Intervention Trials or Observational Studies.” American Journal of Epidemiology 136:1148–59.CrossRefGoogle ScholarPubMed
Grünbaum, Adolf. 1986. “The Placebo Concept in Medicine and Psychiatry.” Psychological Medicine 16:19–38.CrossRefGoogle ScholarPubMed
Holmbeck, Grayson. 1997. “Toward Terminological, Conceptual, and Statistical Clarity in the Study of Mediators and Moderators: Examples from the Child-Clinical and Pediatric Psychological Literatures.” Journal of Consulting and Clinical Psychology 65:599–610.CrossRefGoogle Scholar
Howick, Jeremy. 2012. The Philosophy of Evidenced-Based Medicine. West Sussex: British Medical Journal Books.Google Scholar
Kirsch, Iving. 2010. The Emperor’s New Drugs. New York: Basic.Google Scholar
MacKinnon, David, Lockwood, Chondra, Hoffman, Jeanne, West, Stephen, and Sheets, Virgil. 2002. “A Comparison of Methods to Test Mediation and Other Intervening Variable Effects.” Psychological Methods 7:83–104.CrossRefGoogle ScholarPubMed
Moseley, J. Bruce, O’Malley, Kimberly, Petersen, Nancy, Menke, Terri, Brody, Baruch, Kuykendall, David, Hollingsworth, John C., Ashton, Carol M., and Wray, Nelda. 2002. “A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee.” New England Journal of Medicine 347:81–88.CrossRefGoogle ScholarPubMed
Schulz, Kenneth, Altman, Douglas, Moher, David, and Fergusson, Dean. 2010. “CONSORT 2010 Changes and Testing Blindness in RCTs.” Lancet 375:1144–46.CrossRefGoogle ScholarPubMed