Efekt placebo/nocebo prognozy lekarskiej
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Zakład Filozofii i Bioetyki, Katedra Nauk Społecznych i Humanistycznych, Wydział Nauk o Zdrowiu w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
Adam Jonkisz   

Śląski Uniwersytet Medyczny w Katowicach, Wydział Nauk o Zdrowiu w Katowicach, Katedra Nauk Społecznych i Humanistycznych, Zakład Filozofii i Bioetyki
Med Og Nauk Zdr. 2017;23(1):1–6
The placebo/nocebo effect refers to the action of pharmacologically inactive substances, administered in the receptural form of prescriptions (most often pills), which is identical with the form containing therapeutic substances. This effect may be beneficial, neutral, or adverse to a patient. Interdisciplinary studies of this effect indicate the role of expectations as a psychobiological phenomenon; the results of these studies are also important for medical ethics.

To draw conclusions concerning the placebo effect which are important for medical practice.

Description of the state of knowledge:
The results of empirical studies confirm that mental processes may activate mechanisms similar to those induced by medicines.

1.There is a possible conflict between the need for providing a patient with true and full information (autonomy principle), and principles of nonmaleficence and beneficence. 2. Application of the methods of resolving conflicts of values and norms, recommended in professional ethics, is hampered because the term and criteria of a patient›s wellbeing are unclear and blurred; and the definition of health adopted by the WHO is too broad from the practical aspect. 3. Results of clinical tests of the nocebo effect, and also the results of psychological research on the attribution, confirm that the truth and truthfulness norms are not absolute, and in some situations it is justified not to tell a patient the whole truth, which is considered in the postulates regarding the procedures of informing patients (permissibility of not informing). 4. Good communication with a patient may decrease negative effects of medical procedures and the information provided – especially extremely unfavourable diagnoses and prognoses. 5. The consideration of the nocebo effect of medical prognosis speaks for seeking recommendations concerning informing patients of their prognoses (strict procedures are impossible), which would be both professionally and ethically accepted.

Bąbel P. Placebo i nocebo. Próba integracji. Przegląd Psychologiczny 2006; 49(2): 141‒156. PP_2.49.2006_art.2.pdf (dostęp: 5.05.2016).
Shapiro A K. Semantics of the placebo. Psychiatric Quarterly 1968; 42: 653‒696.
Dolińska B. Placebo. Sopot, 2011.
Miller F G. Clarifying the nocebo effect and its ethical implications. The American Journal of Bioethics 2012; 12(3): 30‒39.
Hauser W, Bartram C, Bartram-Wunn E and Tolle T. Adverse events attributable to nocebo in randomized controlled drug trials in fibromy-algia syndrome and painful diabetic peripheral neuropathy: systematic review. Clin. J. Pain 2012; 28: 437–451.
Colagiuri B, Zazhariae R. Patient expectancy and post-chemotherapy nausea: a meta-analysis. Ann. Behav. Med. 2010 Aug; 40(1): 3‒14. http://! po=45.2381 (dostęp: 1.05.2016).
Benedetti F, Colloca L, Torre E, Lanotte M, Melcarne A, Pesare M, Brgamasco B, Lopiano L. Placebo-responsive Parkinson patients show decreased activity in single neurons of subthalamic nucleus. Nat. Neu¬rosci. 2004; 7: 587‒588.
Vase L, Skyt I, Laue P G, Price D D. Placebo and nocebo effects in chronic pain patients: How expectations and emotional feelings contribute to the experience of pain. Zeitschrift für Psychologie 2004; Vol 222(3): 135‒139.
Rojas-Mirquez JC, Rodriguez-Zuñiga MJ, Bonilla-Escobar FJ, Garcia-Perdomo HA, Petkov M, Becerra L, Borsook D, Linnman C. Nocebo effect in randomized clinical trials of antidepressants in children and adolescents: systematic review and meta-analysis. Front. Behav. Neu-rosci. 2014 Nov; 3(8): 375. PM C4217505/ (dostęp: 1.05.2016).
Barsky AJ, Saintfort R, Rogers MP, Borus JF.Nonspecific medication side effects and the nocebo phenomenon. JAMA 2002; 287: 622‒627.
Colloca L, Benedetti F, Porro CA. Experimental designs and brain mapping approaches for studying the placebo analgesic effect. Eur. J. Appl. Physiol. 2008; 102: 371‒380.
Atlas LY, Wager TD. How expectations shape pain. Neurosci. Lett. 2012 Jun 29; 520(2): 140‒8.
Evers AW, Bartels DJ, van Laarhoven AI. Placebo and nocebo effects in itch and pain. Handb. Exp. Pharmacol. 2014; 225: 205‒214.
Bingel U, Wanigasekera V, Wiech K, et al. The effect of treatment ex¬pectation on drug efficacy: imaging the analgesic benefit of the opioid Remifentanil. Sci Transl Med. 2011; 3: 70‒114.
Tomaszewski M, Ślifirczyk A, Wawryniuk P, Olchowik G, Tomaszew¬ska M. Efekt placebo a skuteczność leczenia. Człowiek i Zdrowie 2013; 4(VII): 30‒40.
Faasse K, Petrie KJ. The nocebo effect: patient expectations and medication side effects. Postgrad Med J 2013; 89: 540‒546.
Colloca L, Miller FG. The nocebo effect and its relevance for clinical practice. Psychosomatic Medicine. 2011b; 73: 598‒603.
Enck P, Benedetti F, Schedlowski M. New insights into the placebo and nocebo responses. Neuron 2008; 59: 195‒206.
Benedetti F, Lanotte M, Lopiano L, Colloca L. When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience. 2007; 147: 260‒71.
Price DD, Finniss DG, Benedetti FA. Comprehensive review of the placebo effect. Recent advances and current thought. Annu. Rev. Psychol. 2008; 59: 565‒590.
Klosterhalfen S, Enck P. Pychobiology of the placebo response. Auton. Neurosci. 2006; 125: 94‒99.
Colloca L, Benedetti F. Placebos and painkillers: is mind as real as matter? Nat. Rev. Neurosci. 2005; 6: 545‒552.
Siwiak-Kobayashi M. Psychologiczne mechanizmy efektu placebo. Farmakoterapia w Psychiatrii i Neurobiologii 2000; 2: 107‒113.
Bavbek S, Aydin O, Sözener ZC, Yüksel S. Determinants of nocebo effect during oral drug provocation tests. Allergol. Immunopathol (Madr). 2014; Jul 31. f=10&pident_articulo=0&pident_usuario=0&pcontactid=&pident_re vista=105&ty=0&accion=L&origen=zonadelectura&web=zl.elsevier. es&lan=en&fichero=S0301–0546(14)00102–5.pdf&eop=1&early=si (dostęp: 1.05.2016).
Crichton F, Chapman S, Cundy T, Petrie KJ. The link between health complaints and wind turbines: support for the nocebo expectations hypothesis. Front Public Health., 2014 Nov; 11(2): 220. (dostęp: 5.05.2016).
Flaten MA, Simonsen T. Olsen H. Drug-related information generates placebo and nocebo responses that modify the drug response. Psycho¬som Med. 1999; 61: 250‒255.
Lancman ME, Asconape JJ, Craven WJ, Howard G, Penry JK. Predictive value of induction of psychogenic seizures by suggestion. Ann Neurol. 1994; 35: 359‒61.
Luparello TJ, Leist N, Lourie CH, Sweet P. The interaction of psychologic stimuli and pharmacologic agents on airway reactivity in asthmatic subjects. Psychosom Med. 1970; 32: 509‒513.
Mondaini N, Gontero P, Giubilei G, et al. Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon? J Sex Med 2007; 4: 1708‒1712.
van Laarhoven AIM, Vogelaar, ML, Wilder-Smith OH, van Riel PLCM, van de Kerkhof PCM, Kraaimaat FW, Evers AWM. Induction of nocebo and placebo effects on itch and pain by verbal suggestions. Pain 2011; 152(7): 1486‒1494.
Kodeks etyki lekarskiej, art. 13 oraz Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty, art. 31: pkt 1, pkt 4.
News. Int. Nurs. Rev. 1998; 42(2): 36. epdf (dostęp 1.05.2016).
Colloca L, Miller FG. Role of expectations in health. Curr Opin Psychiatry 2011a; 24(2): 149‒155.
Försterling F. Atrybucje. Podstawowe teorie, badania i zastosowanie. Gdańsk, 2005.
Łozowski J. Efekt placebo czy efekt relacji? Sztuka Leczenia 2012; 24(1‒2): 49‒56.