Causal diagrams, the placebo effect, and the expectation effect
Eyal Shahar,1 Doron J Shahar2
1Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, 2Department of Mathematics, College of Science, University of Arizona, Tucson, AZ, USA
Abstract: Using causal diagrams, a formal research methodology, we analyzed several definitions of placebo and the placebo effect. We conclude that placebo is an ambiguous, redundant term and that the so-called placebo effect conceals far more interesting effects that are attributed to the patient's expectation. Biomedical research will benefit from abandoning the term placebo effect and focusing instead on a deeper understanding of the expectation variable, including its causes, effects, and effect modifiers. This avenue of research should be pursued by observational cohorts that are nested within clinical trials.
Keywords: causal diagrams, effect modification, placebo, expectation
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