The Power of Placebos: How the Science of Placebos and Nocebos Can Improve Health Care

by Jeremy Howick

The history, philosophy, ethics, and science behind the placebo and nocebo effects.

Placebos are the most widely used treatments in the history of medicine. Thousands of studies show that they can be effective and make us happier and healthier. Yet confusion about what placebos are and how to measure their effects prevents some doctors from using them to help patients. Meanwhile, damage caused by the nocebo effect—the negative effect of expecting something bad—is not widely recognized.

In The Power of Placebos, Jeremy Howick provides an interdisciplinary perspective on placebos and nocebos based on more than twenty years of research and data from over 300,000 patients. This book, the culmination of that research, offers practical ways for researchers, policymakers, and doctors to put placebo and nocebo research into practice to improve health outcomes.

In addition to providing an overview of placebos and nocebos and explaining how belief systems and context can create physiological effects in the body, Howick advocates for a number of controversial positions, including why it may be unethical to include placebos in most clinical trials in which there are already established therapies and why physicians should consider using placebos regularly in their practices. Howick also underscores the importance of the therapeutic effects of interactions between health care practitioners and patients, in the context of care. The Power of Placebos dispels the confusion surrounding placebos and paves the way for doctors to help patients by enhancing placebo effects and avoiding the pitfalls of nocebos.

316 pages, Kindle Edition

Published November 14, 2023

About the author

Jeremy Howick is a Canadian-born, British residing clinical epidemiologist and philosopher of science. He did his PhD at the London School of Economics under the supervision of Professors Nancy Cartwright and John Worrall. He is a senior researcher in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, and the director of the Oxford Empathy Programme there. He is known for his research on evidence-based medicine and the philosophy of medicine, including the use of placebos in clinical practice.[1][2] He is the author of over 75 peer-reviewed papers, as well as two books, The Philosophy of Evidence-Based Medicine in 2011,[3] and Doctor You in 2017.[4] In 2016, he and Paul Aveyard received the Dawkins & Strutt grant from the British Medical Association to study pain treatment.[5] He publishes in Philosophy of Medicine and medical journals.[6]

Reviews

[Gijs Limonard · Rating 4 out of 5]

Admirable attempt to demystify the placebo and nocebo effects; the relevant literature is thoroughly reviewed and the author at least tries to move research in this field forward by making some practical suggestions on how to maximize the utility of the phenomenon.

[Prashanth Bhat · Rating 5 out of 5]

This tells the history of placebo and nocebo. I am not a medical student but still I understood what it is . Placebo won't lower your levels it works on the perception by the brain .but we are unaware of nocebos. I mean always fear that something bad might happen.
This book tells details about that.this is twenty years of research on 300000 patients.
It also explains how beliefs of individuals affect the body.

Overall a must read book.

[Bob Rich · Rating 5 out of 5]

It’s a good day when I learn something new, and I did immediately upon starting to read this book. The concept of a placebo is part of culture. I learned about it in first year Psychology, in 1962. And yet, it was originally dismissed as pseudoscience, and researchers like Professor Howick needed to fight prejudice and disdain to demonstrate its veracity.

Empathy and compassion shine out of this book, much of which is case vignettes of very real-feeling people. I have witnessed the kind of uncaring attitude by medical professionals Howick wants to get rid of. Someone developed diabetes as a result of chemotherapy, and this was seriously affecting her vision. The oncologist’s attitude amounted to “It doesn’t really matter, you’ll be dead soon anyway.” This is the nocebo effect: a self-fulfilling prophecy. Fortunately, the target of this uncaring attitude reacted by changing oncologists.

And it does no harm at all that many of these stories will give you a laugh.

The purpose of the book is set out in a passage worth quoting: “This book is part of the second revolution in placebo studies. The second revolution requires collaboration between doctors and other healthcare professionals, healthcare managers, as well as other groups ranging from hospital designers to patients. Doctors who wish to enhance the care of their patients by taking the science of placebos and nocebos into account can use this book as a manual. Medical researchers who need to make decisions about the ethics of placebo-controlled trials and how to reduce unnecessary nocebo effects can use the book as a guide. Philosophers of medicine and ethicists interested in recent advances in placebo studies can get a grasp of the field in a single, readable volume. Hospital designers who wish to organize their spaces in a way that reinforces what doctors do can be inspired. Policy makers who wish to organize their institutions in a way that promotes patient and practitioner health can find evidence to support initiatives which achieve this. The science in the book can also be used to improve the quality of anyone’s interpersonal communication and relationships” (pp 13-14).

I guess I qualify as a patient in this listing, but then so does almost everyone. And it is written in plain enough language for any intelligent person to understand it. All the same, it is an academic book, in two ways. First, everything is meticulously referenced. Second, though, is the only negative I found. When I was an academic, one of my jokes was that scholarly writing is a (usually) polite form of bickering. Much of the book is just that. Howick presents many of his points in a highly effective manner: he puts forward a number of alternatives, then has an argument with those favouring one view after another, leaving only his preferred interpretation. My reaction is to want to give his dismissed opponents a chance of reply rather than full conviction.

This, however, is a minor point. Reading this book will improve your ability to help yourself and others, to cause good and to avoid doing harm.

[Kelly · Rating 4 out of 5]

I was interested in this, as I have always found the placebo effect to be a very interesting concept, and I've always been curious about the use of placebos in medicine. This book was quite wordy with long paragraphs, but I did find it a very interesting read. There was a lot of information to take it, but the writing still had a lighthearted, informal tone. There were some very interesting stories.

[Tessa B · Rating 3 out of 5]

First of all I absolutely hated how it’s formatted, it’s really just not enjoyable to read huge amounts of text blocks
I have a huge problem with placebos because the pain of woman has always been belittled. So Dr. Around the world use placebos as a fast way to get read of their Patients sometimes.
It explains where the term comes from who invented it and why. It explains the studies that are made about Placebos. It’s really educational