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Ideas and Opinions |

Deconstructing the Placebo Effect and Finding the Meaning Response

Daniel E. Moerman, PhD; and Wayne B. Jonas, MD
[+] Article and Author Information

From University of Michigan, Dearborn, Michigan; and Samueli Institute and Uniformed Services University of the Health Sciences, Bethesda, Maryland.


Grant Support: In part by a grant from the National Science Foundation to Dr. Moerman (NSF SBR-9421128).

Requests for Single Reprints: Daniel E. Moerman, PhD, Department of Anthropology, University of Michigan–Dearborn, 6515 Cherry Hill Road, Ypsilanti, MI 48198; e-mail, dmoerman@umich.edu.

Current Author Addresses: Dr. Moerman: Department of Anthropology, University of Michigan–Dearborn, 6515 Cherry Hill Road, Ypsilanti, MI 48198.

Dr. Jonas: Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda MD 20814.


Ann Intern Med. 2002;136(6):471-476. doi:10.7326/0003-4819-136-6-200203190-00011
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We provide a new perspective with which to understand what for a half century has been known as the “placebo effect.” We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of “meaning,” to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the “meaning response.” We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being.

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Figure.
Data from 83 studies of the use of cimetidine or ranitidine for duodenal ulcer disease.[42]

In all cases, ulcers and ulcer healing were diagnosed endoscopically. Most studies lasted 4 weeks; a few were a bit shorter or longer. Sample sizes ranged from 12 to 210 participants (mean, 58). The quality of these studies was generally good for the era in which they were conducted (mostly between 1976 and 1986), although probably not fully adequate by contemporary standards. This analysis differs from the ordinary, in which placebo and active treatments are combined in an odds ratio, relative risk, or risk difference. The point of this analysis is not, however, to determine whether antisecretory medication is effective; clearly it is. The issue is the relationship between the pharmacologic and the meaningful dimensions of treatment. (A detailed account of these studies is available elsewhere .).

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