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Title: The intriguing transmogrification of the placebo and its role in medical research
Author: Burt, R. A. P.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2002
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The thesis traces placebo from the possibly incorrect translation into St. Jerome’s Vulgate Bible, through religious ceremony to Chaucer’s literature, to inclusion in the medical lexicon and its role in modern research. Though rarely acknowledged, placebos were widely used for treatment until the end of the 20th Century, which practice is unacceptable today. Unfortunately, critics today condemn as unethical all placebo use, precluding any use in clinical research and attributing to it problems that are more accurately related to poor informed consent, ethical review and conduct of research. Modern insistence on rigorous scientific evaluation and evidence-based therapeutic decisions coupled with fiscal restraint and demands for increased patient safety mean that the inclusion of placebo in drug evaluation studies is essential. I have provided counter arguments to the critics’ assertions and drawing on studies of new drugs, in many of which I was closely involved, I show the importance of understanding the need for placebo, the occurrence of placebo effects and the ubiquity of the perceived placebo effects in daily clinical practice and clinical research. While recognising that not all studies always require the inclusion of a placebo I have shown how different designs can incorporate placebo to provide downside assay sensitivity, scientific integrity and validity, how the inclusion of placebo can actually increase patient safety by reducing patient exposure and numbers and how some studies lacking placebo control may themselves be unethical. I conclude by showing that placebo is essential for modern medical research and that a blanket exclusion would render useless, or at best significantly reduce the scientific validity and integrity, of much of the evidence on which modern therapeutics is becoming based.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available