Dear Colleagues,

More so than ever, we clinicians have had to tap into our inner research geek to decide what the evidence is telling us to best treat key problems facing our patients right now: pain, substance use, and the COVID-19 pandemic.

Currently, most treatments (especially but not isolated to drugs) require that their effects go beyond those seen in a placebo control group and many other therapies aspire to demonstrate a similar advantage. Some treatments, like surgical procedures, do not require this. But how much weight should this difference between theoretically active and placebo treatments be given?

If a treatment involves a powerful ritual, induces a large effect size, but produces only a small difference from the purported (theoretical) “active” ingredient, should it be accepted mainly on that incremental “real” additional effect? How should risk and safety be brought into the equation? Who should make the decision as to what is accepted into practice? How should we weight the opinions of scientists testing their theories; companies and regulators applying their criteria for allowing claims, sales, marketing, and coverage; clinicians trying to sort out what is “evidence-based”, and patients who seek the safest and easiest options with the largest probability for improvement? What value do these various decision makers hold on the distinction between “active” and “placebo” effects?

These are the questions we need to answer especially during a time when so much is unknown about the greatest problems facing our patients. I’ll be focusing on the answers to these questions at the newly announced conference of the Society for Interdisciplinary Placebo Studies.

I hope you will join me.

Be well.