letter Perspectives on Placebo Pl acebos and placebo effects are more common than we think-in medicine and in our daily lives. Beyond the sugar pills researchers give to clinical trial participants who don't get the "good stuff," or the drug-less prescriptions certain physicians give to patients whose symptoms are "all in the head," placebos exist in many forms and in many contexts. From drugs, surgeries and alternative medicines, to therapeutic words, actions and symbols, placebos appear under

more »

... different guises. Moreover, from relief of pain, asthma, depression, erectile dysfunction and more to the healing effects embedded in the clinical encounter and its setting , no single placebo effect exists either. With the pervasiveness of placebo in medicine, the phenomenon speaks to the human experience of health and healing and garners intrigue beyond the medical domain. The topic is no longer an esoteric concern of physicians and researchers. Industry, government, media and the public are all discussing placebos; the term has entered our popular vocabulary and the concept thrives in our popular culture. The previous issue of the Journal of Mind-Body Regulation, the first installment of this two-part special issue, explored medical placebos and placebo effects from multiple distinct yet complementary perspectives. We saw how the lens of cultural anthropology provides insight into the psychosocial foundations of placebo effects and how philosophical examination bears on the ethics of placebos in medical practice. Focusing on depression, meta-analyses of clinical trials highlight the effectiveness of placebos, which is comparable to that of widely used pharmaceutical interventions with a much better safety profile. Interviewing psychiatrists reveals that, even if unintentionally eliciting placebo effects through prescription of antidepressants, many forms of meaning-rich and expectation-shaping communication and dosing strategies appear to permeate their interactions with depressed patients. The more we investigate placebos, the more we understand the many implications they impose on industry, regulatory agencies, professional associations, practitioners and patients. As evidenced by the popular media attention the topic receives, placebos also capture the interest of the general public. In his commentary last issue, Dr. Irving Kirsch noted that the concept of placebo has reached the final stage in the life history of an artifact-the exploitation stage-where focus turns to understanding placebo effects for their potential utilities. This is certainly the case in modern medicine but is it true in other domains? Can placebos be studied, understood and applied outside the context of clinical practice and research? Placebos offer a unique paradigm and explanatory model through which to study mind-body interactions as they occur across cultures and societies, in the past, present and future. Capitalizing on the value of control and autonomy in Western society, certain placebos can increase our sense of authorship and agency. For example, few individuals appreciate that the "door close" button in elevators is often dysfunctional and subsequently believe that they are closing the doors by pushing it. Analogies of placebo also appear as developmental tools for transitioning from dependence to independence, amateur to professional, or apprentice to teacher. When teaching a child to swim, a caregiver initially holds the child afloat but later