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THE PLACEBO, BETWEEN ETHICS AND CARE: A placebo is used to fight pain, insomnia or anxiety. The placebo effect is said to be this one produced by this 'fake' medication. However, could it not chiefly be the effect produced by the trust relationship established between a patient and a caregiver at a given moment? This article reflects on the results of a survey carried out in the hospital sector.

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After starting with a brief historical account of the placebo effect organized around the elaboration of clinical trials and around sham therapy as a method, we will offer a psychosocial point of view on the placebo phenomenon. The placebo effect is at the heart of medicine and particularly of therapeutic trials from theoretical research on a drug to its acceptance and its use in every-day clinical practice. The placebo effect intermingles biology, relationships and the context of therapeutic interactions. This type of phenomenon originates as much from biology as from human psychology. Our article puts more precisely into question the part that psychology has in the placebo phenomenon and suggests a chart to address it. This chart refers both to the pharmacodynamic effect given to drugs in a subjective way, and to the collective representations and social interactions depending on them. What can we say about the psychosociological dimensions of the placebo effect? How is it possible to organize the scope of these dimensions to base systematic studies on them in the field of clinical trials? We try to give elements of response to these questions by suggesting the study of the placebo effect as an original field of study by necessarily mobilizing both health sciences and the human and social sciences.

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This article reviews the psychosocial variables, which are of interest in the relationship between the patient and the physician. According to a classical model of social psychology, such a relationship might contribute to the placebo/nocebo effects. We develop herein various relational and contextual variables, taking into account four dimensions (intra-individual, interpersonal, positional and ideological) and their potential effects on therapeutic responses. This applies both in the setting of daily clinical practice and of clinical trials. The placebo effect offers an opportunity for collaboration and dialogue between social scientists and physicians.

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O artigo relata novos desdobramentos no debate médico a propósito do placebo e seus efeitos, relacionados à sua utilização na clínica médica e em ensaios clínicos de drogas e tratamentos.

Cet article porte sur les nouveaux résultats du débat médical sur les placebos et leurs effets par rapport à leur utilisation en clinique médicale et dans des essais cliniques de médicaments et traitements.

This article discusses new perspectives in the medical debate on the effects of placebos. Aspects related to their use in medical clinical work and in writings on drugs and treatment are also taken up.

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The use of placebos within controlled clinical trials for the last 50 years suggests that psycho-physiological effects can be objectified and measured. These are related to the therapeutic results covered by the term "placebo effect". Since Beecher's pioneer article in 1955, this effect is recognised and cited in medical articles as being on average 35% effective on the majority of symptoms. However, the meaning of these measurement is questionable. For example, it does not take into account the spontaneous evolution of symptoms and diseases. In fact, the placebo effect is not the effect measured in the group treated by the placebo. The clinical trial drug controlled against placebo does not make it possible to measure what is thus wrongly called "the placebo effect". Is it possible then to measure and to objectify what is called the placebo effect? And if that is possible, how? This article calls into question the extent of the placebo effect evaluated by means of controlled clinical trials, without denying its importance in medical practice. Firstly it raises the epistemological problem of the real possibility, via experimentation, of objectifying psychological therapeutic effects. And secondly, the question is also raised of the interest for medical care of objectifying those effects.