Placebos Studies and Patient Care: Where are the Nurses?

Placebo research has gained traction in recent years as empirical researchers have begun to shed light on the psychobiological mechanisms underpinning placebo and nocebo effects [e.g., (1, 2)]. A considerable body of evidence now demonstrates that placebo and nocebo effects are ubiquitous in research and clinical settings and may significantly modulate patients' symptoms in prevalent conditions such as pain, migraine, depression, or irritable bowel syndrome (3-5). Following these empirical breakthroughs, experts have begun to advocate new therapeutic protocols aimed at improving patients' care through attention to placebo and nocebo effect in clinical settings (6). So far, however, placebo studies in medicine are largely doctor-centric. While a growing body of research has focused on physicians (and also clinical psychologists and psychotherapists) the literacy, understanding, and attitudes about placebo effects and placebo usage among medical professionals such as nurses, nurse practitioners, and physician assistants have been comparatively less explored. This gap may be due to different factors, such as the incorrect assumption in some regions that, unlike doctors, nurses do not prescribe placebos and do not need to know about placebo/nocebo effects. Yet this view is problematic as non-physician professionals are no less likely to confront clinical situations in which they may influence patient's outcomes through placebo and nocebo effect modulation, and the use of placebos. For example, worldwide many nurses are currently involved in the mass-administration of Covid-19 vaccines, with the possible scope to influence placebo effects among recipients. Furthermore, in their clinical work, non-physician professionals may face ethical and practical challenges related to these effects that significantly differ from those confronted by doctors. In this Opinion our aim is to motivate further empirical research, and ethical debate, specifically with respect to the role of nursing health professionals in influencing placebo and nocebo effects.