Since the days when doctors routinely made house calls and sat by the bedside offering comforting words along with medical care, the doctor-patient relationship has become increasingly impersonal and superficial. As medical technology and treatment have improved, and time constraints have become more demanding, the beneficial effects of meaningful doctor-patient interactions have too often been overlooked. Nonetheless, objective clinical trials have repeatedly shown that real, measurable benefits to the patient occur through the 'placebo effect', the positive effects of the doctor's presence and personality plus the patient's belief in the efficacy of the treatment. Dr W Grant Thompson, a frequent consultant on the design of clinical trials, reviews the history of the placebo effect and the evidence of its benefits to health in this lively, informative, and scientifically rigorous book. He looks at both the planned use of placebos in blind clinical trials and the unplanned placebo effects arising out of the doctor-patient relationship, the passage of time, and the perceptions of the patient. Dr Thompson emphasises that placebos in themselves have no intrinsic benefit; what matters is how the treatment is provided and under what circumstances. He argues that understanding the placebo effect is important for the care of the ill, the design of clinical trials, and healthcare policy planning. He contends that we should be using judiciously the best medical evidence, but even that can be undermined by insensitive delivery. Healthcare policy can only gain from taking both vital components of medical care into consideration. Praised by the "New England Journal of Medicine" as 'a gifted teacher and clinician with a talent for clear exposition,' Dr Thompson has written an important, accessible, and interesting work that deepens our understanding of both the tangible and intangible factors that affect health. He convincingly demonstrates that patients need the best that science has to offer combined with kind and compassionate caregiving by doctors in order for a treatment to be its most effective.
W. Grant Thompson, MD, is professor emeritus of medicine at the University of Ottawa, where he served as chief of the Division of Gastroenterology from 1980 to 1997. An award-winning science writer, he has authored many acclaimed books on the gut and irritable bowel syndrome. He remains active in clinical-trial consulting, medical education, research, and writing.
