The current standard for evaluating medications and treatments, the randomised controlled trial, involves identifying the effects of active ingredients by subtracting out effects produced by placebo. This model effectively isolates medical treatment by comparing it against “medically superfluous,” forces of healing, including social context (eg, medical ritual, patient-provider relationship, institutional reputation, branding), mindset of the patient (eg, the patient’s conscious or embodied expectation to heal), and the body’s natural ability to heal itself with time.
The randomised trial is a good and rigorous standard for testing the efficacy of new medications. But what this model obscures is that, in the practice of medicine, the psychological and social elements underlying placebo effects remain an influence in active treatment (fig 1). Indeed, medical diagnoses and treatments are never isolated from patient mindsets and social context.