['Primum non nocebo' and the obligatory placebo; how can we better please the patient?]

There is ample evidence to support the notion that the context of a treatment influences the efficacy of that treatment. Most doctors feel uncomfortable with the intentional introduction of contextual elements that have no plausible biological effect, because it is not in line with their biomechanical world view and training. Withholding certain information to prevent nocebo effects may even go against our duty to inform patients. We argue that our primary duty is to serve the interest of our patients and that to withhold positive contextual elements or to introduce negative contextual elements conflicts with this duty.