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A Fictionalist Account of Open-Label Placebo.

¹Bournemouth University, Poole, UK.

The Journal of Medicine and Philosophy

|March 26, 2024

Summary

The placebo effect, particularly in open-label placebo (OLP) treatments, is not solely driven by belief. This study proposes a new framework explaining OLP effects through pretence and fictionalism, moving beyond traditional belief-based models for better understanding therapeutic contexts.

Keywords:

fictionalism non-doxastic attitudes open-label placebo placebo effect pretence

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Area of Science:

Philosophy of Medicine
Psychology
Clinical Research

Background:

The definition of the placebo effect is debated, with a broad definition encompassing responses to the psychosocial context of treatment and a narrow definition focusing on deliberate placebo treatments.
Open-label placebo (OLP) treatment, involving non-deceptive administration of placebo pills, is a key paradigm within the narrow definition.
Traditional explanations of the placebo effect in OLP often rely on belief-based mechanisms, which may be insufficient or paradoxical.

Purpose of the Study:

To explore the mechanisms underlying the placebo effect in open-label placebo (OLP) treatments.
To critically evaluate traditional belief-based accounts of OLP.
To propose an alternative theoretical framework for understanding OLP effects.

Main Methods:

Philosophical analysis of existing definitions and theoretical accounts of the placebo effect.
Conceptual exploration of the role of belief versus other psychological attitudes in OLP.
Development of a novel theoretical framework based on pretence and fictionalism.

Main Results:

Traditional belief-based explanations for the placebo effect in OLP are argued to be paradoxical.
A new theoretical account is proposed, positing that the placebo effect in OLP arises from a non-doxastic attitude of pretence.
This pretence is understood within a fictionalist framework, offering a non-belief-based explanation for therapeutic responses to OLP.

Conclusions:

The placebo effect in open-label placebo treatments can be explained without recourse to traditional belief-based models.
A framework integrating pretence and fictionalism offers a viable alternative for understanding OLP's therapeutic efficacy.
This reconceptualization may help resolve definitional disputes and advance research into placebo mechanisms.