The meaning response: thinking about placebos.
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Clinical Trials as Topic↗
Biomedical subjects
Daniel E Moerman
Publications and source records attributed to Daniel E Moerman.
"Symbols and selectivity" revisited.
The author recalls how he came to do one of the first statistical analyses of native American medicinal plants, published in volume 1 of Journal of Ethnopharmacology. The background of that paper, "Symbols and Selectivity," involved a great deal of serendipity.
Anthropology, Cultural↗
Native Americans' choice of species for medicinal use is dependent on plant family: confirmation with meta-significance analysis.
We test the hypothesis that the choice by traditional people of species of plants for medicinal use does or does not depend on the families to which those species belong. Our geographic context is continental North America north of the Rio Grande River. Our plant context is flowering plants. Our ethnological context is Native American traditions. Our null hypothesis is that the probability of any species being medicinal is the fraction of all species that are medicinal, no matter the family to which that species may belong. Classical statistical techniques and the experience of ethnobiologists had already made it clear that among very large plant families, most have either very many or very few medicinal species. Here we use intense computation to simulate thousands of data sets to create predictions to compare with the observed data for medium and small families. Our results clearly show that a surprising number of medium and small families also have very many or very few medicinal species. Recent molecular, fossil and cytological studies have confirmed the evolutionary naturalness of most plant families. This suggests that species in the same family may have inherited from common ancestors similar ecological adaptations, such as ways to protect themselves from herbivores, pathogens or decomposers. Some of these adaptations affect the physiology of the attacking organisms, suggesting an explanation for the clear preferences of Native American traditions to choose medicinal species from some families much more than from others, regardless of the size of those families.
Humans↗
Deconstructing the placebo effect and finding the meaning response.
We provide a new perspective with which to understand what for a half century has been known as the "placebo effect." We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusing the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of "meaning," to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the "meaning response." We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being.
Analgesia↗
The meaning response and the ethics of avoiding placebos.
Because the "placebo effect" seems to result from "deception," it is often disparaged and despised. Rethinking this and realizing that these benefits flow largely from the meaning of medical encounters (and are far better understood as "meaning responses"); realizing that there need be no deception to elicit them and that they are often very desirable, engaging fundamental human biological pathways, puts the ethical dilemma in a new light. It seems unethical to avoid--to evade--coming to a full understanding of how meaning can so profoundly improve human well-being.
Analgesia↗