Group D2 Rio Fernandes Tan (1110286) Shandy Parvita Surojo Putri (1110303) Yuliana (1110304) Ika Fitrianti (1110307)

Dea Ristya Ananda (1110309) Sari Narolita (1110311) Michelle A. Wenas (1110315) Laila Nur (1110347) May 2013

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Outlines
Definition The Difference between Placebo and Nocebo When a Placebo used? Factors Affecting the Placebo Response The Reason Why Placebo Used How Placebo Works? Conclusion Bibliography

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Definition

The placebo effect : The changes produced by things objectively without specific activity for the condition being treated. (Moerman, 2002)

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Definition

Placebo (latin for I shall please) : A pharmacologically inert substance (such as saline solution or a starch tablet) that seems to produce an effect similar to what would be expected of a pharmacologically active substance (such as an an antibiotic). (Car, 2012)

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Definition
The Nocebo Effect : An adverse effect of the placebo response is the manifestation of sideeffects. Nocebo (latin for I shall harm) : Harmless substance that creates harmful effects in a patient who takes it.

Gard, 2000

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Health provider

Think (+) about the medication (actually an inert substance)

Placebo effect happens

Healing

Patient Healing

Think (-) about the medication (only think the adverse effect)
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Nocebo effect happens

When a placebo used?

Condition which have highly subjective components

Minor self limiting ailments

The Conditions

Condition which have fluctuating symptoms

Condition involving heightened awareness of normal bodily sensation

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Kaptchuck et al, 1996

7

Factors Affecting the Placebo Response

Information from healthcare practitioner (be doubt or be confident). Physical charateristic of the placebo (e.g. dosage form, shape, colour, mode of administration, etc.) Patients expectation

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The magnitude of the placebo effect can be enhanced by overt suggestion or prediction of the effects that may occur. (Goodenough and colleagues, 1997) Patients previous experience may be sufficient to act as a cue to enhance placebo effect. (Gard, 2000) Not only an effect of medication colour on the placebo response, but also a gender difference. (Cattaneo et al., 1970)

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The Reason Why Placebo Used

Placebos are considered to be unlikely to cause any adverse effects. Cheaper.

How Placebo Works?

The mechanisms underlying the placebo effect are still unknown. (Brown, 1993) There is a possible link between the placebo effect and plasma cortisol.

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Stress

Cortisol released

Supress immune system

Placebo

Cortisol is secreted at times of stress and is known to supress the immune system, thus if placebo decrease stress, a reduction of plasma cortisol concentration would be expected and thus an increase in activity immune system.

Stress decreased

Cortisol reducted

Increase immune systems activity

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Conclusion
Individual will still respond to a given drug even if the drug is given in a doses too small to be effective or even if the drug or treatment is absent. Placebos are considered to be unlikely to cause any adverse effects.

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Bibliography

Gard, P. (Ed.).(2000). A Behavioural Approach to Pharmacy Practice. Oxford, UK :Blackwell Sciences.

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