[The placebo: beyond pretense and the nuisance variable. Arguments in favor of re-evaluating a significant protherapeutic concept ("aura curae")].
In this theoretical paper the concept of placebo is being investigated within a field of tension: on one side the conventional understanding of "placebo", that is empirically inconsistent and scientifically and ethically unsatisfactory, and on the other side the upgraded concept of "aura curae" as suggested by the author, that appears to be less contradictory and also richer in heuristic potential and, conceivably, may be closer to the essence of "placebo" itself. This statement is being corroborated by six main arguments. The first three arguments are meant to weaken the conventional concept of "placebo": The first argument deals with the empirical inconsistencies of the traditional placebo concept; the second addresses the possible distortion of scientific conclusions drawn from a conventional "placebo-controlled" trial; the third argument deals with the ethical problems of "pretense" and of "withholding adequate medication". The following three corresponding arguments are put forward in support of the upgraded placebo-concept of "aura curae" (Latin: "air of care"; "unspecific healing context"). The fourth argument introduces the concept of "aura curae" itself; the fifth argument deals with two alternatives to the conventional placebo-controlled trial, namely the "placebo-integration" and the "value added efficacy"; the sixth argument concludes with a discussion of the ethical advantages of implementing the concept of "aura curae" in clinical and research practice. The purpose of this paper is to contribute to a comprehensive "healing context", that would better fit the patient's needs; i.e., in addition to the various traditional "therapies" of specific influence (biological and psychosocial), the "protherapeutic" and unspecific effects of the "aura curae" should be integrated into a systemic patient care.