izindaba

Umphumela we-placebo ubhekisela emuzweni wokuba ngcono kwezempilo emzimbeni womuntu ngenxa yokulindelwe okuhle lapho uthola ukwelashwa okungasebenzi, kuyilapho umphumela ohambisanayo we-anti placebo ukwehla kokusebenza okubangelwa ukulindela okungekuhle lapho uthola izidakamizwa ezisebenzayo, noma ukuvela kwemiphumela engemihle ngenxa yokulindela okubi lapho uthola i-placebo, okungase kuholele ekuwohlokeni kwesimo. Zivame ukuba khona ekwelashweni komtholampilo nasocwaningweni, futhi zingathinta ukusebenza kahle kwesiguli kanye nemiphumela.

Umthelela we-placebo kanye nomphumela we-anti-placebo yimiphumela evezwa ukulindela okuhle nokubi kweziguli ngesimo sazo sezempilo, ngokulandelana. Le miphumela ingenzeka ezindaweni ezihlukahlukene zemitholampilo, okuhlanganisa ukusetshenziswa kwezidakamizwa ezisebenzayo noma i-placebo yokwelashwa emisebenzini yomtholampilo noma ezivivinyweni, ukuthola imvume enolwazi, ukuhlinzeka ngolwazi oluhlobene nezokwelapha, kanye nokwenza imisebenzi yokukhuthaza impilo yomphakathi. Umphumela we-placebo uholela emiphumeleni emihle, kuyilapho umphumela we-anti-placebo uholela emiphumeleni eyingozi neyingozi.

Umehluko ekuphenduleni kokwelashwa kanye nezimpawu zokwethulwa phakathi kweziguli ezihlukene zingabalelwa kancane emiphumeleni ye-placebo kanye ne-anti-placebo. Ezenzweni zomtholampilo, imvamisa kanye nokuqina kwemiphumela ye-placebo kunzima ukunquma, kuyilapho ngaphansi kwezimo zokuhlola, imvamisa nokuqina kwemiphumela ye-placebo kubanzi. Isibonelo, ezivivinyweni eziningi zokwelashwa ezingaboni kabili zokwelashwa kobuhlungu noma ukugula kwengqondo, impendulo ku-placebo ifana naleyo emithini esebenzayo, futhi kufika ku-19% yabantu abadala kanye nama-26% wabahlanganyeli asebekhulile abathola i-placebo babike imiphumela emibi. Ngaphezu kwalokho, ezivivinyweni zomtholampilo, kufika ku-1/4 yeziguli ezathola i-placebo ziye zayeka ukuphuza umuthi ngenxa yemiphumela engemihle, okuphakamisa ukuthi umphumela we-anti-placebo ungase uholele ekuyekisweni kwezidakamizwa okusebenzayo noma ukungalandeli kahle.

Izindlela ze-neurobiological ze-placebo kanye nemiphumela ye-anti placebo
Umphumela we-placebo uboniswe ukuthi uhlotshaniswa nokukhululwa kwezinto eziningi, njenge-endogenous opioid, ama-cannabinoids, i-dopamine, i-oxytocin, ne-vasopressin. Isenzo sento ngayinye siqondiswe ohlelweni oluqondiwe (okungukuthi ubuhlungu, ukunyakaza, noma amasosha omzimba) kanye nezifo (ezifana nesifo samathambo noma isifo sikaParkinson). Isibonelo, ukukhululwa kwe-dopamine kuhileleke emphumeleni we-placebo ekwelapheni isifo sika-Parkinson, kodwa hhayi emthelela we-placebo ekwelapheni ubuhlungu obungapheli noma obukhulu.

Ukwanda kobuhlungu obubangelwa ukusikisela kwamazwi ekuhlolweni (umphumela we-anti placebo) kuboniswe ukuthi kulamulwa yi-cholecystokinin ye-neuropeptide futhi kungavinjelwa i-proglutamide (okuwuhlobo A nohlobo lwe-B yomphikisi we-cholecystokinin). Kubantu abanempilo, lolu limi olubangelwa i-hyperalgesia luhlotshaniswa nokwanda komsebenzi we-hypothalamic pituitary adrenal axis. Umuthi we-benzodiazepine i-diazepam ungamelana ne-hyperalgesia kanye nokusebenza ngokweqile kwe-hypothalamic pituitary adrenal axis, okuphakamisa ukuthi ukukhathazeka kuhilelekile kule miphumela ye-anti placebo. Nokho, i-alanine ingavimba i-hyperalgesia, kodwa ayikwazi ukuvimba ukusebenza ngokweqile kwe-hypothalamic pituitary adrenal axis, iphakamisa ukuthi uhlelo lwe-cholecystokinin luhileleke engxenyeni ye-hyperalgesia yomphumela we-anti placebo, kodwa hhayi engxenyeni yokukhathazeka. Umthelela wezakhi zofuzo emiphumeleni ye-placebo kanye ne-anti placebo ihlotshaniswa nama-haplotypes we-nucleotide polymorphisms eyodwa ku-dopamine, i-opioid, nezakhi zofuzo ze-cannabinoid endogenous.

Ukuhlaziywa kwe-meta kwezinga lomhlanganyeli wezifundo ze-20 ezisebenzayo ze-neuroimaging ezibandakanya ababambiqhaza be-603 abanempilo babonise ukuthi umphumela we-placebo ohambisana nobuhlungu ube nomthelela omncane ekubonakalisweni kwezithombe ezisebenzayo ezihlobene nobuhlungu (okubizwa ngokuthi amasignesha obuhlungu be-neurogenic). Umphumela we-placebo ungase udlale indima emazingeni amaningana amanethiwekhi obuchopho, akhuthaza imizwa kanye nomthelela wawo ekuhlangenwe nakho kobuhlungu obuphathekayo obuhlukahlukene. Ukucabanga kobuchopho nomgogodla kubonisa ukuthi umphumela wokulwa ne-placebo uholela ekwandeni kokudluliswa kwesignali yobuhlungu kusuka kumgogodla kuya ebuchosheni. Esivivinyweni sokuhlola impendulo yabahlanganyeli kumakhilimu e-placebo, lawa makhilimu achazwa njengabangela ubuhlungu futhi alebulwe ngokuthi amanani aphezulu noma aphansi. Imiphumela yabonisa ukuthi izifunda zokudlulisa ubuhlungu ebuchosheni nasemgogodleni zavulwa lapho abantu belindeleke ukuba bezwe ubuhlungu obukhulu kakhulu ngemva kokuthola ukwelashwa ngamakhilimu anenani eliphezulu. Ngokufanayo, ezinye izivivinyo ziye zahlola ubuhlungu obubangelwa ukushisa okunganqanyulwa yi-remifentanil yesidakamizwa esinamandla se-opioid; Phakathi kwabahlanganyeli ababekholelwa ukuthi i-remifentanil yayinqanyuliwe, i-hippocampus yenziwa yasebenza, futhi umphumela we-anti placebo uvimbe ukusebenza komuthi, okuphakamisa ukuthi ukucindezeleka nenkumbulo kwakuhilelekile kulo mphumela.

Okulindelekile, Amacebo Olimi, kanye Nemiphumela Yohlaka
Izehlakalo zamangqamuzana kanye nenethiwekhi ye-neural izinguquko eziyisisekelo ze-placebo kanye nemiphumela ye-anti-placebo zilamula ngemiphumela yazo yesikhathi esizayo elindelekile noma ebonakala kusengaphambili. Uma ukulindela kungafezeka, kubizwa ngokuthi ukulindela; Okulindelekile kungalinganiswa futhi kuthonywe izinguquko ekuboneni nasekuqondeni. Okulindelekile kungenziwa ngezindlela ezihlukahlukene, okuhlanganisa okuhlangenwe nakho kwangaphambilini kwemiphumela yezidakamizwa nemiphumela engemihle (njengemiphumela yokudambisa izinhlungu ngemva komuthi), iziqondiso zomlomo (njengokwaziswa ukuthi umuthi othile ungadambisa izinhlungu), noma ukubhekwa komphakathi (njengokubheka ngokuqondile ukukhululeka kwezimpawu kwabanye ngemva kokuphuza umuthi ofanayo). Kodwa-ke, okunye okulindelekile kanye nemiphumela ye-placebo kanye ne-anti-placebo ayikwazi ukwenzeka. Isibonelo, ngokwemibandela singase senze izimpendulo ze-immunosuppressive ezigulini ezifakelwa izinso. Indlela yobufakazi iwukusebenzisa izisusa ezingathathi hlangothi ezazibhangqwe ngaphambilini nama-immunosuppressants ezigulini. Ukusetshenziswa kwe-neutral stimulation kukodwa futhi kunciphisa ukwanda kwamaseli e-T.

Ezilungiselelweni zomtholampilo, okulindelekile kuthonywa indlela izidakamizwa ezichazwa ngayo noma "uhlaka" olusetshenziswayo. Ngemuva kokuhlinzwa, uma kuqhathaniswa nokuphathwa okufihlakele lapho isiguli singazi khona isikhathi sokuphatha, uma ukwelashwa ozokuthola ngenkathi unikeza i-morphine kubonisa ukuthi kunganciphisa ngempumelelo ubuhlungu, kuzoletha izinzuzo ezibalulekile. Ukwaziswa okuqondile kwemiphumela engemihle nakho kungazanelisa ngokwakho. Ucwaningo lwaluhlanganisa iziguli eziphathwe nge-beta blocker atenolol yesifo senhliziyo nesifo somfutho wegazi ophezulu, futhi imiphumela yabonisa ukuthi izehlakalo zemiphumela emibi yezocansi kanye nokungasebenzi kahle kwe-erectile kwakungama-31% ezigulini ezazitshelwe ngamabomu ngemiphumela emibi engase ibe khona, kuyilapho isigameko sasingu-16% kuphela ezigulini ezingaziswanga ngemiphumela emibi. Ngokufanayo, phakathi kweziguli ezithathe i-finasteride ngenxa yokwanda kwe-benign prostate, i-43% yeziguli ezaziswe ngokucacile ngemiphumela emibi yocansi yaba nemiphumela emibi, kuyilapho phakathi kweziguli ezingaziswanga ngemiphumela emibi yocansi, le ngxenye yayingu-15%. Ucwaningo lwaluhlanganisa iziguli ezinesifuba somoya ezazihogela i-nebulize saline futhi zaziswe ukuthi zazihogela izinto ezingezwani nazo. Imiphumela yabonisa ukuthi cishe uhhafu weziguli waba nobunzima bokuphefumula, ukwanda kokungazweli komoya, nokuncipha kwamaphaphu. Phakathi kweziguli ezinesifuba somoya ezihogele ama-bronchoconstrictors, labo abatshelwa ngama-bronchoconstrictors baba nokucindezeleka okunzima kokuphefumula kanye nokungakwazi ukuhamba komoya kunalabo ababetshelwe ngama-bronchodilator.

Ngaphezu kwalokho, ukulindela okubangelwa ulimi kungabangela izimpawu ezithile ezifana nobuhlungu, ukulunywa, nesicanucanu. Ngemuva kokusikisela kolimi, ukugqugquzela okuhlobene nobuhlungu obuphansi kungase kubonakale njengobuhlungu obukhulu, kuyilapho ukugqugquzela okuthintekayo kungase kubonakale njengobuhlungu. Ngokungeziwe ekudambiseni noma ekwandiseni izimpawu, ukulindela okungekuhle nakho kunganciphisa ukusebenza kwezidakamizwa ezisebenzayo. Uma ulwazi olungamanga lokuthi imithi izokwandisa kunokuba idambise ubuhlungu kudluliselwa ezigulini, umphumela we-analgesics wendawo ungavinjelwa. Uma i-5-hydroxytryptamine receptor agonist rizitriptan ibhalwe ngephutha njenge-placebo, inganciphisa ukusebenza kwayo ekwelapheni ukuhlaselwa yi-migraine; Ngokufanayo, ukulindela okungalungile kunganciphisa umphumela we-analgesic wezidakamizwa ze-opioid ebuhlungu obubangelwa ukuhlolwa.

Izindlela zokufunda emiphumeleni ye-placebo kanye ne-anti placebo
Kokubili ukufunda kanye nesimo sakudala kuhileleke emiphumeleni ye-placebo kanye ne-anti placebo. Ezimweni eziningi zomtholampilo, izisusa ezingathathi hlangothi ngaphambilini ezihlotshaniswa nemiphumela enenzuzo noma eyingozi yezidakamizwa ngokusebenzisa i-classical conditioning kungaveza izinzuzo noma imiphumela engemihle ngaphandle kokusetshenziswa kwezidakamizwa ezisebenzayo esikhathini esizayo.

Isibonelo, uma izinkomba zemvelo noma zokunambitha zibhangqwa ngokuphindaphindiwe ne-morphine, izimpawu ezifanayo ezisetshenziswa ne-placebo esikhundleni se-morphine zisengakhiqiza imiphumela yokudambisa ubuhlungu. Ezigulini ze-psoriasis ezithole ukusetshenziswa kwesikhashana komthamo oncishisiwe we-glucocorticoids kanye ne-placebo (okuthiwa umthamo owelula i-placebo), izinga lokuphinda libe khona i-psoriasis lalifana neleziguli ezithola ukwelashwa kwe-glucocorticoid yomthamo ogcwele. Eqenjini lokulawula leziguli ezithole uhlobo olufanayo lokunciphisa i-corticosteroid kodwa zingayitholanga i-placebo ngezikhathi ezithile, izinga lokuphindaphinda laliphakeme ngokuphindwe kathathu kuneqembu le-placebo lokuqhubeka komthamo. Imiphumela efanayo yokulungisa iye yabikwa ekwelapheni ukuqwasha okungapheli nasekusetshenzisweni kwama-amphetamine ezinganeni ezinokuphazamiseka kokunaka kokungasebenzi kahle.

Okuhlangenwe nakho kokwelashwa kwangaphambilini nezindlela zokufunda nazo ziqhuba umphumela we-anti placebo. Kwabesifazane abathola ukwelashwa ngamakhemikhali ngenxa yomdlavuza webele, abangu-30% babo bazobe belindele ukucanuzela kwenhliziyo ngemva kokuchayeka ezimpawu zemvelo (njengokuza esibhedlela, ukuhlangana nabasebenzi bezokwelapha, noma ukungena egumbini elifana negumbi lokumnika) elalingathathi hlangothi ngaphambi kokuchayeka kodwa lalihlotshaniswa nokumnika. Izingane ezisanda kuzalwa ezihlaselwe kaningi ngokushesha zibonakalisa ukukhala nobuhlungu ngesikhathi sokuhlanzwa kotshwala esikhunjeni sazo ngaphambi kokuphuzwa. Ukubonisa izinto ezingezwani nomzimba ezitsheni ezivaliwe ezigulini ezinesifuba somoya kungase kubangele ukuhlaselwa yisifuba somoya. Uma uketshezi olunephunga elithile kodwa olungenayo imiphumela ezuzisayo yebhayoloji lubhangqwe nomuthi osebenzayo onemiphumela engemihle (njenge-tricyclic antidepressants) ngaphambili, ukusetshenziswa kwalolo ketshezi olune-placebo nakho kungase kubangele imiphumela engemihle. Uma izinkomba ezibukwayo (ezifana nokukhanya nemifanekiso) ngaphambili zazibhanqiwe nobuhlungu obubangelwa ukuhlolwa, khona-ke ukusebenzisa lezi zimpawu ezibukwayo kuphela kungase kubangele ubuhlungu esikhathini esizayo.

Ukwazi okuhlangenwe nakho kwabanye kungaholela emiphumeleni ye-placebo kanye ne-anti placebo. Ukubona ukukhululeka kobuhlungu kwabanye kungase futhi kubangele umphumela we-placebo we-analgesic, ofana ngobukhulu nomthelela we-analgesic otholwe uwena ngaphambi kokwelashwa. Kunobufakazi bokuhlola obuphakamisa ukuthi indawo yomphakathi kanye nokuboniswa kungabangela imiphumela engemihle. Isibonelo, uma ababambiqhaza bebona abanye bebika imiphumela emibi ye-placebo, babike ubuhlungu ngemva kokusebenzisa isigcobo esingasebenzi, noma ukuhogela umoya wasendlini ochazwa ngokuthi “ongase ube nobuthi,” kungase futhi kuholele emiphumeleni engemihle kubahlanganyeli abavezwe endaweni efanayo, isigcobo esingasebenzi, noma umoya wasendlini.

Imithombo yezindaba eminingi kanye nemibiko yemithombo yezindaba engekho emthethweni, ulwazi olutholwe ku-inthanethi, nokuxhumana okuqondile nabanye abantu abanezimpawu konke kungakhuthaza ukusabela okulwa ne-placebo. Isibonelo, izinga lokubika lemiphumela emibi kuma-statins lihlotshaniswa nokushuba kwemibiko engemihle ngama-statins. Kunesibonelo esicacile ngokukhethekile lapho inani lezehlakalo ezimbi ezibikiwe lenyuka ngezikhathi ze-2000 ngemva kwemibiko emibi yezindaba kanye nethelevishini ibonise izinguquko eziyingozi endleleni yomuthi we-thyroid, futhi ihilela kuphela izimpawu ezithile ezishiwo emibikweni embi. Ngokufanayo, ngemva kokukhuthazwa komphakathi kuholela izakhamuzi zomphakathi ukuba zikholelwe ngephutha ukuthi zichayeka entweni enobuthi noma imfucumfucu eyingozi, izehlakalo zezimpawu ezibangelwa ukuchayeka okucatshangelwayo ziyenyuka.

Umthelela wemiphumela ye-placebo kanye ne-anti placebo ocwaningweni nasekuzijwayezeni komtholampilo
Kungase kube usizo ukunquma ukuthi ubani othambekele ekubeni nemiphumela ye-placebo kanye ne-anti-placebo ekuqaleni kokwelashwa. Ezinye izici ezihlobene nalezi zimpendulo ziyaziwa okwamanje, kodwa ucwaningo lwesikhathi esizayo lunganikeza ubufakazi obungcono bokusebenza balezi zici. Ukuba nethemba kanye nokuba sengozini kwesiphakamiso akubonakali kuhlobene eduze nempendulo ye-placebo. Kunobufakazi obusikisela ukuthi umphumela we-anti placebo kungenzeka kakhulu ezigulini ezikhathazeke kakhulu, ezike zaba nezimpawu zezizathu zezokwelapha ezingaziwa, noma ezinokucindezeleka okukhulu kwengqondo phakathi kwalabo abasebenzisa izidakamizwa ezisebenzayo. Okwamanje abukho ubufakazi obucacile mayelana nendima yobulili emiphumeleni ye-placebo noma ye-anti-placebo. Ukucabanga, ubungozi bezakhi zofuzo eziningi, izifundo zenhlangano ebanzi yofuzo, kanye nezifundo ezingamawele kungasiza ukucacisa ukuthi izindlela zobuchopho nofuzo ziholela kanjani ezinguqukweni zezinto eziphilayo ezisebenza njengesisekelo semiphumela ye-placebo kanye ne-anti placebo.

Ukusebenzisana phakathi kweziguli nodokotela basemtholampilo kungathinta amathuba okuba nemiphumela ye-placebo kanye nemiphumela engemihle ebikiwe ngemva kokuthola i-placebo nezidakamizwa ezisebenzayo. Ukwethenjwa kweziguli kodokotela basemtholampilo kanye nobuhlobo babo obuhle, kanye nokuxhumana okuqotho phakathi kweziguli nodokotela, kuye kwafakazelwa ukuthi kunciphisa izimpawu. Ngakho-ke, iziguli ezikholelwa ukuthi odokotela banozwela futhi ezibika izimpawu zomkhuhlane ovamile zithambile futhi zifushane ngokwesikhathi kunalezo ezikholelwa ukuthi odokotela abanaluzwela; Iziguli ezikholelwa ukuthi odokotela bazwela futhi zithola ukwehla kwezinkomba ezihlosiwe zokuvuvukala, njenge-interleukin-8 ne-neutrophil count. Okulindelwe okuhle kodokotela basemtholampilo nakho kudlala indima kumphumela we-placebo. Ucwaningo oluncane oluqhathanisa ama-anesthetic analgesics kanye nokwelashwa kwe-placebo ngemva kokukhipha izinyo lubonise ukuthi odokotela babeqaphela ukuthi iziguli ezithola ama-analgesics zazihlotshaniswa nokukhululeka okukhulu kobuhlungu.

Uma sifuna ukusebenzisa umphumela we-placebo ukuze sithuthukise imiphumela yokwelashwa ngaphandle kokuthatha indlela yokuba ubaba, enye indlela iwukuchaza ukwelashwa ngendlela engokoqobo kodwa eyakhayo. Ukuphakamisa okulindelekile kwezinzuzo zokwelapha kuye kwaboniswa ukuthuthukisa impendulo yesiguli ku-morphine, i-diazepam, ukuvuselela ubuchopho obujulile, ukuphathwa kwe-intravenous ye-remifentanil, ukuphathwa kwendawo ye-lidocaine, izindlela zokwelapha ezihambisanayo nezihlanganisiwe (ezifana ne-acupuncture), ngisho nokuhlinzwa.

Ukuphenya okulindelwe yisiguli kuyisinyathelo sokuqala sokufaka lokhu okulindelekile ekusebenzeni komtholampilo. Lapho kuhlolwa imiphumela yomtholampilo elindelekile, iziguli zingacelwa ukuba zisebenzise isilinganiso se-0 (ayikho inzuzo) kuya ku-100 (inzuzo enkulu ongayicabanga) ukuze zihlole izinzuzo zazo zokwelapha ezilindelekile. Ukusiza iziguli ziqonde lokho ezikulindele ngokuhlinzwa kwenhliziyo okukhethiwe kunciphisa imiphumela yokukhubazeka ezinyangeni ze-6 ngemuva kokuhlinzwa; Ukunikeza isiqondiso ngamasu okubhekana neziguli ngaphambi kokuhlinzwa kwangaphakathi kwesisu kunciphisa kakhulu ubuhlungu bangemva kokuhlinzwa kanye nesilinganiso somuthi we-anesthesia (ngo-50%). Izindlela zokusebenzisa le miphumela yohlaka azihlanganisi nje kuphela ukuchaza ukufaneleka kokwelashwa ezigulini, kodwa nokuchaza inani leziguli ezizuzayo kukho. Ngokwesibonelo, ukugcizelela ukusebenza kwemithi ezigulini kunganciphisa isidingo semithi edambisa ubuhlungu ngemva kokuhlinzwa iziguli ezingakwazi ukuzilawula.

Ezenzweni zomtholampilo, kungase kube nezinye izindlela zokuziphatha zokusebenzisa umphumela we-placebo. Olunye ucwaningo lusekela ukusebenza kahle kwendlela “ye-placebo yelebula evulekile,” ehilela ukunikeza i-placebo kanye nomuthi osebenzayo nokwazisa iziguli ngokwethembeka ukuthi ukwengeza i-placebo kufakazelwe ukuthuthukisa imiphumela enenzuzo yomuthi osebenzayo, ngaleyo ndlela kuthuthukisa ukusebenza kwawo. Ukwengeza, kungenzeka ukugcina ukusebenza kahle komuthi osebenzayo ngokusebenzisa isimo ngenkathi unciphisa kancane kancane umthamo. Indlela ethile yokusebenza iwukubhangqa umuthi nezimpawu zezinzwa, eziwusizo ikakhulukazi ezidakamizweni ezinobuthi noma eziluthayo.

Ngokuphambene nalokho, ulwazi olukhathazayo, izinkolelo eziyiphutha, okulindelekile okungenathemba, isipiliyoni esibi esidlule, ulwazi lwezenhlalo, kanye nendawo yokwelashwa kungaholela emiphumeleni engemihle futhi kunciphise izinzuzo zokwelashwa okunezimpawu kanye ne-palliative. Imiphumela engemihle engaqondile yezidakamizwa ezisebenzayo (izikhawu, ezihlukahlukene, umthamo ozimele, nokuphindaphindeka okungathembeki) ivamile. Le miphumela engemihle ingase iholele ekungabambeleli kahle kweziguli ohlelweni lokwelapha (noma uhlelo lokuyeka) olunqunywe udokotela, okudinga ukuthi zishintshele komunye umuthi noma zengeze eminye imithi yokwelapha le miphumela engemihle. Nakuba sidinga ucwaningo olwengeziwe ukuze sinqume ukuhlobana okucacile phakathi kwakho kokubili, le miphumela engemihle engaqondile ingase ibangwe umphumela we-anti placebo.

Kungase kusize ukuchaza imiphumela emibi esigulini kuyilapho uqokomisa izinzuzo. Kungase futhi kube usizo ukuchaza imiphumela engemihle ngendlela esekelayo kunokuba ngendlela ekhohlisayo. Isibonelo, ukuchazela iziguli inani leziguli ezingenayo imiphumela emibi, kunokuba inani leziguli ezinemiphumela emibi, kunganciphisa izehlakalo zale miphumela emibi.

Odokotela banesibopho sokuthola imvume esemthethweni enolwazi ezigulini ngaphambi kokusebenzisa ukwelashwa. Njengengxenye yenqubo yemvume enolwazi, odokotela kudingeka banikeze ulwazi oluphelele ukuze basize iziguli ekwenzeni izinqumo ezinolwazi. Odokotela kumele bachaze ngokucacile nangokunembile yonke imiphumela emibi engaba yingozi futhi ebalulekile emtholampilo, futhi bazise iziguli ukuthi yonke imiphumela emibi kufanele ibikwe. Kodwa-ke, ukufakwa kuhlu kwemiphumela engemihle nengaqondile engadingi ukunakekelwa kwezokwelapha ngamunye ngamunye kwandisa amathuba okuba khona kwayo, okudala inkinga kodokotela. Isixazululo esisodwa esingaba khona ukwethula umphumela we-placebo ezigulini bese ubuza ukuthi zizimisele yini ukufunda ngemiphumela emibi, engaqondile yokwelashwa ngemva kokuqaphela lesi simo. Le ndlela ibizwa ngokuthi “imvume yokwaziswa engokokuqukethwe” kanye “nokucatshangelwa okugunyaziwe”.

Ukuhlola lezi zinkinga neziguli kungase kube usizo njengoba izinkolelo eziyiphutha, okulindelekile okukhathazayo, kanye nomuzwa ongemuhle ngemithi yangaphambilini kungaholela kumphumela we-anti-placebo. Yimiphi imiphumela ecasulayo noma eyingozi abaye baba nayo ngaphambili? Yimiphi imiphumela emibi abakhathazeke ngayo? Uma njengamanje behlushwa yimiphumela engemihle, ungakanani umthelela abacabanga ukuthi le miphumela engemihle inawo? Ingabe balindele ukuthi imiphumela engemihle ibe yimbi ngokuhamba kwesikhathi? Izimpendulo ezinikezwa iziguli zingase zisize odokotela badambise ukukhathazeka kwabo ngemiphumela engemihle, kwenze ukwelashwa kubekezeleleke kakhudlwana. Odokotela bangaqinisekisa iziguli ukuthi nakuba imiphumela engemihle ingase ibe nzima, empeleni ayinangozi futhi ayiyona ingozi ngokwezokwelapha, okungase kunciphise ukukhathazeka okubangela imiphumela engemihle. Ngokuphambene nalokho, uma ukusebenzisana phakathi kweziguli nodokotela basemtholampilo kungakwazi ukudambisa ukukhathazeka kwabo, noma ngisho kukwenze kube kubi nakakhulu, kuzokwandisa imiphumela emibi. Ukubuyekezwa kwekhwalithi yezifundo zokuhlola nezomtholampilo kuphakamisa ukuthi ukuziphatha okungalungile okungenazwi kanye nezindlela zokuxhumana ezingenandaba (njengenkulumo ezwelayo, ukungabhekani ngamehlo neziguli, inkulumo eyisiphukuphuku, nokumamatheka ebusweni) kungakhuthaza umphumela wokulwa ne-placebo, ukunciphisa ukubekezelelana kwesiguli ebuhlungu, futhi kunciphise umphumela we-placebo. Imiphumela ecatshangelwayo ngokuvamile iyizimpawu ezazinganakwa ngaphambili noma zinganakwa, kodwa manje sekuthiwa zibangelwa imithi. Ukulungisa lesi sihloko esiyiphutha kungenza umuthi ubekezeleleke kakhulu.

Imiphumela engemihle ebikwe iziguli ingase ivezwe ngendlela engasho lutho nefihlekile, izwakalise ukungabaza, ukubhukha, noma ukukhathazeka mayelana nemithi, uhlelo lokwelapha, noma amakhono ochwepheshe kadokotela. Uma kuqhathaniswa nokuveza ukungabaza ngokuqondile kodokotela basemtholampilo, imiphumela engemihle iyisizathu esingenamahloni futhi esamukeleka kalula sokuyeka imithi. Kulezi zimo, ukucacisa nokuxoxa ngokukhululekile ngokukhathazeka kwesiguli kungase kusize ukugwema izimo zokuyekwa noma ukungathobeli imithetho.

Ucwaningo ngemiphumela ye-placebo kanye ne-anti placebo lunengqondo ekwakhiweni nasekusetshenzisweni kwezivivinyo zomtholampilo, kanye nokuchazwa kwemiphumela. Okokuqala, lapho kungenzeka khona, izivivinyo zomtholampilo kufanele zibandakanye amaqembu okungenelela mahhala ukuze achaze izici ezididayo ezihlobene nemiphumela ye-placebo kanye ne-anti placebo, njengencazelo yokwehla kwezimpawu. Okwesibili, ukuklanywa kwe-longitudinal yocwaningo kuzothinta izehlakalo zokuphendula ku-placebo, ikakhulukazi ekwakhiweni kwe-crossover, njengoba kubahlanganyeli abathole umuthi osebenzayo kuqala, okuhlangenwe nakho okuhle kwangaphambili kuzoletha okulindelekile, kuyilapho ababambiqhaza abathole i-placebo kuqala abazange. Njengoba ukwazisa iziguli ngezinzuzo ezithile kanye nemiphumela engemihle yokwelashwa kungase kwenyuse izehlakalo zalezi zinzuzo nemiphumela engemihle, kungcono kakhulu ukugcina ukungaguquguquki ezinzuzweni kanye nolwazi lwemiphumela engemihle olunikezwa ngesikhathi senqubo yemvume enolwazi kuzo zonke izivivinyo zokufunda umuthi othile. Kuhlaziyo lwemeta lapho ulwazi lwehluleka ukufinyelela ukuvumelana, imiphumela kufanele ihunyushwe ngokuqapha. Kungcono kakhulu ukuthi abacwaningi abaqoqa idatha ngemiphumela engemihle bangazi kokubili iqembu lokwelapha kanye nesimo semiphumela emibi. Lapho uqoqa idatha yomthelela oseceleni, uhlu lwezimpawu ezihlelekile lungcono kunohlolo oluvulekile.