安慰剂、“安慰剂效应”与“确定性知识”  

Placebo, Placebo Effect and “Causal Certainty Knowledge”

作　　者：郭喨[1] 王赵琛[2] GUO Liang;WANG Zhaochen(Research Center for Marxism Theory Innovation and Communication,Zhejiang University,Hangzhou,Zhejiang,310058;School of Population Medicine and Public Health,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100730)

机构地区：[1]浙江大学马克思主义理论创新与传播研究中心,浙江杭州310058 [2]中国医学科学院北京协和医学院群医学及公共卫生学院,北京100730

出　　处：《自然辩证法通讯》2024年第8期43-49,共7页Journal of Dialectics of Nature

摘　　要：安慰剂可以引发“安慰剂效应”,即“通过作用于被干预者心理而非直接作用于生理引致症状或主诉的改善”。人类历史上,安慰剂发挥了重要的“替代治疗”作用;当代医学中,“临床实践”与“临床试验”广泛涉及安慰剂。“确定性知识”是解释当代医学实践与医学试验对待安慰剂及其“安慰剂效应”态度差异的根本:“临床实践”旨在“运用确定性知识”,“临床试验”旨在“生产确定性知识”,这一差别决定了二者的不同态度。临床实践中,所有“不明因果关系”的治疗利益优先考虑安慰剂解释,“不明利益归于安慰剂”;临床试验中,将安慰剂视为干扰因子、通过实验手段予以排除。在临床试验“确定性知识”生产过程中,安慰剂过滤掉了潜在的不确定性,建立了“有效性”标准。如果混淆了“确定性知识”的生产与运用,不能从概念上区分临床试验与临床实践、不能在实践中区分受试者与患者,就会产生“治疗误解”,不利于受试者权益保护。同时,对“知识确定性”的过度追求可能有悖于医学实践与医学试验的终极目标,应当重视其伦理后果。“Placebo” means “I shall please” and can trigger a “placebo effect”, i.e. “an improvement in symptoms or complaints caused by acting psychologically rather than directly physiologically on the person being intervened with”. It has historically played a unique role as a "placebo treatment". The difference between modern medicine's "clinical trials' ', which aim to "produce causally certain knowledge", and "clinical practice", which aims to "apply causally certain knowledge", has led to different attitudes towards "placebo". Clinical practice prioritises the "placebo" explanation for all therapeutic benefits for which there is no clear causal relationship;in clinical trials, the "placebo" is considered a confounding factor to be excluded by experimental means due to its lack of clear physiological causality. In the production of "causal certainty knowledge" in clinical trials, "placebo"filters out potential uncertainty and establishes the criterion of "validity". Failure to distinguish conceptually between clinical trials and clinical practice, and to distinguish between subjects and patients in practice, can lead to “therapeutic misunderstandings” and is detrimental to the protection of subjects' rights. At the same time, the excessive pursuit of "intellectual certainty" may run counter to the ultimate goal of contemporary medicine and its ethical consequences should be taken seriously.

关 键 词：安慰剂 安慰剂效应 临床实践 临床试验 确定性知识 

分 类 号：B849[哲学宗教—应用心理学] R395[哲学宗教—心理学]