Theme 2: perceptions and conceptions of placebos
The discussions also revealed how participants perceived placebos as a “non-real” form of treatment, with descriptors such as “pseudo-medication”, “does nothing”, and “not a real treatment” being used. Nevertheless, the placebo effect itself was largely accepted and spoken about as a real phenomenon. Participants suggested that the terminology around how placebos functioned should be clear to patients, indicating that placebos “help” or provide temporary “relief” rather than “work”. The labels “pure” and “impure” were also viewed as holding inherent connotations that could potentially affect a patient’s attitude towards placebo use. Some participants likened their perception of placebos to foods in which an active ingredient has been removed (e.g. decaffeinated coffee) or to lifestyle cosmetics that have unproven health benefits but create a “feel good” mindset through the action of attending to health.Participants noted that a patient's initial mindset or expectations prior to receiving a placebo could expedite their efficacy. Initial positive expectations were linked to a more widespread enculturation around the use of placebos as a legitimate form of treatment, and the role of clinicians in engendering a positive view of placebo use for their patients. A patient’s religious or socio-cultural background was viewed as potentially influencing their perceptions towards placebos and their predisposition towards their use; alongside previous poor experiences with healthcare services.