Brief discussion
respiratory infections, respiratory infection, pain, infection, depression
RESPIRATORY INFECTIONS, INFECTION, RESPIRATORY INFECTION, HEAT
Study 3 extended our previous focus group study and online experiment through the comparison of different prescribing contexts and their respective effects on public attitudes around placebos. We replicated our previous findings on the acceptability of different placebo types for replacing unnecessary antibiotic treatments in the context of respiratory infections and showed that public acceptability of clinical placebo use differed for different clinical scenarios.Hence, our clinical scenario hypothesis on the effect of the prescribing context on placebo attitudes was confirmed. However, contrary to our predictions, participants demonstrated the most favourable placebo attitudes in the infection condition, followed by the depression condition and finally the back pain condition. Similar to the results from Study 2, there were notable differences between the general acceptability and the personal acceptability ratings for using antibiotics in our respiratory infection scenario. Again, participants showed a stronger preference for antibiotics when they were asked to indicate their personal willingness to receive each treatment, thus providing further evidence for differences in self and other decision-making.The comparatively lower acceptability and efficacy ratings for clinical placebo use to treat depression and back pain are more difficult to interpret. Based on our initial focus group study, we had indeed predicted lower ratings in the context of pain management, because participants had described beliefs that highly tangible symptoms of pain may not be effectively managed with placebos. However, with several participants from the focus groups suggesting mental health as the prescribing context most appropriate for placebo use, we had expected to find more positive attitude ratings in the depression scenario. One possibility for the unexpected findings is that the infection scenario stood out by highlighting societal consequences (i.e. antimicrobial resistance) as well as personal side effects of medicine overuse. Based on this explanation, more detailed patient information on both societal and personal consequences of overtreatment across different treatment contexts might help to further raise placebo acceptability.With regard to our second hypothesis, the Treatment type hypothesis, all our predictions were confirmed. Similar to the results from Study 2, open-label impure placebos received the highest acceptability ratings compared to the other types of placebos and the open-label pure placebo condition received the lowest ratings for expected effectiveness. Furthermore, as predicted, the active medical treatment was overall rated most favourable, even though the infection scenario differed from this pattern as described above. These findings suggest that any clinical treatment using blinded placebos should be avoided, but highlight the specific potential of using open-label impure placebo treatments such as anti-inflammatory lozenges, vitamin supplements or pain relief heat spray more strategically. Given previous survey findings on the existing practice involving the informal use of impure placebos [