General discussion
respiratory infections, infection, chronic illness, anxiety
RESPIRATORY INFECTIONS, INFECTION, CHRONIC ILLNESS, DISEASE
Our three-part, mixed methods study provides the first comprehensive evidence for the public acceptability of clinical placebos. It thereby indicates support for a novel, behavioural approach to reduce overtreatment in primary care. Our qualitative and quantitative results both highlight particular potential for the use of open-label impure placebos, which are treatments with known pharmacological value for some of the patients’ symptoms, but without therapeutic effects for the underlying illness. This is aligned with previous research, which suggested patient support for and curiosity about open-label placebos [Our results demonstrated interesting differences in self- and other decision-making. When presented with a decision scenario on respiratory infections involving the potential inappropriate use of antibiotics, participants generally opposed the use of antibiotics. Yet, they still indicated a personal preference for receiving antibiotics if they were the ones suffering from the infection. This suggests heightened levels of loss aversion when making choices for oneself as found in previous experimental research [Additionally, Study 2 suggests that individual levels of placebo acceptability and beliefs around effectiveness may vary depending on a person’s demographic background, previous medical history and individual differences in health anxiety and health literacy. Older people, individuals suffering from chronic illness or those showing higher levels of health anxiety, may be less amenable to placebo use. Individuals with lower health literacy may be less accepting of open-label placebos, supporting previous research which found that health literacy predicted people’s responses to health messages [Finally, our results suggest an important role of language when communicating information about placebos. Specific terms such as “impure” or “sugar pills” may carry negative connotations suggestive of contamination or child-like properties respectively, which could shape public attitudes around placebos and should therefore be avoided. These findings are aligned with previous results on the effects of language framing, including work highlighting the importance of disease names and related medical terminology [