Placebo responders are different from placebo nonresponders, with implications for the design of clinical trials and the provision of clinical care. Placebo responders, for example, are thought to have brain signaling pathways that differ in subtle ways from nonresponders’ pathways. Ultimately, these pathways—especially the dopamine, opioid, endocannabinoid, and serotonin pathways—differ at the genetic level.
The genes or gene patterns that affect the placebo response are bound to be extensive—so extensive, in fact, that they may merit the term placebome. The term already graces the title of a paper prepared by researchers at the Beth Israel Deaconess Medical Center. This paper—“Genetics and the placebo effect: the placebome”—appeared April 13 in the journal Trends in Molecular Medicine.
“Evidence that genetic variations in these pathways can modify placebo effects raises the possibility of using genetic screening to identify placebo responders and thereby increase randomized clinical trial efficacy and improve therapeutic care,” the researchers proposed. “Furthermore, the possibility of interaction between placebo and drug molecular pathways warrants consideration in randomized clinical trial design.”
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