The Role of Placebo Effect in UK Healthcare: A Dissertation

This dissertation investigates the placebo effect within the UK healthcare system, examining its meaning, influencing factors, and challenges. The research explores the concept of placebo treatments, their impact on patient outcomes, and the psychological and physiological mechanisms involved. The study delves into factors affecting the placebo effect, such as the patient-doctor relationship, treatment heterogeneity, and patient beliefs. The research methodology includes a literature review, data analysis, and findings that address the research questions. The dissertation aims to provide recommendations for improving the placebo effect, offering strategies for healthcare organizations to enhance patient care. The findings highlight the significance of understanding the placebo effect for effective patient treatment and clinical study management, emphasizing the importance of patient perception and the need for standardized treatment approaches within the UK healthcare context. The conclusion summarizes the research findings and offers practical recommendations for future research and healthcare practices.

Running Head: DISSERTATION
DISSERTATION

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Abstract
The main aim of this research is to analyze the placebo treatment in the healthcare
organization of UK. This research report considers many sections like introduction part,
research methodology, literature review, data analysis and findings, and conclusion
discussion. The first chapter of this report discusses research background, research aim and
objectives, research justification, and research question. In the second chapter, it critically
analyzes the place effect regarding healthcare organization. The research methodology
discusses the many tools and techniques, which could support to collect data about current
research matter. The data analysis part examined that collected data through numerical and
non-numerical method. The last section of this report discusses recommendation and
conclusion part that represents the whole research in a specific manner.

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Table of Contents
Chapter1 Introduction Research title......................................................................................3
1.1 Research Background.......................................................................................................3
1.2 Industry background.........................................................................................................3
1.3 Research aim and objectives............................................................................................3
1.4 Research questions...........................................................................................................4
1.5 Research rational..............................................................................................................4
1.6 Dissertation structure........................................................................................................4
Introduction.........................................................................................................................4
Literature Review...............................................................................................................5
Research Methodology.......................................................................................................5
Data Analysis and Findings................................................................................................5
Conclusion and Recommendation......................................................................................6
Chapter2: Literature review.......................................................................................................7
2.1 Introduction......................................................................................................................7
2.2 To analyse meaning and concept of placebo effect..........................................................7
2.3 To address the Influencing factors for the placebo effect................................................8
2.4 To recommend the strategies to control the placebo effect............................................10
2.5 Summary.........................................................................................................................12
..................................................................................................................................................13
Chapter 3: Research methodology...........................................................................................13
3.1 Introduction....................................................................................................................13
3.2 Research philosophy.......................................................................................................13
3.3 Research approach..........................................................................................................14
3.4 Types of Research..........................................................................................................15
3.5 Research design..............................................................................................................15
3.6 Research strategy............................................................................................................16
3.8 Data collection method...................................................................................................16
3.9 Data analysis...................................................................................................................18
3.10 Sampling technique......................................................................................................18
3.11 Ethical consideration....................................................................................................19
3.12 Research limitation.......................................................................................................20
3.13 Summary.......................................................................................................................20
Chapter 4: Data analysis and findings......................................................................................21
4.1 Introduction....................................................................................................................21
Chapter 5 Findings...................................................................................................................37
5.1 Introduction....................................................................................................................37
5.2 To explore meaning and concept of placebo effect: in context of UK health care
organization..........................................................................................................................37
5.3 To identify challenges of placebo effects: in context of UK health care organization. 38
5.4 To recommend the approaches for improving place effect: in context of UK health care
organization..........................................................................................................................40
To explore meaning and concept of placebo effect: in context of UK health care
organization..........................................................................................................................41
To identify challenges of placebo effects: in context of UK health care organization.......41
To recommend the approaches for improving place effect: in context of UK health care
organization..........................................................................................................................42
Chapter 5: Conclusion and recommendation...........................................................................43
To analyse meaning and concept of placebo effect..............................................................43
To address the Influencing factors for the placebo effect....................................................43

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To recommend the strategies to control the placebo effect..................................................43
Recommendation..................................................................................................................44
To analyse Meaning and concept of placebo effect: in context of UK health care..............44
To address the Influencing factors for the placebo effect: in context of UK health care.....44
To recommend the strategies to control the placebo effect: in context of UK health care. .45
References................................................................................................................................46
Appendixes...............................................................................................................................54

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Chapter1 Introduction
Research title
The research area of this study is to examine the effect of placebo: in context of UK
healthcare.
1.1 Research Background
A placebo is a treatment which is estimated to have no inherent pharmacological benefits. It
is used for comparison of clinical studies as it could be supportive of examining the
efficiency of new clinical treatments. The placebo treatment could a sign and symptom of
improving health illness (Wilhelm, et al., 2016). In addition, it is also found that the effect of
the placebo functions as a healing in the ailment verity. It is still used as a viable treatment
option by the doctors with surprising frequency. In the UK, Psychologists and neuroscientists
are interested in the placebo treatment. Moreover, brain and body of the patient are worked
positively at the time of treatment. The research of placebo effects shows that human brain
could be influenced by this treatment (Koog, 2016). The place could impact on biological
factors of the body that could enable the patient to think positive relegating their treatment.
Placebos could be worked as a therapeutic process to treat patients but in current time it is
used to manage the clinical study and trails (Boehm, et al., 2017)
1.2 Industry background
The healthcare sector is increased in the UK due to higher demand for healthcare product and
services. The healthcare organization is practiced centric approach for attracting a large
number of patients. From the analysis of part data, it is found that health care services are
increased in the UK that would improve the economic situation of the country.
1.3 Research aim and objectives
It is effective for the researcher to determine reliable goals of research issue as it could help
to meet research matter. The primary aim of this research issue is to determine placebo effect

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in the context of Healthcare UK. For this, there are many objectives, which are described as
below:
 To explore meaning and concept of placebo effect: in context of UK healthcare
organization.
 To identify challenges of placebo effects: in context of UK healthcare organization.
 To recommend the approaches for improving place effect: in context of UK
healthcare organization.
1.4 Research questions
 What is meaning and concept of placebo effects: in context of healthcare
organization?
 What are the factors that could affect the placebo: in context of healthcare
organization?
 What are the strategies that could improve placebo: in context of healthcare
organization?
1.5 Research rational
This research is significant for the researcher to gain their awareness towards the meaning
and concept of place effect. It is imperative for the company to comprehend about the
placebo effect for effectively treating the patients. In the present scenario, the placebo therapy
could support organization to improve the health of patient without using pills (Durgam, et
al., 2016).
1.6 Dissertation structure
This research structure is practiced to meet research objectives appropriately. The dissertation
structure is explained as follow:

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Introduction
It is a significant part of the study because it would consider many factors like research title,
research aim and objectives, research background, research question, and research rationale.
It will also help to create the best known in the context of research matter. The introduction
section also helps to develop an understanding of research limitation that will be faced by
research scholar during the research study (Hammami, et al., 2016). Thus, this part also
supports to obtain the reliable result in the context of research matter.
Literature Review
This section helps to identify the research concern by using numerous theories, models, and
concepts. The literature review section will enable the researcher to evaluate the data in terms
of research concern (Garcia, 2015). In this part, many journals, books, academic articles, and
magazines are considered as its support in creating theoretical knowledge about research
matter (Warwick, et al., 2015).
Research Methodology
The research methodology is supportive to identify appropriate technique for collecting data
about research matter. In this, the researcher uses numerous techniques to meet objectives of
the research. Moreover, researcher methodology entailed many techniques to collect data like
research philosophies, research strategies, research approaches, data collection methods, data
analysis methods, research limitations, sampling methods, and ethical consideration (Ghosh,
et al., 2018). It could be effective for improving validity and reliability of research result. The
research tools help the researcher to meet research aim and objectives.
Data Analysis and Findings
The data analysis part helps to determine the collected information of research. In this, it
supports researcher to separately obtain reliable information and identify them for each
research objective (Glund, et al., 2015). It also helps the researcher to organize the data

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through effective data analysis techniques. In this, research scholar will enable the researcher
to evaluate information to consider certain methods like MS-excel software and Literature
review method. Consequently, it helps to obtain a reliable conclusion.
Conclusion and Recommendation
This is the last section of research that enables to summarize whole research as per the
research findings. It also helps to develop a link between research findings and research
objectives as it could support in attaining reliable summary. This section also discusses
strategies for solving research concern. This part is supportive to identify the practical effect
for an upcoming research study.

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Chapter2: Literature review
2.1 Introduction
The literature review section helps the researcher to increase their understanding about
research concern by investigating of current literature systematically. An effective literature
review considers many methods like books, journals, books, and magazine as it could create
theoretical knowledge about research matter (Lubotzky and Aran, 2017). Moreover, the
literature review supports to explore the information in the context of the placebo effect. It
also creates understanding towards the factors that could be a negative impact on placebo
treatment. This section determines the issue faced by healthcare organization during placebo
treatment. Moreover, it can also be stated that the literature review part helps to identify the
recommendation for dealing with issues that healthcare organization face in improving
placebo treatment.
2.2 To analyze meaning and concept of placebo effect
According to Shukla and Rai (2015), placebo treatment could have a favorable therapeutic
impact on the patient, even pills or treatment is not active. It is known as a placebo response.
It is also stated that placebo effect is working on approximately 20 to 40% of patients.
Furthermore, it is also analyzed that patient who feels they have received a pain-relieving
meditation then it could directly impact on their brain. As a result, the patient will be capable
to improve their existing illness. The endogenous opioid is a combination of two elements
like enkephalins and endorphins that could be normal pain-relieving chemicals as it could
produce in the body. Insensibility of placebo effect could rely on the beginning of
endogenous opioids in the brain.
Espay et al. (2015) argued that placebo effect in a patient with post-operative ache could be
clogged by opiate antagonist naloxone. A placebo is everything which seems to tangible
medical treatment but it is not. It could be determined as a short-term treatment. Placebos

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could affect the health of the patient by decline their health issues. The placebo effect is
determined as a phenomenon where patient health would improve by individual believes. It is
an interesting phase of human psychology because it shows the power of human regarding
their treatment. It enables individual to believe that something is functioning that indicates
placebo effect. The placebo effect is developed not only from a sensible belief in the pills but
also from the subconscious link between improvement and skills of being treated.
In support of this, Fuchs et al. (2014) stated that in the brain of a patient, central nervous
system or dopamine is activated after placebo management. It is also addressed that placebo
effect does not provide a primary health benefit to the patient but it could modestly impact on
the patient-reported result. Further, nausea and pain could easily decline with placebo
therapy. It is also analyzed that fluctuation in placebo could be influenced by differences in
trial design and how doctors and caretaker informed to the patient about their treatment.
2.3 To address the Influencing factors for the placebo effect
McInnes et al. (2015) argued that many factors could influence placebo therapy such as lack
of principles in PRM therapies, treatment heterogeneity, the relationship between patient and
doctors, and belief of patient, motivation, and experience. It is stated lack of standard in
Physiological Regulating Medicine (PRM) could deliver inaccurate information to their
patient about their treatment as it could also a negative impact on behavior. Moreover, it is
also found that there are certain exercises as it could apply separately to endurance,
stretching, and strengthening. It is complicated for PRM to standardize each therapy of
treatment.
In support of this, Azaïs et al. (2014) stated that treatment heterogeneity could also influence
placebo effect, which could be occurred by lack of physician’s skills regarding injections,
nerve blocks, and acupuncture. Thus, it can also be said that managing such interventions
becomes complicated with this significant variability source. It makes more complication to

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design an effective placebo treatment in such circumstance. For managing levels of skills,
there is need to perform multicentric studies as it would support to effectively control skills
and experience. It is also found that experience and skills of doctors could also influence
placebo effect.
In oppose to this, Demant et al. (2014) explained that personal interaction between patient
and therapist could influence the behavior of the patient. For illustration, language and speech
treatment after brain harm. In addition, it is also found that cognitive behavioral therapy
could support to determine the relationship between therapist and patient. Moreover, it is also
found that level of interaction could support to identify the level of the placebo effect as well
as induce real effects. It is also stated that inspiration and preference could be a challenge for
utilizing placebo effect on the patient.
As per the view of Ridker et al. (2017), personal beliefs, last experience, and inspiration
could negatively impact on the placebo effect. Patients have diverse needs and requirements
with non-pharmacological managements in PRM. It is because needs of patients could
influence the placebo effect. Moreover, Placebo effect would be increased in certain
treatment such as home exercises, cognitive-behavioral interventions, and occupational
therapy.
On the other side, Crawford et al. (2015) examined that it is also found that sometimes PRM
involvements could encourage small sizes, hence it is analyzed that large sample sized could
enhance total cost. In addition, it is also stated that sometimes PRM involvement in a chronic
situation as it would increase cost and length of study. Hence, it can be said that long-term
follow up could influence placebo effect by creating complexity in placebo use due to ethical
issues for long-term of placebo intervention.
In oppose to this, Huttner et al. (2015) illustrated that lack of appropriate training could also
influence placebo effect because appropriate training method could support to directly

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influence the behavior of patents and make healthier in targeted time and period. It is also
stated that size of pills could also influence the placebo effect. There are many characteristics
of pills that could also affect patient behaviors such as the larger size of pills, injections, and
color of medicine. It is also stated that patients have thought that larger sized pills could be
effective more than then smaller pills.
In support of this, Youssef et al. (2018) stated that patients believe that injection is more
powerful than pills. It is also found that attitude of persons could also increase chances of
placebo effect among patients. Beside this, placebo cannot work if the patient has a doubt
regarding their treatment. In addition, it is also found that when the patient believes on their
doctors then there is more probability of placebo effect success.
Application of medical device could support to deal with infectious diseases. Miller et al.
(2016) have conducted a meta-analysis on depression disease where they found that there is
no difference between placebo therapy and transcranial magnetic stimulation. It is also stated
that healthcare organization has needed to determine the patient who has to believe in placebo
therapy rather than another source of treatment. As a result, healthcare organization would be
capable to offer healthcare service in limited time.
2.4 To recommend the strategies to control the placebo effect
In support of this, Gerdesmeyer, et al. (2017) stated that placebo effect in PRM could be
challenging for an organization to obtain positive benefits. Healthcare organization should
develop a depth understanding of placebos for getting a positive outcome. Healthcare
organization is not aware of the mechanism of placebo effects. Hence, the organization is
requisite to critically discover biological techniques of placebo effects as it could be
supportive for placebo treatments.
Morrison et al. (2018) argued that patients would react differently to the placebo treatment.
Hence, research could be conducted to address predictors for placebo outcome. It is

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significant for a healthcare organization to gain their understanding of different effects of
placebo before implementing placebo in individual treatment. It is also suggested that
healthcare organization should test devices for the placebo effect. PRM is a field which
practices many techniques and physical modalities for evaluating the place effects. In
addition, it is also found that healthcare organization is mandated to get permission from
FDA to treat Parkinson’s disease because unethical application of placebo device could
negatively impact on the patient to believe in treatment.
In oppose to this, Boers et al. (2016) explained that healthcare organization should focus on
implantable device in order to determine interval period of treatment. It could help to offer
accurate treatment in specified time. Moreover, health organization could use a placebo on
children as it could be more beneficial for obtaining a favorable result. The organization
should obtain the experience with pediatrics patients because there is more probability of
placebo effects application. Consequently, the organization will be capable to get the highest
quality.
It is also found that organization should perform sound research on children because
techniques of disease could be different in adult and children. Moreover, children could not
be benefited from advances in drug tool expansion. In addition, the organization should
consider standard format for the children as compared to the adults as it could be beneficial to
obtain higher profit from the placebo effects. Health organization should determine the
shorted time frame for identify the placebo effect on the patient as it could be effective for
obtaining accurate treatment. It could also be imperative for eliminating ethical issues from
treatment.
According to the Hall et al. (2015), doctors should necessarily use surgery or invasive process
in PRM treatment for improving the health of patients. But, at the same time, the placebo
effect avoids surgery and drug in their treatment. Hence, it can be said that there is the

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difference between sham surgery and the placebo effect. The sham surgery process could be
ethically unacceptable. It is because, the sham-controlled method would promote the process,
which is not effective in the treatment. In addition, it is also found that placebo eliminates
common surgical intervention in the treatment of chest pain.
In support of this, Lindheime et al. (2015) explained that arthroscopy for knee osteoarthritis is
showed that result after arthroscopic surgery is not effective as compared to placebo surgery.
Hence, an alternative process like small incision of sham surgery group could be necessary
for real effectiveness. This mediation is associated with the surgery needs. The organization
should also need to placebo-controlled trails through surgical techniques as it could be
effective for offering the best treatment to the patients.
2.5 Summary
With respect to above discussion, it can be concluded that this section identifies the effect of
placebo within the organization which enables the healthcare company to obtain competitive
benefits. Furthermore, it can also be examined that Placebo therapy could favorably impact
on improving the health of the patient. Moreover, there are many factors that could influence
the placebo therapy like many factors lack of principles in PRM therapies, treatment
heterogeneity, and the relationship between patient and doctors. Other factors are the belief in
patient, motivation, and experience.

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Chapter 3: Research methodology
3.1 Introduction
This research is appropriate to obtain the in-depth information in relation to research issue in
a rational way. This chapter of research methodology is supportive for a researcher to acquire
the facts and figures from a lot of respondents. Consequently, it is beneficial for a researcher
to accomplish their research with the particular time period.
3.2 Research philosophy
Research philosophy is a belief of generating facts and figures in regards to research issue.
The rationale of research philosophy helps to address the technique of gathering information
and analyzing and interpreting it by using an appropriate procedure of research (Simonet, al.,
2014). Research philosophy could be classified into distinct sorts such as positivism,
interpretivism and realism philosophy (Archer, et al. 2016). In this way, realism philosophy is
exercised to gather the truthful facts and figures by using the evaluation of data and
respondents in relation to the research subject. It is also effective for a researcher to capture
the accurate information and opinion regarding the subject of investigation. It also makes able
a researcher to acquire the real and authentic data with regards to the subject matter of
research and executing tools of statistical information. On the other side, research has used
positivism research philosophy because of the objective environment of the research subject
(Andrieu, et al., 2017). This philosophy relies on hypothesis development. In contrast,
interpretivism research philosophy is practiced in case research issue is subjective in nature.
For this research study, the researcher will practice interpretivism research philosophy to get
detail understanding in the context of current research matter. As a result, it is effective for
research philosophy for the research scholar as it could support to obtain the valid and
reliable outcome regarding research subject matter (Gros, et al., 2017). On the other side,
research scholar has not implemented both realism and positivism research philosophies

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because there is no requirement to execute the strategic tools. There is also no need for
creating, verifying evidence and evaluation of outcome according to findings.
3.3 Research approach
A research approach is a vital technique of methodology because it has been practiced to
develop a rationale judgment with regards to research designs and techniques. By using the
research approach, a research scholar could be competent to represent the facts and figures in
a systematic way (Colagiuri, et al., 2015). Approaches to research could be classified into
different categorized such as inductive and deductive approach. This research makes able a
research scholar to prove the reliability of particular tool for pooling and evaluating the facts
and figures. It is also beneficial for a researcher to gain the depth information regarding the
research concern. Consequently, these approaches of research are advantageous for a research
scholar to accomplish the research goals and objectives in a methodological manner.
Deductive approach is applicable for a research scholar due to its effectiveness with
positivism philosophy (Little, et al., 2017). Inductive approach is appropriate for a research
scholar as it is relevance with interpretivism research philosophy. Deductive approach is
implemented to endorse the hypothesis regarding research issue (Aranow, et al., 2015).
A research scholar should collect a high quantity of information regarding research subject
matter in order to approve or reject the hypothesis. But, inductive approach demonstrates the
elasticity with regards to collecting data because there is no need of developing a hypothesis
regarding research subject matter (Chiswick, et al., 2015).
For this dissertation, an inductive approach is executed in this research rather than deductive
approach. Because, it provides a research scholar to gain their theoretical information
associated with research subject matter. This approach of research aids a research scholar to
accomplish the research aim and objectives in particular time duration. It also helps a
research scholar to collect the information and reach at the valid conclusion regarding the

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subject matter. On the other hand, a deductive approach is not appropriate for this research
because there is no need to develop the hypothesis associated with research subject matter
(Chataway, et al., 2014).
3.4 Types of Research
There is certain kind of research, which appropriately aids a research scholar to analyze the
research design. This type of research includes descriptive, explanatory and exploratory
research design. In such way, exploratory research illustrates the primary research in which a
research scholar can determine the research issue by building hypothesis (Pelusi, et al., 2017).
Explanatory research is used to provide depth knowledge with regards to the subject matter of
research. Descriptive research is also known for causal research. It also demonstrates the
cause and effect link between different variables (Ammendolia, et al., 2016).
For completing this dissertation, explanatory research is selected by a research scholar. This
research is beneficial to complete the research in particular time duration. It is also significant
to provide depth information associated with research scholar. On the other hand, both
descriptive and exploratory research design has not selected by a research scholar. Since, it is
not a primary research and also no need to collect the detail data regarding the subject matter
of research.
3.5 Research design
A research design helps to acquire the valid facts and figures associated with research subject
issue. There are different sorts of research methods is incorporated by an investigator such as
quantitative and qualitative research design (Hofmann, et al., 2015). These research designs
also support the research scholar to pool the data. In this way, the qualitative research is
helpful for research scholar to improve their knowledge regarding research issue. In addition
to this, qualitative research design aids an investigator to improve their knowledge with
respect to research issue. The quantitative research design is exercised to assess the

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quantitative facts and figures regarding research subject issue. This technique is implemented
to determine the opinion, belief, and ideas of research respondents. The mixed data pooling
technique aids to acquire the appropriate result (Edmond, et al., 2015).
3.6 Research strategy
A research strategy is an effective element of research which facilitates a research to assess
the research concern by pooling the attitude regarding research question in a methodological
way (Jorsal, et al., 2017). A researcher can pool the contextual information and assess the
data for obtaining a particular conclusion. They can exercise a high range of strategies of
research such as survey through a questionnaire, observation, case study, interview, focused
group, experiment, literature review (Buonfiglio, et al., 2017).
For this research, both surveys through questionnaire and interview strategies are
implemented by a research scholar to gather the large quantity of information regarding
placebo effect-a case of UK healthcare. Under the survey through questionnaire, close-ended
questionnaire structure is executed to conduct the investigation. On the other side, open-
ended questionnaire was chosen to conduct the interview on respondents. A research scholar
could collect the data in minimum time and expenses by executing survey through a
questionnaire (Hofmann, et al., 2016). It could improve the research quality and influence a
large number of stakeholders. On the other hand, a research scholar has implemented
interview strategy to gather the data regarding research concern. It also enables a research
scholar to build liaison with respondents. Consequently, it aids to attain the aim and
objectives of research in the specified time period (Kleveland, et al., 2016). An execution of
interview strategy helps a research scholar to create a link with respondents. It also aids to
obtain the appropriate outcome because of exercising both secondary and primary resources.

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3.8 Data collection method
The data gathering technique helps to gather feasible information by executing the different
sources as it is beneficial to accomplish the predetermined research objectives. It is addressed
that the feasible data pooling process allows an investigator to acquire authentic facts and
figures with respect to research issue (Ashar, et al., 2017). Under this dissertation, certain sort
of information gathering technique is included such as primary and secondary data pooling
sources. In such way, primary information demonstrates the data which is collected from
first-hand resources. There are several resources, which are entailed in primary data gathering
technique like experimental, survey through a questionnaire, interview, and focus group. The
secondary data gathering technique is helpful to gather the theoretical data regarding research
issue (Giugliano, et al., 2017). Since, it is effective to attain the particular objectives in
particular time duration. These sources of data are already published and it is predetermined
by the investigator to acquire reliable and valid data. There are different techniques, which
have entailed as secondary data gathering sources. These sources are a newspaper, articles,
journals, online sources, governmental reports, magazines, and textbooks.
This research is used to analyze the effect of placebo. For this, a research scholar has chosen
both primary and secondary data gathering technique to pool feasible data regarding research
issue (Knorr, et al., 2016). Under this, the primary data gathering technique is beneficial to
generate a direct link with participants as it could be effective for capture the beliefs and
ideas about research subject matter. Furthermore, the secondary data gathering technique
enables a research scholar to generate the theoretical aspect about the concern of research.
The secondary data is gathered from different sources such as journals, articles, online
websites, and academic publication. Survey through questionnaire and interview technique is
implemented by an investigator to conduct the investigation. This technique is beneficial to
reach at the appropriate conclusion. These techniques are supportive for a research scholar to

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obtain the views and beliefs of respondents about particular research issue (Bottoms, et al.,
2014).
3.9 Data analysis
After collecting the facts and figures, it is significant for the investigator to assess the
gathered evidence by data analysis technique (Rosén, et al., 2017). In this way, there is a
large number of data evaluation tool are exercised by the investigator to assess the gathered
information such as determination of statistical, content and conversation analysis (Shepherd,
et al., 2015). The data analysis tool is significant for effectively assessing data and obtains an
appropriate outcome (Leonard, et al., 2016). The statistical data tool is implemented by an
investigator to attain the goal and objective of the investigation. Under this, a research scholar
has implemented different bar graphs and column charts to assess the collected data and
obtain an appropriate result. It is significant for an investigator to modify the information into
meaningful manner. In addition, MS-excel software is implemented by an investigator to
obtain the appropriate result (Jörg, et al., 2018). It makes competent to the researcher to
increase their knowledge regarding existing research concern.
3.10 Sampling technique
Sampling is a technique to select the right applicant for acquiring the information about
research subject matter. There is two sampling technique, which has been considered in the
investigation such as probability and non-probability sampling technique (Lefebvre, et al.,
2016). It helps an investigator to select the feasible sample size from a predetermined
population (Tuttle, et al., 2015). The probability sampling technique is a significant method
to pool the suitable sample size for conducting the investigation. This technique facilitates an
investigator to randomly choose the research participants and conduct the research effectively
(Mohammadpour, et al., 2018). This method also offers equivalent opportunities to choose
the research participants. The non-probability sampling technique is implemented with the

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intention of choosing the participants as per the distinct standards like education, age, gender,
and experience (Gunawardhana, et al., 2017).
Under this dissertation, 50 patients who have believed in Placebo in their medical treatment
and 5 doctors who have awareness about the placebo were chosen from UK healthcare
industry. Under this dissertation, an investigator has executed random probability sampling
technique to choose the respondents without partialities. It is beneficial to obtain the survey
through questionnaire and interview (Moore, et al., 2017). An investigator has exercised
email technique to give earlier information and take their consent from doctors and
administration department for conducting the survey through questionnaire and interview
(Baud, et al., 2016). Under this dissertation, an investigator facilitates accurate instruction to
obtain the interview because it would be prominent for acquiring the valid and reliable result.
3.11 Ethical consideration
An ethical consideration is significant for a researcher because of accomplishing the
particular aim and objectives in an ethical way. Under this, an investigator has implemented
the guidelines of university and college with regards to obtaining the investigation. A
researcher has also maintained the privacy of respondents (Goodwin, et al., 2015). As a
result, it can be significant to create a positive association in future.
Under this dissertation, there are some elements, which are entailed in the dissertation such as
lack of plagiarism, copyright act violation, and lack of data manipulation. The reference
concern could be overcome from the investigation by offering the credit to the actual writer
(Rajakumar, et al., 2015). An investigator will give in-text in each paragraph hence it could
aid to conduct the investigation in an ethical way. An investigator has implemented wide-
ranging communication to assess the gathered information with regards to research issue.
Furthermore, prior consent is essential for an investigator from targeted doctors and patients
to conduct the valid data regarding research concern (Amidfar, et al., 2017). The ethical

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approach is prominent to gather the data from the doctors and patients. It is effective for an
investigator to maintain the authenticity of research result. It also aids an investigator to
arrive at the valid conclusion. A researcher has built instruction to keep the confidential
information of research participants in the research (Osani and Bannuru, 2016).
3.12 Research limitation
There are certain elements, which generates difficulty in the investigation to accomplish the
aim and objectives. There are small numbers of respondents that have not demonstrated their
awareness to contribute to interview and survey through a questionnaire (Khaw, et al., 2017).
It could generate the trouble for an investigator to choose feasible sample size for completing
the aim and objectives. Furthermore, cost, resources, and targeted time duration could restrict
the investigator to conduct the research and obtain the appropriate result (Michaan, et al.,
2016).
3.13 Summary
As per the analysis, it could be concluded that feasible determination of research technique is
implemented by an investigator to accomplish the aim and objectives of research in a
particular time framework. It could be summarized that a researcher will include different
techniques such as approaches, philosophies, strategies, and data gathering process to assess
the research issue. The research methodology makes competent to an investigator to acquire a
reliable and valid result. An investigator has focused on the ethical norms to complete the
research study in an ethical way.

DISSERTATION 23
Chapter 4: Data analysis and findings
4.1 Introduction
This chapter aids to assess the findings which are gathered from interview and survey through
questionnaire techniques. It makes able an investigator to classify the findings with regards to
research aim and objectives as it could be significant to comprehend the effects of placebo in
UK healthcare. This chapter aids to assess the gathered information by exercising MS-excel
software. Since, it provides backing to intense knowledge about the result of research. It
describes different sort of questionnaire associated with demographic, interview-based and
objective based techniques.
Demographical related question
Under this research, the survey through questionnaire is gathered from doctors and patients
who come from different sectors regarding gender and experience. It is described as follow:
Gender
Table 1: Gender
Gender
Male 20
Female 20

DISSERTATION 24
2020
Gender
Male
Female
As per the above table and chart, it is evaluated that 20 participants were chosen to complete
the research. Under this, both 20 males and 20 females were selected to conduct the
investigation. The researcher has provided equal chances to females as males to complete the
research. This investigation aids to pool appropriate outcome from patients due to the high
amount of respondents.
Age-group
Table 2: Age-group
Age-group
Under 23 12
24-32 8
33- 51 11
More 51 9

DISSERTATION 25
Under 23 years 24-32 years 33- 51 years More than 51
years
0
2
4
6
8
10
12
14
12
8
11
9
Age-group
Age-group
Age-group
From the above table and chart, it is depicted that a high number of participants i.e. 12 out
of 40 participants come under 23 while 11 out of 40 employees belong to 33-51 age-group.
This age-group person has high knowledge about the research issue.
Experience
Experience in healthcare organization
0-4 years 10
5-9 years 13
9-11 years 11
More 11 years 8

DISSERTATION 26
0-4years 5-9 years 9-11 years More 11
years
0
2
4
6
8
10
12
14
10
13 11
8
Experience in health care
organization
Experience in health care
organization
As per the above table and chart, it could be exhibited that 13 out of 40 participants has 5-9
years of experience. In opposed to this, 8 out of 40 respondents have more than 11 years of
experience.
Objective Based questionnaire
To analyze meaning and concept of placebo effect
Under this questionnaire, an investigator asked with participants with respect to meaning and
concept of the placebo effect. In such research question, the researcher has acquired the belief
of respondents regarding meaning and concept of the placebo effect. Through this question,
an investigator asked with respondents about the placebo treatment could have a favorable
therapeutic impact on the patient, even pills or treatment is not active. In such way, following
respondents are gathered from the questionnaire.
Placebo treatment could have a favorable therapeutic impact
Table 3: Placebo treatment could have a favorable therapeutic impact
Placebo treatment could have a favorable therapeutic impact
Yes 25
No 15

DISSERTATION 27
25
15
Placebo treatment could have a
favourable therapeutic impact
Yes
No
With regards to above table and chart, it is assessed that 25 out of 40 participants believed
that placebo treatment could have a favorable therapeutic impact on the patient, even pills or
treatment is not active. In contrast to this, 15 out of 40 participants do not believe in the
given statement.
Endogenous opioid is a combination of two elements
Table 4: Endogenous opioid is a combination of two elements
Under this, an investigator asked with respondents regarding the endogenous opioid is a
combination of two elements like enkephalins and endorphins that could be normal pain-
relieving chemicals as it could produce in the body. In addition, the Following outcome is
obtained by performing the survey through a questionnaire:
Endogenous opioid is a combination of two elements
Strongly Agree 12
Agree 16
Neutral 5
Disagree 4
Strongly Disagree 3

DISSERTATION 28
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
0 2 4 6 8 10 12 14 16 18
12
16
5
4
3
Endogenous opioid is a combination
of two elements
Endogenous opioid is a
combination of two
elements
From the above table, it is analyzed that 28 out of 40 participants were agreed with the
statement that the endogenous opioid is a combination of two elements like enkephalins and
endorphins that could be normal pain-relieving chemicals as it could produce in the body. On
the other side, 7 out of 40 participants do not believe in the given statement.
Table 5: Placebo management could influence the central nervous system or brain of
patients
Under this questionnaire, an investigator asked with participants about the Brain of the
patient, central nervous system or dopamine is activated after placebo management. The
below outcome is acquired by conducting the survey through a questionnaire:
Placebo management could influence the central nervous system or brain of patients
Strongly Agree 10
Agree 11
Neutral 9
Disagree 6
Strongly Disagree 4

DISSERTATION 29
Strongly
Agree Agree Neutral Disagree Strongly
Disagree
0
2
4
6
8
10
12
10 11 9
6 4
Placebo management could influence
the central nervous system or brain
of patients
Placebo management
could influence the central
nervous system or brain of
patients
As per the above table and chart, it could be evaluated that 21 out 40 participants believed
that Placebo management could influence the central nervous system or brain of patients. In
opposed to this, 10 out of 40 participants do not agree with the statement.
Table 6: Nausea and pain could easily decline by placebo effect
Under the survey through a questionnaire, an investigator asked with participants about the
Nausea and pain could easily decline by the placebo effect. The below table shows the
number of responses regarding the given statement:
Nausea and pain could easily decline by placebo effect
Yes 35
No 5

DISSERTATION 30
35
5
Nausea and pain could be easily
decline by placebo effect
Yes
No
As per the above assessment, it is also evaluated that 35 out of 40 participants believed that
Nausea and pain could easily decline by the placebo effect. On the other hand, 5 out of 40
participants do not believe with this statement.
To address the Influencing factors for the placebo effect
Under the survey through a questionnaire, an investigator asked with targeted patients about
the influencing factors for the placebo effects. In such way, an investigator asked with the
selected patient that the influence key factor for the placebo treatment. The below result is
gathered by conducting the survey through a questionnaire.
Table 7: key factor could influence the placebo treatment
Under this survey through a questionnaire, an investigator asked with respondents regarding
the key factor could influence the placebo treatment such as lack of principles in PRM
therapies, Treatment heterogeneity, Relationship between patient and doctors and Belief of
patient, motivation, and experience. An investigator obtains the below outcome:
Key factor could influence the placebo treatment
lack of principles in PRM therapies 12
Treatment heterogeneity 8
Relationship between patient and doctors 9

DISSERTATION 31
Belief in patient, motivation, and experience 11
0
4
8
12 12
8 9 11
Key factor could influence the placebo
treatment
Key factor could influence the
placebo treatment
As per the above chart and table, it is identified that 12 out of 40 participants were agreed that
lack of principles in PRM therapies is a key factor could, which could influence the Placebo
treatment. In opposed to this, 8 out of 40 respondents opined that treatment heterogeneity is a
key factor could, which could influence the Placebo treatment.
Table 8: Lack of standard of Physiological Regulating Medicine (PRM) could deliver
inaccurate information to their patient
Under this survey through a questionnaire, an investigator gets the opinion of targeted
patients regarding the statement “lack of standard of Physiological Regulating Medicine
(PRM) could deliver inaccurate information to their patient about their treatment as it could
also a negative impact on behavior”. In such case, following responses were obtained:
Lack of standard of Physiological Regulating Medicine (PRM) could deliver
inaccurate information to their patient
Yes 30
No 10

DISSERTATION 32
30
10
Lack of standard of Physiological
Regulating Medicine (PRM) could
deliver inaccurate information to
their patient
Yes
No
With regards to above chart and table, it is demonstrated that 30 out of 10 participants were
agreed with the statement that the lack of standard of Physiological Regulating Medicine
(PRM) could deliver inaccurate information to their patient about their treatment as it could
also a negative impact on behavior. In opposed to this, 10 out of 40 participants do not
believe on this statement.
Table 9: Treatment heterogeneity could also influence placebo effect
In this question, an investigator asked with participants that the treatment heterogeneity could
also influence placebo treatment that is occurred by lack of physician’s skills regarding
injections, nerve blocks, and acupuncture. The following responses collected from this
question:
Treatment heterogeneity could also influence placebo effect
Strongly Agree 12
Agree 13
Neutral 4
Disagree 6
Strongly Disagree 5

DISSERTATION 33
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
0 2 4 6 8 10 12 14
12
13
4
6
5
Treatment heterogeneity could also
influence placebo effect
Treatment heterogeneity
could also influence
placebo effect
As per the above table and chart, it could be stated that 25 out of 40 patients were agreed with
the statement that the treatment heterogeneity could also influence placebo treatment that is
occurred by lack of physician’s skills regarding injections, nerve blocks, and acupuncture. On
the contrary, 11 out of 40 patients were not agreed with the statement.
Table 10: Level of interaction could support to identify level of placebo effect
Under this, an investigator gets the belief and opinion of respondents regarding the level of
interaction could support to identify the level of the placebo effect and induce real effects. In
such way, the following number of responses was obtained through this question:
Level of interaction could support to identify level of placebo effect
Yes 25
No 15

DISSERTATION 34
25
15
Level of interaction could support to
identify level of placebo effect
Yes
No
With respect to above table and chart, it could be opined that 25 out of 40 participants
believed that level of interaction could support to identify the level of the placebo effect and
induce real effects. In opposed to this, 15 out of 40 participants do not believe on given
statement.
Table 11: key factor could negatively impact on placebo treatment
Under this survey through a questionnaire, a research scholar asked with respondents
regarding the key factor could negatively impact on placebo treatment such as Person's
attitude, Doctor/patient relationship, Characteristics of placebo and Use of medical devices.
The below responses were obtained from the participants about this question:
a key factor could negatively impact on placebo treatment
Person's attitude 12
Doctor/patient relationship 8
Characteristics of placebo 11
Use of medical devices 9

DISSERTATION 35
Person's attitude
Doctor/patient relationship
Characteristics of placebo
Use of medical devices
0
2
4
6
8
10
12
14 12
8
11
9
key factor could negative impact on
placebo treatment
key factor could negative
impact on placebo treatment
From the above chart and table, it is examined that 12 out of 40 participants were agreed with
the statement that attitude of a person is a key factor could negatively impact on placebo
treatment. On the other hand, 8 out of 40 participants were believed that doctor/patient
relationship is a key factor could negatively impact on placebo treatment.
To recommend the strategies to control the placebo effect
This question is relied on gathering the information regarding the strategies to control the
placebo effect. Through this, the targeted patients gave their different opinion with regards to
key approaches used by doctors to eliminate the issues of place effect, which are described as
below:
Table: 12
Key approaches used by doctors to eliminate the issues of place effect
Testing of implantable devices in Neurology
1
2
Use of placebo in Children
1
1
Use of sham procedures/surgical trials– insights from surgical trials 8

DISSERTATION 36
Develop a better understanding of placebos 9
0
4
8
12
12 11 8 9
Key approaches used by doctors to
eliminate the issues of place effect
Key approaches used by
doctors to eliminate the issues
of place effect
From the above table and chart, it could be depicted that 12 out of 40 participants believed
that Testing of implantable devices in Neurology is a key approach used by doctors to
eliminate the issues of place effect. In contrast to this, 8 out of 40 respondents believed that
develop a better understanding of placebos is a key approach used by doctors to eliminate the
issues of place effect.
Table 13:
Pediatric trials should also involve in placebo
Strongly Agree 13
Agree 12
Neutral 6
Disagree 5
Strongly Disagree 4

DISSERTATION 37
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
0 2 4 6 8 10 12 14
13
12
6
5
4
Pediatric trials should also involve
in placebo
Pediatric trials should
also involve placebo
As per the above table and chart, it could be evaluated that 25 out of 40 respondents believed
that healthcare organization could use placebo treatment in the pediatric trials to improve
their outcome quality. In contrast to this, 9 out of 40 participants do not believe in the given
statement.
Interview questionnaire
For conducting the interview, 5 doctors have selected to complete the main aim and
objectives of the research.
Demographic description
Table 14: Gender
Gender
Male 2
Female 3

DISSERTATION 38
2
3
Gender
Male
Female
Above table and chart opined that 2 out of 5 participants are male and rest 3 are female. It
indicates that researcher has conducted the interview by giving the most preference to
females.
Table 15: Age-group
Age group
Under 22 1
23-30 1
31-49 2
More 49 1
Under 22 23-30 31-49 More 49
0
0.5
1
1.5
2
2.5
1 1
2
1
Age group
Age group

DISSERTATION 39
From the above table and chart, it could be demonstrated that 2 out of 5 participants comes
under 31-49 years while only 1 out of 5 participants comes under 22, 1 participants belong to
23-30 years and 1 respondents belong to more than 49 years.
Table: Experience in healthcare organization
Experience in healthcare organization
0-3years 1
4-10 years 2
11-13 years 1
Above 13 years 1
0-3years 4-10 years 11-13 years Above 13
years
0
0.5
1
1.5
2
2.5
1
2
1 1
Experience in health care
organization
Experience in health care
organization
As per the above chart and table, it could be exhibited that 2 out of 5 participants have 4-10
years of experience while 1 out of 5 participants has 0-3 years, 1 participants have 11-13
years and 1 participants have above 13 years of experience in the healthcare sector.

DISSERTATION 40
Chapter 5 Findings
5.1 Introduction
This section supports to identify the findings, which are gathered from survey through
questionnaire and interview method. It permits the researcher to classify the findings for
attaining the specified aim and objectives of the research. It could also be effective to
determine the placebo treatment on UK healthcare organization. Moreover, this chapter also
helps to evaluate the gathered data through MS-Excel software as it would help to gain the
quality of research result (Block, et al., 2017). It discusses different kinds of a questionnaire
that are associated with objectives based, interview-based, and demographical method.
Furthermore, it is also addressed that the gathered data is evaluated by literature review for
attaining research aim and objectives (Sabbagh, et al., 2017).
5.2 To explore meaning and concept of placebo effect: in context of UK healthcare
organization
From the analysis of survey through a questionnaire, it is found that most of the respondents
believe that placebo treatment could have a favorable therapeutic impact on the patient, even
pills or treatment is not active. It is also evaluated that a large number of participants seeks
that the endogenous opioid is a combination of two elements like enkephalins and endorphins
that could be normal pain-relieving chemicals as it could produce in the body.
These findings are supported by the view of Bo et al. (2016) as placebo treatment could direct
positive impact on the patient health when pills and treatment are not working. It is also
found that placebo effect is functioning on approx. 20 to 40% of the patient. Moreover, it is
also examined that patient who thinks that their health is improved by pills. In this condition,
their brain is working on the basis of their thinking. Consequently, the patient could be
improved by their existing disease. There are certain factors such as enkephalins and

DISSERTATION 41
endorphin is considered in the endogenous opioid. It is a normal pain-relieving chemical,
which would create in the brain of a patient. The placebo effect insensibility could be based
on endogenous opioids in the body.
It is also examined that huge amount of research candidates could believe that placebo
management could influence the central nervous system or brain of patients. Moreover, it is
also found that participants also believe that nausea and pain could easily decline by the
placebo effect.
These findings are supported by the view of Røjskjær et al. (2015) nervous structure and
brain is affected by the brain of a patient. It is also examined that placebo treatment cannot
primarily influence the health of people. It would modest impact on the patient-reported
outcome. Moreover, and pain and sickness, and vomiting health illness could be easily
improved by placebo therapy. It is examined that placebo treatment could be influenced by
differences in the trial design and how physician provide the instruction regarding treatment.
5.3 To identify challenges of placebo effects: in context of UK healthcare organization
On behalf of the survey through a questionnaire, it is also addressed that a large number of
respondents seeks that lack of standard in PRM could influence the Placebo treatment in the
healthcare sector.
These findings are supported by the view of Moreira‐Lucas et al. (2017) as there are certain
factors that could influence the placebo treatment like motivation, and experience, treatment
heterogeneity, the relationship between patient and doctors, the belief of patient, and lack of
principles in PRM therapies. It is also found that most of the respondents believe that lack of
standard in Physiological Regulating Medicine (PRM) could influence the placebo treatment
by offering inaccurate data to patients about their treatment. It is also addressed that there are
many exercises as it could imply for strengthening, endurance, and stretching. Hence, it is
difficult for PRM to make a standard for each therapy as it would negatively impact on the

DISSERTATION 42
placebo treatment. It is also found that more of respondents seek that 40 out of 30
respondents believe that lack of standard of Physiological Regulating Medicine (PRM) could
be a major issue of placebo treatment.
These findings are supported by the opinion of Achiron et al. (2015) as Physiological
Regulating Medicine could be imperative for the placebo effect because it enables doctors to
offer adequate health services to the patient and satisfy them in less time and cost. Beside
this, lack of standards in Physiological Regulating Medicine would offer incorrect data to
patients about their treatment due to the availability of many therapies in the PRM.
It is also examined that a large number of respondents seeks that treatment heterogeneity
could also influence placebo treatment that is occurred by lack of physician’s skills regarding
injections, nerve blocks, and acupuncture. It is also found that interaction could support to
identify the level of the placebo effect and induce real effects.
These findings are supported by the opinion of De Oliveira Jr, et al. (2017) as treatment
heterogeneity would also directly impact on the placebo treatment. The treatment
heterogeneity is occurred by the skills of physician’s regarding nerve blocks, acupuncture,
and injections. Hence, it is also found that doctors could improve their skills regarding such
activity for improving the application of placebo effect. It creates more difficulty to design
significant placebo treatment in such condition.
It is also found that most of the respondents believe that level of interaction could support to
identify the level of the placebo effect and induce real effects. These findings are supported
by the opinion of Tahapary et al. (2017) personal interaction between patient and doctors
could direct impact on the patient behavior. For example, speech treatment, and language
after brain harm. Moreover, it is also addressed that cognitive behavioral therapy could help
to identify the association between the therapist and patient. Furthermore, It is also addressed

DISSERTATION 43
that level of interaction would help to determine the level of the placebo effect. It is also
illustrated that inspiration could be complicated for using placebo effect on the patient.
It is also examined that many key factors that could negatively impact on the placebo
treatment such as Doctor/patient relationship, person’s attitude, Characteristics of placebo,
and Use of medical devices. Thus, it is also illustrated that most of the respondents believe
that person’s attitude could negatively influence placebo treatment. These findings are
supported by the view of Kohavi et al. (2017) as inspiration, personal beliefs, and personal
beliefs could direct impact on placebo effects. Patients have different needs and with non-
pharmacological supervisions in PRM. It is also identified that demand of patients regarding
healthcare services could direct impact on the placebo effects. Furthermore, Placebo effect
could be enhanced in these treatments like occupational therapy, home exercises, and
cognitive-behavioral interventions.
5.4 To recommend the approaches for improving place effect: in context of UK
healthcare organization
On behalf of the survey through a questionnaire, it is also addressed that a large number of
respondents seeks that testing of the implantable device in Neurology could use by doctors in
placebo treatment.
These findings are supported by the view of Masanja et al. (2015) as healthcare organization
could concentrate on an implantable device with respect to identifies the treatment period of
the patient. It will also help to provide accurate treatment in the limited time. Furthermore,
Health Company could imply placebo on children, which could be effective for getting a
positive result. The company would get experience with pediatrics patients because there is
more chance of getting favorable outcome form placebo treatment. As a result, the company
will be capable to obtain the highest quality.
Interview method

DISSERTATION 44
To explore meaning and concept of placebo effect: in context of UK healthcare
organization
From the analysis of interview method, it is found that most of the research participants seek
that sickness and pain of patients could be declined by placebo treatment. These findings are
supported by the views of Raine et al. (2015) as pain and nausea would easily decline by
placebo therapy. It is also examined that difference in trail design and treatment method of
doctors could direct impact on the treatment of placebo.
To identify challenges of placebo effects: in context of UK healthcare organization
From the interview method, it is addressed that a large number of participants believe that
placebo treatment could be affected by many factors could influence placebo therapy like
lack of principles in PRM therapies, treatment heterogeneity, the relationship between patient
and doctors, and belief of patient, motivation, and experience. But, at the same time, it is also
addressed that most of the research candidates believed that lack of standard in PRM could
direct impact on the placebo treatment.
These findings are supported by the view of Chen et al. (2018) as lack of standard in
Physiological Regulating Medicine (PRM) could deliver inaccurate information to their
patient about their treatment as it could also a negative impact on behavior.
In addition, it is also found that placebo treatment could also influence certain reasons like
doctor and patient’s relationship, place characteristics, and use of the medical device.
These findings are supported by the view of Rovner et al. (2017) as a personal relationship
between doctors and therapist would affect the behavior of the patient. Speech treatment and
language improvement after brain harm could be enhanced by the placebo effect. Moreover,
it is also addressed that cognitive behavioral therapy as it would support to identify the
relationships between patient and therapist. Furthermore, it is also addressed that level of

DISSERTATION 45
interaction would also determine the placebo treatment result. It is also found that motivation
and need would also directly impact on the placebo treatment.
To recommend the approaches for improving place effect: in context of UK healthcare
organization
From the interview method, it is addressed that there are many strategies that could be used
by healthcare organization to improve the placebo treatment in their working place such as
Testing of implantable devices in Neurology, Use of placebo in Children, Use of sham
procedures/surgical trials– insights from surgical trials, and develop a better understanding of
placebos. It is found that most of the respondents seek that the Testing of implantable devices
in Neurology could be a key strategy for improving placebo treatment in the healthcare
organization. These findings are supported by Gaztanaga et al. (2015) as the healthcare
organization could concentrate on an implantable device with respect to identifies the interval
time of treatment. Consequently, it would support the doctor to offer accurate treatment in
particular time. Furthermore, health organization would also use the placebo on children for
avoiding pills and surgery. The healthcare organization could also gain their understanding
towards the pediatric trials as it could be supportive to improve the outcome quality of
placebo effect. It is also found that a large number of respondents seek that the healthcare
organization should develop the best understanding about placebo as could support to the best
practice of placebo.
These findings are supported by the view of Faisy et al. (2016) as healthcare company should
create the best understanding towards the placebo effects as it could support to obtain the
favorable result. It is also stated that organizations are not aware of placebo effects
mechanism.Therefore, a company is needed to critically investigate about the biological
techniques, which will be helpful for placebo treatment.

DISSERTATION 46
Chapter 5: Conclusion and recommendation
To analyze meaning and concept of placebo effect
It could be concluded that placebo treatment could have a positive therapeutic impact on the
patient, even medicines or treatment is not active. It is also evaluated that the endogenous
opioid is a set of different components such as endorphins and enkephalins. It could be basic
pain-relieving chemicals because it may create in the body. It could be summarized that
Placebo management could impact on the central nervous system or brain of a patient. It
could be exhibited that Nausea and pain could be easily decreased by Placebo effect.
To address the Influencing factors for the placebo effect
From the above discussion, it could be concluded that there are some key factors that could
influence the placebo treatment named lack of principles in PRM therapies, Treatment
heterogeneity, Relationship between patient and doctors and Belief of patient, motivation,
and experience (Bernstein, 2017). It could be evaluated that the lack of standard of
Physiological Regulating Medicine (PRM) can provide the wrong data to their patient about
their treatment as it could also have an adverse effect on their behavior. It could be
summarised that heterogeneity factor can impact on Placebo treatment (Kristensen, et al.,
2018). This factor could be raised due to the inadequacy of physician’s proficiency with
respect to nerve blocks, acupuncture, and injection. It could be concluded that lack of
interaction could aid to demonstrate the level of placebo effects and persuades real treatment.
It could be summarized that there is a certain key factor, which could adversely impact on the
treatment of Placebo named doctor/patient relationship, person’s attitude, use of medical
devices and characteristics of placebo (Farhang and Grondin, 2018).
To recommend the strategies to control the placebo effect
It could be concluded that there are different key approaches, which could be implemented by
doctors to overcome the concern from placebo treatment. These strategies are testing of

DISSERTATION 47
implantable devices in neurology, use of placebo in children, use of sham procedures/surgical
trials, insights from surgical trials, and develop a better understanding of placebos. It could be
summarized that healthcare organization could use placebo treatment in pediatric trials to
improve their outcome quality.
Recommendation
To analyze Meaning and concept of placebo effect: in context of UK healthcare
From the above analysis, it can be suggested that placebo could positively influence patient
illness when pills are not working. In addition, it is addressed that health organization should
deeply understand placebo effect for effectively implement it in the treatment of patients
(Sørensen, et al., 2016). It is not necessary that placebo method could work on all the
situation of patients (Quraishi, et al., 2015). In addition, it is also evaluated that patients who
believed that medicines are effective then their brain is starting to run on behalf of their belief
(Lewis, 2016). Hence, it could support to improve their sickness. Moreover, it is also
suggested that organization should also gain their understanding about two factors such as
enkephalins and endorphins as it could be normal pain-relieving chemicals, which is
produced in the human body (Garcia-Peris, et al., 2016).
To address the Influencing factors for the placebo effect: in context of UK healthcare
It is also suggested that there are different factors that could influence place treatment in the
healthcare organization such as lack of principles in PRM therapies, treatment heterogeneity,
the relationship between patient and doctors, Belief of patient, motivation, and experience
(Violi, et al., 2017). Other factors are Person's attitude, Doctor/patient relationship,
Characteristics of placebo, and Use of medical devices. Moreover, it is also addressed that the
cognitive behavioral therapy could help to identify the relation between therapist and patient
(Kam-Hansen, et al., 2014). Further, it is also found that level of interaction could support to
determine the level of placebo treatment (Broatch, et al., 2014).

DISSERTATION 48
It is also suggested that organization should also gain their understanding towards experience,
personal beliefs, and motivation could negatively impact on placebo treatment (Banaszewska,
et al., 2016). It is also recommended that organization should need to understand the demand
of patients for effective use of placebo (Han, et al., 2018).
To recommend the strategies to control the placebo effect: in context of UK healthcare
Health organisation should need to understand the mechanism of placebo effect for getting
positive result. Healthcare organisation should critically investigate about biological
techniques of placebos treatment (Bar Yoseph, et al., 2015). In addition, it is also found that
health care company should concentrate on the implantable device with respect to identify the
treatment time (Brock, et al., 2016). As a result, doctors could be capable to determine time
for accurate treatment. Furthermore, health company should use place treatment on children
as it would support to effectively practice placebo (Wang, et al., 2015). In addition, it is also
determined that there are different factors that could improve placebo practices like testing of
implantable devices in neurology, use of placebo in children, use of sham procedures/surgical
trials– insights from surgical trials, and develop a better understanding of placebos
(Cummings,et al., 2014).

DISSERTATION 49
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Lumbar Spinal Stenosis: A Protocol for a Randomized Controlled Trial’, Journal of
chiropractic medicine, 15(3), pp. 197-203.
Andrieu, S., Guyonnet, S., Coley, N., Cantet, C., Bonnefoy, M., Bordes, S., ... & Desclaux, F.
(2017) ‘Effect of long-term omega 3 polyunsaturated fatty acid supplementation with or
without multidomain intervention on cognitive function in elderly adults with memory
complaints (MAPT): a randomised, placebo-controlled trial’, The Lancet Neurology, 16(5),
pp. 377-389.
Aranow, C.L., Dall'Era, M., Massarotti, E. M., Mackay, M. C., Koumpouras, F., ... &
Callahan, S. (2015) ‘Randomized, double‐blind, placebo‐controlled trial of the effect of
vitamin d3 on the interferon signature in patients with systemic lupus
erythematosus’, Arthritis & Rheumatology, 67(7), pp. 1848-1857.
Archer, D. F., Watts, N., Gallagher, C., Simon, J., Duan, W. R., Rowan, J. P., ... & Williams,
L. A. (2016) ‘The effect of elagolix on bone mineral density: safety results from two
randomized, placebo-controlled studies in women with endometriosis-associated
pain’, Fertility and Sterility, 106(3), pp. e276-e277.

DISSERTATION 50
Archer, D. F., Watts, N., Gallagher, C., Simon, J., Duan, W. R., Rowan, J. P., ... & Williams,
L. A. (2016) ‘The effect of elagolix on bone mineral density: safety results from two
randomized, placebo-controlled studies in women with endometriosis-associated
pain’, Fertility and Sterility, 106(3), pp. e276-e277.
Ashar, Y. K., Chang, L. J., & Wager, T. D. (2017) ‘Brain mechanisms of the placebo effect: an
effective appraisal account’, Annual review of clinical psychology, 13, pp. 73-98.
Azaïs, J., Salle, V. P., Barnetche, T., Bonnet, C., Dufauret-Lombard, C., Trèves, R., & Bertin,
P. (2014) ‘Clinical efficacy rate of the non-specific effect (the placebo effect) in the tumour
necrosis factor inhibitors for rheumatoid arthritis treatment after methotrexate failure: meta-
analysis’,. Fundamental and Clinical Pharmacology, 28, P. 95.
Banaszewska, B., Wrotyńska-Barczyńska, J., Spaczynski, R. Z., Pawelczyk, L., & Duleba, A.
J. (2016) ‘Effects of resveratrol on polycystic ovary syndrome: a double-blind, randomized,
placebo-controlled trial’, The Journal of Clinical Endocrinology & Metabolism, 101(11), pp.
4322-4328.
Bar Yoseph, R., Livnat, G., Schnapp, Z., Hakim, F., Dabbah, H., Goldbart, A., & Bentur, L.
(2015) ‘The effect of vitamin D on airway reactivity and inflammation in asthmatic children:
A double‐blind placebo‐controlled trial’, Pediatric Pulmonology, 50(8), pp. 747-753.
Baud, O., Maury, L., Lebail, F., Ramful, D., El Moussawi, F., Nicaise, C., ... & Andrini, P.
(2016) ‘Effect of early low-dose hydrocortisone on survival without bronchopulmonary
dysplasia in extremely preterm infants (PREMILOC): a double-blind, placebo-controlled,
multicentre, randomised trial, The Lancet, 387(10030), pp. 1827-1836.
Bernstein, C. N. (2017) ‘the impact of the placebo effect in Crohn's disease’, Alimentary
pharmacology & therapeutics, 45(11), pp. 1471-1472.
Block, G. A., Bushinsky, D. A., Cunningham, J., Drueke, T. B., Ketteler, M., Kewalramani, R.,
... & Silver, J. (2017) ‘Effect of etelcalcetide vs placebo on serum parathyroid hormone in

DISSERTATION 51
patients receiving hemodialysis with secondary hyperparathyroidism: two randomized
clinical trials’, Jama, 317(2), pp.146-155.
Bo, S., Ponzo, V., Ciccone, G., Evangelista, A., Saba, F., Goitre, I., ... & Gambino, R. (2016)
‘Six months of resveratrol supplementation has no measurable effect in type 2 diabetic
patients. A randomized, double blind, placebo-controlled trial’, Pharmacological
research, 111, pp. 896-905.
Boehm, K., Berger, B., Weger, U., & Heusser, P. (2017) ‘Does the model of additive effect in
placebo research still hold true? A narrative review’, JRSM open, 8(3), pp.
2054270416681434.
Boers, M., Aletaha, D., Mela, C. M., Baker, D. G., & Smolen, J. S. (2016) ‘Glucocorticoid
effect on radiographic progression in placebo arms of rheumatoid arthritis biologics
trials’, The Journal of rheumatology, 43(6), pp. 1024-1026.
Bottoms, L., Buscombe, R., & Nicholettos, A. (2014) ‘The placebo and nocebo effects on peak
minute power during incremental arm crank ergometry’, European journal of sport
science, 14(4), pp. 362-367.
Broatch, J. R., Petersen, A., & Bishop, D. J. (2014) ‘Postexercise cold water immersion
benefits are not greater than the placebo effect’, Medicine and science in sports and
exercise, 46(11), pp. 2139-2147.
Brock, G., Heiselman, D., Maggi, M., Kim, S. W., Vallejo, J. M. R., Behre, H. M., ... & Ni, X.
(2016) ‘Effect of testosterone solution 2% on testosterone concentration, sex drive and
energy in hypogonadal men: results of a placebo controlled study’, The Journal of
urology, 195(3), pp. 699-705.
Buonfiglio, L. G. V., Cano, M., Pezzulo, A. A., Calderon, O. G. V., Zabner, J., Gerke, A. K.,
& Comellas, A. P. (2017) ‘Effect of vitamin D 3 on the antimicrobial activity of human

DISSERTATION 52
airway surface liquid: preliminary results of a randomised placebo-controlled double-blind
trial’, BMJ open respiratory research, 4(1), p. e000211.
Chataway, J., Schuerer, N., Alsanousi, A., Chan, D., MacManus, D., Hunter, K., ... & Fox, N.
C. (2014) ‘Effect of high-dose simvastatin on brain atrophy and disability in secondary
progressive multiple sclerosis (MS-STAT): a randomised, placebo-controlled, phase 2
trial’, The Lancet, 383(9936), pp. 2213-2221.
Chen, D. L., Huang, H. J., Byers, D. E., Shifren, A., Belikoff, B., Engle, J. T., ... & Fujiwara,
H. (2018) ‘The peroxisome proliferator-activated receptor agonist pioglitazone and 5-
lipoxygenase inhibitor zileuton have no effect on lung inflammation in healthy volunteers by
positron emission tomography in a single-blind placebo-controlled cohort study’, PloS
one, 13(2), p. e0191783.
Chen, D. L., Huang, H. J., Byers, D. E., Shifren, A., Belikoff, B., Engle, J. T., ... & Fujiwara,
H. (2018) ‘The peroxisome proliferator-activated receptor agonist pioglitazone and 5-
lipoxygenase inhibitor zileuton have no effect on lung inflammation in healthy volunteers by
positron emission tomography in a single-blind placebo-controlled cohort study’, PloS
one, 13(2), p. e0191783.
Chiswick, C., Reynolds, R. M., Denison, F., Drake, A. J., Forbes, S., Newby, D. E., ... &
Lashen, H. (2015) ‘Effect of metformin on maternal and fetal outcomes in obese pregnant
women (EMPOWaR): a randomised, double-blind, placebo-controlled trial’, The lancet
Diabetes & endocrinology, 3(10), pp. 778-786.
Colagiuri, B., Schenk, L. A., Kessler, M. D., Dorsey, S. G., & Colloca, L. (2015) ‘The placebo
effect: from concepts to genes’, Neuroscience, 307, pp. 171-190.
Crawford, G., Tovar, G., Olivier, F., Dilgil, M., Gudi, A., Shah, A., & Homburg, R. (2015)
‘The effect of intrauterine injection of seminal plasma on Ivf results a prospective double-

DISSERTATION 53
blind randomised placebo-controlled trial’ Bjog: An International Journal of Obstetrics and
Gynaecology, 122, pp. 379.
Cummings, J., Isaacson, S., Mills, R., Williams, H., Chi-Burris, K., Corbett, A., ... & Ballard,
C. (2014) ‘Pimavanserin for patients with Parkinson's disease psychosis: a randomised,
placebo-controlled phase 3 trial’, The Lancet, 383(9916), pp. 533-540.
De Oliveira Jr, G. S., Bialek, J., Marcus, R. J., & McCarthy, R. (2017) ‘Dose-Ranging Effect
of Systemic Diphenhydramine on Postoperative Quality of Recovery After Ambulatory
Laparoscopic Surgery: A Randomized, Placebo-Controlled, Double-blinded, Clinical
Trial’, Survey of Anesthesiology, 61(2), pp. 34-35.
Demant, D. T., Lund, K., Vollert, J., Maier, C., Segerdahl, M., Finnerup, N. B., & Sindrup, S.
H. (2014) ‘The effect of oxcarbazepine in peripheral neuropathic pain depends on pain
phenotype: a randomised, double-blind, placebo-controlled phenotype-stratified
study’, PAIN®, 155(11), pp. 2263-2273.
Durgam, S., Earley, W., Lu, K., Németh, G., Laszlovszky, I., Szatmári, B., ... & Nasrallah, H.
A. (2016) ‘Cariprazine for negative symptoms of schizophrenia: pooled post hoc analysis of 2
randomized, double-blind, placebo-and active-controlled trials’, European
Neuropsychopharmacology, 26, P. S552.
Edmond, K. M., Newton, S., Shannon, C., O'Leary, M., Hurt, L., Thomas, G., ... & Bahl, R.
(2015) ‘Effect of early neonatal vitamin A supplementation on mortality during infancy in
Ghana (Neovita): a randomised, double-blind, placebo-controlled trial’, The
Lancet, 385(9975), pp. 1315-1323.
Espay, A. J., Norris, M. M., Eliassen, J. C., Dwivedi, A., Smith, M. S., Banks, C., &
Szaflarski, J. P. (2015) ‘Placebo effect of medication cost in Parkinson disease A randomized
double-blind study’, Neurology, 84(8), pp. 794-802.

DISSERTATION 54
Faisy, C., Meziani, F., Planquette, B., Clavel, M., Gacouin, A., Bornstain, C., ... & Ricard, J.
D. (2016) ‘Effect of acetazolamide vs placebo on duration of invasive mechanical ventilation
among patients with chronic obstructive pulmonary disease: a randomized clinical
trial’, Jama, 315(5), pp. 480-488.
Farhang, B., & Grondin, L. (2018) ‘The Effect of Zinc Lozenge on Postoperative Sore Throat:
A Prospective Randomized, Double-Blinded, Placebo-Controlled Study’, Anesthesia &
Analgesia, 126(1), pp. 78-83.
Fuchs, C. S., Tomasek, J., Yong, C. J., Dumitru, F., Passalacqua, R., Goswami, C., &
Melichar, B. (2014) ‘Ramucirumab monotherapy for previously treated advanced gastric or
gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised,
multicentre, placebo-controlled, phase 3 trial’, The Lancet, 383(9911), pp. 31-39.
Garcia, J. (2015) Teaching the Placebo Effect. Academic Psychiatry, 39(1), pp.122-122.
Garcia-Peris, P., Velasco, C., Hernandez, M., Lozano, M. A., Paron, L., De La Cuerda, C., ...
& Guarner, F. (2016) ‘Effect of inulin and fructo-oligosaccharide on the prevention of acute
radiation enteritis in patients with gynecological cancer and impact on quality-of-life: a
randomized, double-blind, placebo-controlled trial’, European journal of clinical
nutrition, 70(2), p. 170.
Gaztanaga, J., Farkouh, M., Rudd, J. H., Brotz, T. M., Rosenbaum, D., Mani, V., ... & Fayad,
Z. A. (2015) ‘A phase 2 randomized, double-blind, placebo-controlled study of the effect of
VIA-2291, a 5-lipoxygenase inhibitor, on vascular inflammation in patients after an acute
coronary syndrome’, Atherosclerosis, 240(1), pp. 53-60.
Gerdesmeyer, L., Klueter, T., Rahlfs, V. W., Muderis, M. A., Saxena, A., Gollwitzer, H., ... &
Prehn-Kristensen, A. (2017) ‘Randomized Placebo-Controlled Placebo Trial to Determine the
Placebo Effect Size’, Pain physician, 20, pp. 387-396.

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Ghosh, S., Ghosh, T., Mondal, R., Patra, S., Das, S., Ali, S. S., ... & Saha, S. (2018) ‘Efficacy
of Arsenicum album 30cH in preventing febrile episodes following DPT-HepB-Polio
vaccination− a randomized, double-blind, placebo-controlled clinical trial’, Complementary
Therapies in Medicine, 36, pp. 59-62.
Giugliano, R. P., Mach, F., Zavitz, K., Kurtz, C., Schneider, J., Wang, H., ... & Honarpour, N.
(2017) ‘Design and rationale of the EBBINGHAUS trial: A phase 3, double‐blind, placebo‐
controlled, multicenter study to assess the effect of evolocumab on cognitive function in
patients with clinically evident cardiovascular disease and receiving statin background lipid‐
lowering therapy—A cognitive study of patients enrolled in the FOURIER trial’, Clinical
cardiology, 40(2), pp. 59-65.
Glund, S., Stangier, J., Schmohl, M., Gansser, D., Norris, S., van Ryn, J., ... & Reilly, P.
(2015) ‘Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant
effect of dabigatran in healthy male volunteers: a randomised, placebo-controlled, double-
blind phase 1 trial’, The Lancet, 386(9994), pp. 680-690.
Goodwin, P. J., Parulekar, W. R., Gelmon, K. A., Shepherd, L. E., Ligibel, J. A., Hershman, D.
L., ... & Thompson, A. M. (2015) ‘Effect of metformin vs placebo on weight and metabolic
factors in NCIC CTG MA. 32’, JNCI: Journal of the National Cancer Institute, 107(3).
Gros, P., Chen, R., Feinstein, A., Lang, A. E., & Burke, M. J. (2017) ‘Neurostimulation for the
treatment of functional neurological disorders: Novel therapeutic strategy or placebo
effect?’, Brain Stimulation: Basic, Translational, and Clinical Research in
Neuromodulation, 10(2), p. 471.
Gunawardhana, L., McLean, L., Punzi, H. A., Hunt, B., Palmer, R. N., Whelton, A., & Feig, D.
I. (2017) ‘Effect of Febuxostat on Ambulatory Blood Pressure in Subjects With
Hyperuricemia and Hypertension: A Phase 2 Randomized Placebo‐Controlled
Study’, Journal of the American Heart Association, 6(11), p. e006683.

DISSERTATION 56
Hall, K. T., Loscalzo, J., & Kaptchuk, T. J. (2015) ‘Genetics and the placebo effect: the
placebome’, Trends in molecular medicine, 21(5), pp. 285-294.
Hammami, M. M., Hammami, S., Al-Swayeh, R., Al-Gaai, E., Farah, F. A., & De Padua, S. J.
(2016) ‘Drug* placebo interaction effect may bias clinical trials interpretation: hybrid
balanced placebo and randomized placebo-controlled design’, BMC medical research
methodology, 16(1), P. 166.
Han, Y., Kwon, E. Y., Yu, M. K., Lee, S. J., Kim, H. J., Kim, S. B., ... & Choi, M. S. (2018)
‘A Preliminary Study for Evaluating the Dose-Dependent Effect of d-Allulose for Fat Mass
Reduction in Adult Humans: A Randomized, Double-Blind, Placebo-Controlled
Trial’, Nutrients, 10(2), p. 160.
Hofmann, S. G., Fang, A., & Brager, D. N. (2015) ‘Effect of intranasal oxytocin administration
on psychiatric symptoms: a meta-analysis of placebo-controlled studies’, Psychiatry
research, 228(3), p. 708.
Hofmann, S. G., Fang, A., & Brager, D. N. (2016) ‘Notice of Retraction and Replacement:
Hofmann et al. Effect of intranasal oxytocin administration on psychiatric symptoms: A
meta-analysis of placebo-controlled studies’, Psychiatry Research, 228, pp. 708-714.
Huttner, A., Dayer, J. A., Yerly, S., Combescure, C., Auderset, F., Desmeules, J., & Kaya, G.
(2015) ‘The effect of dose on the safety and immunogenicity of the VSV Ebola candidate
vaccine: a randomised double-blind, placebo-controlled phase 1/2 trial’, The Lancet
Infectious Diseases, 15(10), pp.1156-1166.
Jörg, L., Pecaric‐Petkovic, T., Reichenbach, S., Coslovsky, M., Stalder, O., Pichler, W., &
Hausmann, O. (2018) ‘Double‐blind placebo‐controlled trial of the effect of omalizumab on
basophils in chronic urticaria patients’, Clinical & Experimental Allergy, 48(2), pp. 196-204.
Jorsal, A., Kistorp, C., Holmager, P., Tougaard, R. S., Nielsen, R., Hänselmann, A., ... &
Boesgaard, T. W. (2017) ‘Effect of liraglutide, a glucagon‐like peptide‐1 analogue, on left

DISSERTATION 57
ventricular function in stable chronic heart failure patients with and without diabetes (LIVE)
—a multicentre, double‐blind, randomised, placebo‐controlled trial’, European journal of
heart failure, 19(1), pp. 69-77.
Kam-Hansen, S., Jakubowski, M., Kelley, J. M., Kirsch, I., Hoaglin, D. C., Kaptchuk, T. J., &
Burstein, R. (2014) ‘Altered placebo and drug labeling changes the outcome of episodic
migraine attacks’, Science translational medicine, 6(218), pp. 218ra5-218ra5.
Khaw, K. T., Stewart, A. W., Waayer, D., Lawes, C. M., Toop, L., Camargo Jr, C. A., &
Scragg, R. (2017) ‘Effect of monthly high-dose vitamin D supplementation on falls and non-
vertebral fractures: secondary and post-hoc outcomes from the randomised, double-blind,
placebo-controlled ViDA trial’, The Lancet Diabetes & Endocrinology, 5(6), pp. 438-447.
Kleveland, O., Kunszt, G., Bratlie, M., Ueland, T., Broch, K., Holte, E., ... & Aakhus, S.
(2016) ‘Effect of a single dose of the interleukin-6 receptor antagonist tocilizumab on
inflammation and troponin T release in patients with non-ST-elevation myocardial infarction:
a double-blind, randomized, placebo-controlled phase 2 trial’, European heart
journal, 37(30), pp. 2406-2413.
Knorr, U., Koefoed, P., Gluud, C., Wetterslev, J., Winkel, P., Gether, U., ... & Kessing, L. V.
(2016) ‘Effect of escitalopram versus placebo on GRα messenger RNA expression in
peripheral blood cells of healthy individuals with a family history of depression–a secondary
outcome analysis from the randomized AGENDA trial’, Nordic journal of psychiatry, 70(4),
pp. 297-302.
Kohavi, L., Sprecher, E., Zur, E., & Artzi, O. (2017) ‘The Effect of Tranilast 8% Liposomal
Gel Versus Placebo on Post-Cesarean Surgical Scars: A Prospective Double-Blind Split-Scar
Study’, Dermatologic Surgery, 43(9), pp. 1157-1163.

DISSERTATION 58
Koog, Y. H. (2016) ‘Effect of placebo acupuncture over no-treatment: a simple model
incorporating the placebo and nocebo effects’, Complementary therapies in medicine, 24, pp.
69-72.
Kristensen, S., Schmidt, E. B., Schlemmer, A., Rasmussen, C., Johansen, M. B., &
Christensen, J. H. (2018) ‘Beneficial effect of n-3 polyunsaturated fatty acids on
inflammation and analgesic use in psoriatic arthritis: a randomized, double blind, placebo-
controlled trial’, Scandinavian journal of rheumatology, 47(1), pp. 27-36.
Lefebvre, J. C., & Bednar, J. T. (2016) ‘Causes and Consequences: Pain Research and the
Placebo Effect’, Questioning Causality: Scientific Explorations of Cause and Consequence
Across Social Contexts, p. 185.
Leonard, M. B., Shults, J., Long, J., Baldassano, R. N., Brown, J. K., Hommel, K., ... & Lee,
D. (2016) ‘Effect of Low‐Magnitude Mechanical Stimuli on Bone Density and Structure in
Pediatric Crohn's Disease: A Randomized Placebo‐Controlled Trial’, Journal of Bone and
Mineral Research, 31(6), pp. 1177-1188.
Lewis, S. (2016) ‘Neuroimmunology: Immune to the placebo effect’, Nature Reviews
Neuroscience, 17(9), pp. 535-535.
Lindheimer, J. B., O’Connor, P. J., & Dishman, R. K. (2015) ‘Quantifying the placebo effect
in psychological outcomes of exercise training: a meta-analysis of randomized trials’, Sports
Medicine, 45(5), pp. 693-711.
Little, P., Hayward, G., Hay, A., Moore, M., Jawad, S., Williams, N., & Perrera, R. (2017)
‘Effect of oral dexamethasone without immediate antibiotics vs placebo on acute sore throats
in adults: a randomized clinical trial’, JAMA, 317(15), pp. 1535-1543.
Lubotzky, A., & Aran, A. (2017) ‘THE PLACEBO EFFECT-NEUROBIOLOGICAL
ASPECTS’, Harefuah, 156(3), pp.181-184.

DISSERTATION 59
Masanja, H., Smith, E. R., Muhihi, A., Briegleb, C., Mshamu, S., Ruben, J., ... & Bahl, R.
(2015) ‘Effect of neonatal vitamin A supplementation on mortality in infants in Tanzania
(Neovita): a randomised, double-blind, placebo-controlled trial’, The Lancet, 385(9975),
pp.1324-1332.
McInnes, I. B. Giles, J. T., Bathon, J. M., Salmon, J. E., Beaulieu, A. D., & Sattar, N. (2015)
‘Effect of interleukin-6 receptor blockade on surrogates of vascular risk in rheumatoid
arthritis: MEASURE, a randomised, placebo-controlled study’, Annals of the rheumatic
diseases, 74(4), pp. 694-702.
Michaan, N., Baruch, Y., Topilsky, M., Amzalag, S., Iaskov, I., Many, A., & Maslovitz, S.
(2016) ‘The effect of glucose administration on perceived fetal movements in women with
decreased fetal movement, a double-blinded placebo-controlled trial’, Journal of
Perinatology, 36(8), p. 598.
Miller, P. D., Hattersley, G., Riis, B. J., Williams, G. C., Lau, E., Russo, L. A., ... &
Fitzpatrick, L. A. (2016) ‘Effect of abaloparatide vs placebo on new vertebral fractures in
postmenopausal women with osteoporosis: a randomized clinical trial’, Jama, 316(7), pp.
722-733.
Mohammadpour, N., Jazayeri, S., Tehrani-Doost, M., Djalali, M., Hosseini, M., Effatpanah,
M., ... & Karami, E. (2018) ‘Effect of vitamin D supplementation as adjunctive therapy to
methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial’,
Nutritional neuroscience, 21(3), pp. 202-209.
Moore, C. M., Robertson, N. L., Jichi, F., Damola, A., Ambler, G., Giganti, F., ... & Arya, M.
(2017) ‘The effect of dutasteride on magnetic resonance imaging defined prostate cancer:
MAPPED—A Randomized, Placebo Controlled, Double-Blind Clinical Trial’, The Journal of
urology, 197(4), pp. 1006-1013.

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Moreira‐Lucas, T. S., Duncan, A. M., Rabasa‐Lhoret, R., Vieth, R., Gibbs, A. L., Badawi, A.,
& Wolever, T. (2017) ‘Effect of vitamin D supplementation on oral glucose tolerance in
individuals with low vitamin D status and increased risk for developing type 2 diabetes
(EVIDENCE): A double‐blind, randomized, placebo‐controlled clinical trial’, Diabetes,
Obesity and Metabolism, 19(1), pp. 133-141.
Morrison, R. L., Fedgchin, M., Singh, J., Van Gerven, J., Zuiker, R., Lim, K. S., ... & Drevets,
W. C. (2018) ‘Effect of intranasal esketamine on cognitive functioning in healthy
participants: a randomized, double-blind, placebo-controlled study’, Psychopharmacology,
pp. 1-13.
Osani, M. C., & Bannuru, R. R. (2016) ‘What clinicians should know about differential
placebo effects’, Journal of comparative effectiveness research, 5(3), pp. 289-296.
Pelusi, C., Giagulli, V. A., Baccini, M., Fanelli, F., Mezzullo, M., Fazzini, A., ... & Labate, A.
M. M. (2017) ‘Clomiphene citrate effect in obese men with low serum testosterone treated
with metformin due to dysmetabolic disorders: A randomized, double-blind, placebo-
controlled study’, PloS one, 12(9), p. e0183369.
Quraishi, S. A., De Pascale, G., Needleman, J. S., Nakazawa, H., Kaneki, M., Bajwa, E. K., ...
& Bhan, I. (2015) ‘Effect of cholecalciferol supplementation on vitamin D status and
cathelicidin levels in sepsis: a randomized, placebo-controlled trial’, Critical care
medicine, 43(9), p. 1928.
Raine, A., Portnoy, J., Liu, J., Mahoomed, T., & Hibbeln, J. R. (2015) ‘Reduction in behavior
problems with omega‐3 supplementation in children aged 8–16 years: a randomized, double‐
blind, placebo‐controlled, stratified, parallel‐group trial’, Journal of Child Psychology and
Psychiatry, 56(5), pp. 509-520.
Rajakumar, K., Moore, C. G., Yabes, J., Olabopo, F., Haralam, M. A., Comer, D., ... & Holick,
M. F. (2015) ‘Effect of vitamin D3 supplementation in black and in white children: a

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randomized, placebo-controlled trial’, The Journal of Clinical Endocrinology &
Metabolism, 100(8), pp. 3183-3192.
Ridker, P. M., MacFadyen, J. G., Thuren, T., Everett, B. M., Libby, P., Glynn, R. J., &
Siostrzonek, P. (2017) ‘Effect of interleukin-1β inhibition with canakinumab on incident lung
cancer in patients with atherosclerosis: exploratory results from a randomised, double-blind,
placebo-controlled trial’, The Lancet, 390(10105), pp. 1833-1842.
Røjskjær, J. O., Gade, E., Kiel, L. B., Lind, M. N., Pedersen, L. M., Kristensen, B. B., ... &
Foss, N. B. (2015) ‘Analgesic effect of ultrasound‐guided transversus abdominis plane block
after total abdominal hysterectomy: a randomized, double‐blind, placebo‐controlled
trial’, Acta obstetricia et gynecologica Scandinavica, 94(3), pp. 274-278.
Rosén, A., Yi, J., Kirsch, I., Kaptchuk, T. J., Ingvar, M., & Jensen, K. B. (2017) ‘Effects of
subtle cognitive manipulations on placebo analgesia–An implicit priming study’, European
Journal of Pain, 21(4), pp. 594-604.
Rovner, A. J., Stallings, V. A., Rutstein, R., Schall, J. I., Leonard, M. B., & Zemel, B. S.
(2017) ‘Effect of high-dose cholecalciferol (vitamin D 3) on bone and body composition in
children and young adults with HIV infection: a randomized, double-blind, placebo-
controlled trial’, Osteoporosis International, 28(1), pp. 201-209.
Sabbagh, M. N., Ramaswamy, S., Hampel, H., & Bruinsma, B. (2017) ‘DIFFERENCE IN
COGNITIVE DECLINE BETWEEN COMBINATION THERAPY WITH DONEPEZIL
AND INTEPIRDINE (RVT-101) AND DONEPEZIL MONOTHERAPY: RESULTS FROM
A 48 WEEK MULTINATIONAL PLACEBO-CONTROLLED STUDY IN MILD TO
MODERATE ALZHEIMER'S DISEASE’, Alzheimer's & Dementia: The Journal of the
Alzheimer's Association, 13(7), pp. 263-264.
Shepherd, A. I., Wilkerson, D. P., Dobson, L., Kelly, J., Winyard, P. G., Jones, A. M., ... &
Gilchrist, M. (2015) ‘The effect of dietary nitrate supplementation on the oxygen cost of

DISSERTATION 62
cycling, walking performance and resting blood pressure in individuals with chronic
obstructive pulmonary disease: A double blind placebo controlled, randomised control
trial’, Nitric Oxide, 48, pp. 31-37.
Shukla, G. S., & Rai, P. K. (2015) ‘Effect of placebo on depression’, International Journal of
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DISSERTATION 63
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DISSERTATION 64
Appendixes
Demographic information
1. Can you please tick on your gender?
A. Male
B. Female
2. Can you mark on your age group?
A. Under 23
B. 24-32
C. 33- 51
D. More 51
3. Please tick your experience health care organization?
A. 0-4years
B. 5-9 years
C. 9-11 years
D. More 11 years
Objectives based question
To explore the meaning and concept of placebo effect
Do you agree that placebo treatment could have a favourable therapeutic impact on patient,
even pills or treatment is not active?
A. Yes
B. No
In your opinion, the endogenous opioid is a combination of two elements like enkephalins
and endorphins that could be normal pain-relieving chemicals as it could produce in the
body?
A. Strongly Agree

DISSERTATION 65
B. Agree
C. Neutral
D. Disagree
E. Strongly Disagree
Do you think that placebo management could influence the central nervous system or brain of
patients?
A. Strongly Agree
B. Agree
C. Neutral
D. Disagree
E. Strongly Disagree
In your opinion, nausea and pain could be easily decline by placebo effect?
A. Yes
B. No
To address the Influencing factors for the placebo treatment
In your opinion, which key factor could influence the placebo treatment?
A. lack of principles in PRM therapies
B. Treatment heterogeneity
C. Relationship between patient and doctors
D. Belief of patient, motivation, and experience
Do you think that lack of standard of Physiological Regulating Medicine (PRM) could
deliver inaccurate information to their patient about their treatment as it could also negative
impact on behaviour?
A. Yes
B. No

DISSERTATION 66
Do you think that treatment heterogeneity could also influence placebo treatment that is
occurred by lack of physician’s skills regarding injections, nerve blocks, and acupuncture?
A. Strongly Agree
B. Agree
C. Neutral
D. Disagree
E. Strongly Disagree
In your opinion, level of interaction could support to identify level of placebo effect and
induce real effects?
A. Yes
B. No
In your opinion, which key factor could negative impact on placebo treatment?
A. Person's attitude
B. Doctor/patient relationship
C. Characteristics of placebo
D. Use of medical devices
To recommend the strategies to control the placebo effect
In your opinion, which key approaches could be used by doctors to eliminate issues of
placebo treatment at the time of treatment?
A. Testing of implantable devices in Neurology
B. Use of placebo in Children
C. Use of sham procedures/surgical trials– insights from surgical trials
D. Develop a better understanding of placebos
Do you think that health care organization could use placebo treatment in the pediatric trials
to improve their outcome quality?

DISSERTATION 67
A. Strongly Agree
B. Agree
C. Neutral
D. Disagree
E. Strongly Disagree
Interview questionnaire
Please specify your gender?
A. Male
B. Female
2. Please mention your age group?
A. Under 22
B. 23-30
C. 31-49
D. More 49
3. Please mark your experience in health care organization?
A. 0-3years
B. 4-10 years
C. 11-13 years
D. Above 13 years