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Placebo effects and racial and ethnic health disparities: an unjust and underexplored connection
  1. Phoebe Friesen1,2,
  2. Charlotte Blease3,4
  1. 1 Philosophy Department, CUNY Graduate Center, New York City, New York, USA
  2. 2 Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3 Program in Placebo Studies, General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 School of Psychology, University College Dublin, Dublin, Ireland
  1. Correspondence to Phoebe Friesen, Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; phoebe.friesen{at}ndph.ox.ac.uk

Abstract

While a significant body of bioethical literature considers how the placebo effect might introduce a conflict between autonomy and beneficence, the link between justice and the placebo effect has been neglected. Here, we bring together disparate evidence from the field of placebo studies and research on health inequalities related to race and ethnicity, and argue that, collectively, this evidence may provide the basis for an unacknowledged route by which health disparities are exacerbated. This route is constituted by an uneven distribution of placebo effects, resulting from differences in expressions of physician warmth and empathy, as well as support and patient engagement, across racial and ethnic lines. In a discussion of the ethical implications of this connection, we argue that this contribution to health disparities is a source of injustice, consider ways in which these disparities might be ameliorated and suggest that this conclusion is likely to extend to other realms of inequality as well.

  • placebo effect
  • healthcare disparities
  • minority health
  • race relations
  • social justice
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Footnotes

  • Contributors PF conceived of the manuscript and developed the first draft. CB and PF revised the draft several times each and both signed off on the final submission.

  • Funding Social Sciences and Humanities Research Council of Canada Doctoral Award, Fulbright Scholar Award, and Irish Research Council Marie Skłodowska-Curie Award (grant number: CLNE/2017/226).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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