What is therapeutic? Conceptual analysis of the notions of placebo, placebo effect, specific effect, and therapeutic

The concepts of therapeutic, placebo, and placebo effect are polysemous and a source of confusion. We aim to shed some light on and define these challenging concepts. This highlights the crucial role of assessing the causal effect of treatments by means of randomized, triple-blind, placebo-controlled, intention-to-treat clinical trials (controlling the risk of false positives), which are the only studies where it is possible to ensure causality and specificity, and thus to define what constitutes a therapeutic treatment. In the end, whether with a real drug (demonstrated effective) or with a placebo, it is the organism/ the (living) person that reacts to its consumption. In the case of medication, this reaction is linked both to the pharmacological substance and to the “signal” conveyed by taking the drug: a signal that has meaning for the individual in a given cultural context. This clarification makes it possible to reintegrate into medical care the treatments and healing factors that are usually neglected, because they are said to be effective only through their “placebo effect.” From a pragmatic point of view, these therapeutic or self-healing factors are useful for care, even if their effectiveness is linked to an optimized placebo effect. They should therefore be studied for their own sake.