Liz Wager: Training and the placebo effect

Liz WagerI’ve been at the Vienna School of Clinical Research running a publication workshop for an enthusiastic bunch of doctors, researchers and drug company folk. Back home, catching up on my reading, Diana Wood’s BMJ editorial on problem based learning struck a chord. She argues that we don’t really know whether problem based learning works better than other teaching methods. But that’s true of an awful lot of training.

A few years ago, the BMJ did a randomized trial of reviewer training. This showed that that neither attending a course nor doing a distance learning package had much effect on reviewer performance. But the BMJ carried on offering the face-to-face training sessions for a while because reviewers liked them.

At the time, I thought this was a bit spineless, but I realise I’m in no position to criticize, since I make at least some of my living by peddling unproven training courses. Maybe it’s enough if participants enjoy the course and think it helps them – but some firmer evidence would be nice.

Still pondering about the effects of training, I was delighted by the study from Kaptchuk and colleagues (May 3, 336:999), showing that warm and encouraging human interaction accounts for much of the placebo effect. It’s maybe not a surprising finding, and it probably goes a long way to explain the success of many complementary therapies and why it’s ridiculous to expect GPs to deal with patients in 7- (or even 10-) minute time slots but it is, nevertheless, useful.

It made me think about the difference between giving information and training. The students attending my workshop in Vienna were smart, keen and well-educated. Most had already published some research and must have read masses of journal articles. Virtually everything I taught them was quite easily available in books and websites. But I was struck that none of the students had heard of the CONSORT statement on trial reporting ( and only a handful were aware of the ICMJE authorship criteria ( As well as lectures, the course included practical exercises: these can be a salutory experience for a trainer when you see whether students have really got your message. Confucius certainly knew a thing or two when he wrote ‘What I hear, I forget; what I see, I remember; what I do, I understand’.

So what’s this got to do with placebos? Only that, for all the possibilities of on-line training and distance learning (which I don’t decry), it still seems that humans respond best to interaction with another human being.  Any comments? Have your say on the blog.

 About Liz Wager

Liz Wager is a freelance writer, trainer and publications consultant who works
for a number of pharmaceutical companies, communication agencies, publishers and
academic institutions. She is also the Secretary of COPE (the Committee On
Publication Ethics) and a member of the BMJ’s Ethics Committee.