This plenary took place on Monday, October 5, at 8:30 am during the International Conference on Communication in Healthcare (ICCH) 2009, in Miami Beach, Florida, USA. The Silent Healer; The Role of Communication in the Placebo Effect Jozien Bensing, PhD, was born in 1950 in Tilburg, the Netherlands. After finishing her formal education as clinical psychologist at Utrecht University, she started a research career at the Netherlands Institute for General Practitioners. She is founder and first president of the European Association of Communication in Health Care. In 1985 she became director of the Netherlands Institute for Health Services Research. She was appointed as full professor of Health Psychology at Utrecht University in 1991. She is a member of several councils and committees on the interface between the scientific world and healthcare, such as the Netherlands Society of Sciences, the Dutch Royal Academy of Sciences, the Dutch Health Council and the National Advisory Council on Health Research. She supervised more than 20 PhD-theses and wrote more than 200 publications, mostly on healthcare communication and related issues. In 2003 Jozien Bensing became the first non-American to receive the international George Engel Award for “outstanding research contributing to the theory, practice and teaching of effective healthcare communication and related skills” from the American Academy on Physician and Patient (now AACH). In 2004 she received a royal decoration (‘Officer of the Order of Orange Nassau’) for her work in translating scientific knowledge into public. She received the prestigious SPINOZA-award for her research on doctor-patient communication in 2006; in 2007 she was chosen to become a member of the Royal Netherlands Academy of Sciences, which consists of the top-200 most prestigious Dutch scientists.

1. The Silent Healer the Role of Communication in Placebo Effects Jozien Bensing William Verheul 2009 Bensing Ask for permission before adopting

2. Placebo “ I will please” 2009 Bensing Ask for permission before adopting

6. Around the midst of the 17th century, the times they were a’ changing …….. Throughout history, physicians have always been well aware of the healing power of a comforting attitude Acknowledgment: Hanneke de Haes 2009 Bensing Ask for permission before adopting Jan Steen, 1650 W. Chandler, 1785

8. This could be a happy marriage Unfortunately, there is a hierarchy 2009 Bensing Ask for permission before adopting The Science of Medicine The Art of Medicine

11. Beecher Placebo research Placebo-controlled clinical trials ? 2009 Bensing Ask for permission before adopting

14. It is getting time to open the black box of the physician’s healing power White, 1988 How can we learn to understand (and thus enhance) placebo-effects? 2009 Bensing Ask for permission before adopting

16. How do patients recover? Dutch Medical Schools (p/y): 2000 clinical trials 900 PhD theses 7500 publications 2009 Bensing Ask for permission before adopting Natural course Biomedical treatment Placebo (context) effects Health outcome

20. Non-specific or incidental factors can also have negative influences on patient outcomes Nocebo effects 2009 Bensing Ask for permission before adopting

23. What can cause placebo effects? Treatment characteristics (e.g. colour, size, shape of drug) Health care setting (e.g. home, hospital, room layout) Patient characteristics (e.g. illness / treatment beliefs, anxiety, adherence) Patient-practitioner relationship (e.g. compassion, reassurance, suggestion) Practitioners characteristics (e.g. status, sex, illness and treatment beliefs) DiBlasi et al, Lancet, 2001 2009 Bensing Ask for permission before adopting

26. Mechanism 1: classic conditioning The natural response of a dog on the infusion of adrenaline is: elevated blood pressure Amaral & Sabbatini, 1999 2009 Bensing Ask for permission before adopting

27. The natural response of a dog on the infusion of acethylcholine is: lowered blood pressure Mechanism 1: classic conditioning 2009 Bensing Ask for permission before adopting

28. Amaral & Sabbatini, 1999 Mechanism 1: classic conditioning 2009 Bensing Ask for permission before adopting

31. Pain reduction based on expectancies: open versus hidden treatment With several types of painkillers, patients experience more pain relief if they know the painkiller is administrated Price, 2008 2009 Bensing Ask for permission before adopting

32. Hidden vs open paradigma Colloca & Benedetti, 2005 2009 Bensing Ask for permission before adopting

41. Medicine is a delicate balance between art, science and communication (Carole Guzman) 2009 Bensing Ask for permission before adopting

42. This could be a happy marriage Unfortunately, there is a hierarchy Art and science should be integrated 2009 Bensing Ask for permission before adopting The Science of Medicine The Art of Medicine

45. New technologies (neuro-imaging) Collaca & Benedetti, 2005 2009 Bensing Ask for permission before adopting

47. Coherence of skin conductance ( participating in versus watching a medical visit) 2009 Bensing Ask for permission before adopting

50. change in: "The treatment will help against the pain" Participating in visit Watching visit 2009 Bensing Ask for permission before adopting

51. change in "the pain will continue for a long time" Participating in visit Watching visit 2009 Bensing Ask for permission before adopting

52. Change in state anxiety Participating in visit Watching visit 2009 Bensing Ask for permission before adopting

57. Let us open the black box of the physician’s healing power ! facilitating Open – closed questions EMPATHY Summarizing Eye contact Nodding Tailoring I nterruptions Expectancies Explicit vs implicit Information Being Positive - Neutral Experiences 2009 Bensing Ask for permission before adopting

58. For information: [email_address] [email_address] 2009 Bensing Ask for permission before adopting

59. 2009 Bensing Ask for permission before adopting