Drawing from his seminal work The Power of Placebos (Johns Hopkins University Press), Professor Jeremy Howick presents a rigorous examination of placebo and nocebo phenomena that challenges fundamental assumptions in contemporary medical research and clinical practice. This keynote advances the argument for a paradigm shift beyond the first placebo revolution, which established scientific legitimacy for placebo effects, toward a more ethically grounded and methodologically sophisticated approach to therapeutic intervention.

The presentation critically interrogates the widespread deployment of placebo controls in clinical trial design, systematically deconstructing the purported methodological advantages including assay sensitivity, absolute effect size determination, and participant recruitment efficiency. Professor Howick demonstrates that these justifications lack robust scientific foundation when proven therapeutic alternatives exist, raising profound ethical concerns about withholding established treatments from research participants.

Central to this discourse is the imperative to harness placebo mechanisms through evidence-based clinical communication, therapeutic alliance building, and contextual healing factors. The keynote explores how negative expectancy effects—nocebo phenomena—can undermine treatment efficacy through iatrogenic harm, while positive therapeutic contexts can enhance clinical outcomes through neurobiologically mediated pathways.

This scholarly presentation advocates for methodological reform in clinical research ethics, proposing restrictions on placebo-controlled trials when proven therapies are available, while simultaneously calling for the systematic integration of placebo science into evidence-based medical practice.