「安慰剂」在新药研发过程中处处可见，amylose 和 amylopectin是安慰剂糖丸的主要成分，其实就是淀粉（标题注释）。 安慰剂效应究竟是应该被消除的统计噪声，还是一种被低估的真实治疗机制？当一针生理盐水能让帕金森患者的大脑释放出与真药相当的多巴胺，当假手术的疗效与真手术完全持平。我们要回答的问题是：如果安慰剂这么强，新药研发的投入还有意义吗？如果安慰剂能治病，我们可以只给病人吃糖丸吗？这期节目我们一起聊聊安慰剂效应在大脑中究竟通过哪些神经通路起效；它为什么越来越强以至于成为新药研发的障碍；我们可以只用安慰剂来治病吗？ 时间轴[00:14] 怀特先生的故事：一针盐水就让肿瘤消失了 [02:54] 二战护士用生理盐水冒充吗啡止痛，战士不疼了 [06:22] 不光吃药，手术也有安慰剂效应 [12:32] 安慰剂不光能安慰，还能「反安慰」 [19:10] 安慰剂管用的三条神经通路：内源性阿片系统、多巴胺奖赏系统、HPA 轴 [28:32] 安慰剂成了新药上市的绊脚石 [39:31] 临床试验如何对付安慰剂效应 [44:14] 只用安慰剂能治病吗？📬【联系我们】 联系我们：zyx3200@163.com 微信：atgcdoctorschat，备注「加听友群」 【参考文献】Klopfer, B. (1957). Psychological Variables in Human Cancer. Journal of Projective Techniques, 21(4), 331–340. Franklin, B., Lavoisier, A. L., et al. (1784). Rapport des commissaires nommés par le Roi pour faire l'examen du magnétisme animal. Paris. Beecher, H. K. (1955). The Powerful Placebo. Journal of the American Medical Association, 159(17), 1602–1606. Moseley, J. B., O'Malley, K., Petersen, N. J., et al. (2002). A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine, 347(2), 81–88. de la Fuente-Fernández, R., Ruth, T. J., Sossi, V., Schulzer, M., Calne, D. B., & Stoessl, A. J. (2001). Expectation and Dopamine Release: Mechanism of the Placebo Effect in Parkinson's Disease. Science, 293(5532), 1164–1166. Levine, J. D., Gordon, N. C., & Fields, H. L. (1978). The Mechanism of Placebo Analgesia. The Lancet, 2(8091), 654–657. Reeves, R. R., & Ladner, M. E. (2007). Nocebo Effects with Antidepressant Clinical Drug Trial Placebos. General Hospital Psychiatry, 29(3), 275–277. Ader, R., & Cohen, N. (1975). Behaviorally Conditioned Immunosuppression. Psychosomatic Medicine, 37(4), 333–340. Kaptchuk, T. J., Friedlander, E., Kelley, J. M., et al. (2010). Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PLOS ONE, 5(12), e15591. Wechsler, M. E., Kelley, J. M., Boyd, I. O. E., et al. (2011). Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine, 365(2), 119–126. Plassmann, H., O'Doherty, J., Shiv, B., & Rangel, A. (2008). Marketing Actions Can Modulate Neural Representations of Experienced Pleasantness. Proceedings of the National Academy of Sciences, 105(3), 1050–1054. Rutherford, B. R., & Roose, S. P. (2013). A Model of Placebo Response in Antidepressant Clinical Trials. American Journal of Psychiatry, 170(7), 723–733. Khan, A., et al. (2017). Has the Rising Placebo Response Impacted Antidepressant Clinical Trial Outcome? Data from the US Food and Drug Administration 1987–2013. World Psychiatry, 16(2), 181–192. Neumora Therapeutics. (2025). KOASTAL-1 Phase 3 Trial of Navacaprant in Major Depressive Disorder. 临床试验公告。 Scientific American (2024). Placebo Effect: A Cure in the Mind. 在小宇宙查看该单集文稿
