Zur semiotischen Rekonstruktion des Placeboeffektes

The rise and success of the modern science, first in physics, later in biology and medicine, was based on a mechanic-linear model of causality. Its only category of explanation of natural processes is the mechanical machine. Such a point of view is reductionistic and does not justice to living organisms. As human beings using and processing signs we cannot recognize ourselves in this model. As all living creatures we perceive, interpret and answer the stimuli of the environment. To explain the behavior of organisms we need a semiotic-circular causality. Semiotics, the study of signs, try to perceive and interpret processes of signs. Language serves as a paradigmatic model. Semiotics can be subdivided in semantics, the theory of meaning, in syntax, the theory of the forms and the arrangement of the signs, and in pragmatics, the theory of the contextual rules of communication. Pragmatics as a subject of inquiry in its own right attained its scientific status in the last few decades only. Semiotics are not concerned exclusively with language, but help as so-called "biosemiotics" also to explain the network of communication on and between the different levels of organisation of molecules, cells, organs or organism. Living organisms are networks connecting these levels with each other and with the environment. The Denkstil of established pharmacology is likewise restricted to mechanic causality. Phenomena unexplained by physics are classified as unscientific. As a consequence the placebo effect is defined as 'non-specific' or 'non-characteristic'. Such negative definitions exclude concrete questions of investigation. If we accept a biosemotic view in pharmacology, that is to say that we see drugs as signs consisting of a physical vehicle equipped with meaning, then the lock-and-key-concept becomes the syntactic level and the effect on the metabolism of the cell mediated by second messengers, on the organ and on the organism becomes the semantic level. The establishment of structure-effect-relations are the only goal of the classic pharmacology, just as syntax and semantics are the only domain of the classic semiotics. But the therapy with drugs must be seen in a broader treatment context. One has to include the level of the organism of the doctor-patient-relation or the placebo effect and of the internal organismic system levels as individual response to a drug, dependent on the genetic idiosyncrasy, the environment of the cell, the recent past, the thermodynamic activity etc. The assumption of steady state conditions are unrealistically restrictive. The semiotic expansion of the pharmacology will not invalidate the achievements of classic pharmacology, but elucidates in addition a view of the pragmatic components and makes the scientific integration of the placebo phenomenon into the drug therapy possible. The placebo effect looses its inconsistency. From a biosemiotic point of view the randomized placebo controlled double blind trial must be seen as a restriction to unrealistic conditions of investigation. The pragmatic regularities and thus a scientific approach to the processes happening within the therapeutic triangle of therapist, drug and patient are excluded. The comparison of a drug with a placebo is a category-mistake. By comparing semantics with pragmatics, the investigator confounds the levels of analysis. A semiotic pharmacology expanded by pragmatics increases the number of aspects of the therapeutical situation. Pharmacology ought to pay more attention to pragmatic aspects of drug therapy.