amakuru

Ingaruka ya placebo bivuga ibyiyumvo byubuzima bwiza mumubiri wumuntu bitewe nibyifuzo byiza mugihe uhabwa imiti idahwitse, mugihe ingaruka zijyanye na anti placebo nigabanuka ryingaruka ziterwa no gutegereza nabi mugihe wakiriye imiti ikora, cyangwa kubaho ingaruka mbi bitewe nibiteganijwe nabi mugihe wakiriye umwanya wawo, bishobora gutuma ibintu byangirika. Bakunze kuboneka mubuvuzi nubushakashatsi, kandi birashobora kugira ingaruka kumikorere yabarwayi nibisubizo.

Ingaruka ya placebo hamwe na anti-placebo ningaruka ziterwa nabarwayi bafite ibyifuzo byiza nibibi byubuzima bwabo. Izi ngaruka zishobora kugaragara mubidukikije bitandukanye byubuvuzi, harimo gukoresha imiti ikora cyangwa umwanya wo kuvura mubikorwa byubuvuzi cyangwa ibigeragezo, kubona uruhushya rubimenyeshejwe, gutanga amakuru ajyanye nubuvuzi, no gukora ibikorwa biteza imbere ubuzima rusange. Ingaruka ya placebo iganisha kumusubizo mwiza, mugihe anti-placebo iganisha ku ngaruka mbi kandi mbi.

Itandukaniro mubisubizo byokuvura nibimenyetso byerekana abarwayi batandukanye birashobora guterwa igice na plaque na anti-placebo. Mubikorwa byubuvuzi, inshuro nuburemere byingaruka za placebo biragoye kubimenya, mugihe mubihe byubushakashatsi, inshuro nuburemere bwingaruka za placebo ni nini. Kurugero, mubigeragezo byinshi byubuvuzi-buhumyi bwo kuvura ububabare cyangwa uburwayi bwo mumutwe, igisubizo cya placebo gisa nkicy'ibiyobyabwenge bikora, kandi abagera kuri 19% byabantu bakuru na 26% byabasaza bitabiriye umwanya wabo bavuze ingaruka mbi. Byongeye kandi, mu bigeragezo by’amavuriro, abagera kuri 1/4 cy’abarwayi bakiriye umwanya wabo bahagaritse gufata imiti kubera ingaruka mbi, byerekana ko ingaruka zo kurwanya ibibanza zishobora gutuma ibiyobyabwenge bihagarara cyangwa kutubahiriza amategeko.

Uburyo bwa neurobiologique ya placebo n'ingaruka zo kurwanya umwanya
Ingaruka ya placebo yerekanwe ko ifitanye isano no kurekura ibintu byinshi, nka opioide endogenous, urumogi, dopamine, oxytocine, na vasopressine. Igikorwa cya buri kintu kigamije sisitemu igenewe (ni ukuvuga ububabare, kugenda, cyangwa sisitemu yumubiri) n'indwara (nka artite cyangwa indwara ya Parkinson). Kurugero, kurekura dopamine bigira uruhare mubikorwa bya platbo mukuvura indwara ya Parkinson, ariko ntabwo bigira ingaruka kumwanya wo kuvura ububabare budakira cyangwa bukabije.

Kwiyongera k'ububabare buterwa no gutanga igitekerezo mu magambo (ingaruka ya anti placebo) byagaragaye ko byahujwe na neuropeptide cholecystokinin kandi bishobora guhagarikwa na proglutamide (ni ubwoko bwa A na B reseptor antagonist ya cholecystokinin). Ku bantu bafite ubuzima bwiza, uru rurimi rwatewe na hyperalgesia ifitanye isano no kongera ibikorwa bya hypothalamic pituito adrenal axis. Umuti wa benzodiazepine diazepam urashobora kurwanya hyperalgesia hamwe na hyperactivite ya hypothalamic pituito adrenal axis, byerekana ko guhangayika bigira uruhare muri izo ngaruka zo kurwanya ibibanza. Nyamara, alanine irashobora guhagarika hyperalgesia, ariko ntishobora guhagarika gukabya gukabije kwa hypothalamic pituito adrenal axis, byerekana ko sisitemu ya cholecystokinin igira uruhare mubice bya hyperalgesia mubice byo kurwanya anti-placebo, ariko ntibigire igice cyo guhangayika. Ingaruka za genetics kuri platbo na anti-placebo zifitanye isano na haplotypes ya polymorphism imwe ya nucleotide imwe muri dopamine, opioid, na endogenous cannabinoid genes.

Urwego rwabitabiriye meta-isesengura ryubushakashatsi 20 bukora bwa neuroimaging burimo 603 bitabiriye ubuzima bwiza bwerekanye ko ingaruka ya placebo ijyanye nububabare yagize ingaruka nke gusa kububabare bujyanye no kwerekana amashusho (byitwa umukono wububabare bwa neurogeneque). Ingaruka ya placebo irashobora kugira uruhare mubyiciro byinshi byurusobe rwubwonko, biteza imbere amarangamutima n'ingaruka zabyo kubintu byinshi bibabaza. Kwerekana ubwonko nu mugongo byerekana ko anti-placebo itera kwiyongera kwanduza ibimenyetso byububabare biva mu ruti rwumugongo bijya mu bwonko. Mu bushakashatsi bwo gusuzuma igisubizo cyabitabiriye amavuta yo kwisiga, aya mavuta yasobanuwe ko atera ububabare kandi yanditseho ko ari hejuru cyangwa make kubiciro. Ibisubizo byerekanye ko uturere twanduza ububabare mu bwonko no mu ruti rwumugongo twakoraga mugihe abantu bari biteze ko bazagira ububabare bukabije nyuma yo kuvurwa hamwe na cream ihenze. Mu buryo nk'ubwo, ubushakashatsi bumwe na bumwe bwagerageje ububabare buterwa n'ubushyuhe bushobora koroherezwa n'ibiyobyabwenge bya opioid remifentanil; Mu bitabiriye amahugurwa bemezaga ko remifentanil yahagaritswe, hippocampus yarakozwe, kandi ingaruka zo kurwanya ibibanza byahagaritse imikorere y’ibiyobyabwenge, byerekana ko guhangayika no kwibuka byagize uruhare muri izo ngaruka.

Ibiteganijwe, Ibimenyetso byururimi, ningaruka zifatika
Ibyabaye kuri molekuline hamwe nuyoboro uhindura imiyoboro ishingiye kuri platbo hamwe na anti-placebo ingaruka zahujwe nibiteganijwe cyangwa biteganijwe kubizaza. Niba ibyateganijwe bishobora kugerwaho, byitwa gutegereza; Ibiteganijwe birashobora gupimwa no guterwa nimpinduka mubitekerezo no kumenya. Ibiteganijwe birashobora kubyara muburyo butandukanye, harimo nubunararibonye bwambere bwingaruka zibiyobyabwenge ningaruka mbi (nkingaruka zidakira nyuma yimiti), amabwiriza mumagambo (nko kumenyeshwa ko imiti runaka ishobora kugabanya ububabare), cyangwa kwitegereza imibereho (nko kureba neza ibimenyetso byoroheje mubandi nyuma yo gufata imiti imwe). Ariko, bimwe mubiteganijwe hamwe n'ingaruka zo kurwanya ibibanza ntibishobora kugerwaho. Kurugero, turashobora gushiraho uburyo bwo gukingira immunosuppressive kubarwayi barimo guterwa impyiko. Uburyo bwo kubihamya ni ugukoresha ibidafite aho bibogamiye byahujwe na immunosuppressants ku barwayi. Gukoresha imbaraga zidafite aho zibogamiye byonyine bigabanya ikwirakwizwa rya T selile.

Mugihe cyamavuriro, ibyateganijwe biterwa nuburyo ibiyobyabwenge bisobanurwa cyangwa "urwego" rukoreshwa. Nyuma yo kubagwa, ugereranije nubuyobozi bwipfutse ubusa aho umurwayi atazi igihe cyubuyobozi, niba imiti uzahabwa mugihe utanga morphine yerekana ko ishobora kugabanya ububabare, bizana inyungu zikomeye. Ibisobanuro bitaziguye kubitera ingaruka nabyo birashobora kuba byuzuye. Ubushakashatsi bwarimo abarwayi bavuwe na beta blocker atenolol kubera indwara z'umutima na hypertension, kandi ibisubizo byagaragaje ko kuba ingaruka z’imibonano mpuzabitsina no kudakora neza ari 31% ku barwayi bamenyeshejwe nkana ingaruka zishobora gutera, mu gihe indwara zabaye 16% gusa ku barwayi batamenyeshejwe ingaruka mbi. Mu buryo nk'ubwo, mu barwayi bafashe finasteride kubera kwaguka kwa prostate, 43% by'abarwayi bamenyeshejwe ku buryo butaziguye ingaruka z’imibonano mpuzabitsina bahuye n'ingaruka mbi, mu gihe mu barwayi batamenyeshejwe ingaruka z’imibonano mpuzabitsina, iki gipimo cyari 15%. Ubushakashatsi bwarimo abarwayi ba asima bahumeka saline ya nebulize bamenyeshwa ko bahumeka allergens. Ibisubizo byerekanye ko hafi kimwe cya kabiri cy’abarwayi bahuye n’ingorane zo guhumeka, kongera imbaraga zo guhumeka, no kugabanya ubushobozi bw’ibihaha. Mu barwayi ba asima bahumekeye imitsi ya bronchoconstrictors, abamenyeshejwe ibijyanye na bronchoconstrictors bahuye n’ububabare bukabije bw’ubuhumekero ndetse n’umuyaga uhumeka kurusha abamenyeshejwe na bronchodilators.

Byongeye kandi, imvugo iterwa nururimi irashobora gutera ibimenyetso byihariye nkububabare, guhinda, no kugira isesemi. Nyuma yo gutanga ururimi, ibitera imbaraga bijyanye nububabare buke burashobora kubonwa nkububabare bukabije, mugihe ibitera imbaraga bishobora kubonwa nkububabare. Usibye gutera cyangwa kongera ibimenyetso, ibyifuzo bibi birashobora no kugabanya imikorere yibiyobyabwenge. Niba amakuru y'ibinyoma avuga ko imiti iziyongera aho kugabanya ububabare yagejejwe ku barwayi, ingaruka zo gusesengura zaho zirashobora guhagarikwa. Niba 5-hydroxytryptamine reseptor agonist rizitriptan yanditseho amakosa nka placebo, irashobora kugabanya imbaraga zayo mukuvura ibitero bya migraine; Mu buryo nk'ubwo, ibyifuzo bibi birashobora kandi kugabanya ingaruka zo kuvura imiti ya opioid kububabare buterwa n'ubushakashatsi.

Uburyo bwo kwiga muri placebo n'ingaruka zo kurwanya umwanya
Byombi kwiga hamwe na classique ya classique bigira uruhare muri placebo na anti-placebo. Mubihe byinshi byubuvuzi, ibitera kutagira aho bibogamiye mbere bifitanye isano ningaruka mbi cyangwa mbi zibiyobyabwenge binyuze muburyo bwa kera birashobora gutanga inyungu cyangwa ingaruka mbi udakoresheje imiti ikora mugihe kizaza.

Kurugero, niba ibidukikije cyangwa uburyohe bwibimenyetso byahujwe inshuro nyinshi na morphine, ibimenyetso bimwe bikoreshwa hamwe na placebo aho kuba morphine birashobora gutanga ingaruka zidasanzwe. Mu barwayi ba psoriasis bakiriye intera ikoreshwa ya glucocorticoide yagabanutse hamwe na placebo (ibyo bita dose exting placebo), igipimo cya psoriasis cyongeye kugaragara nkicy'abarwayi bahabwa imiti yuzuye ya glucocorticoid. Mu itsinda rishinzwe kugenzura abarwayi bahawe uburyo bumwe bwo kugabanya corticosteroide ariko ntibakire umwanya muto, igipimo cyo kwisubiramo cyikubye inshuro eshatu icy'itsinda rikomeza kuvura. Ingaruka nkizo zagaragaye mu kuvura kudasinzira karande no mu gukoresha amphetamine ku bana bafite ikibazo cyo kutitonda cyane.

Ubunararibonye bwo kuvura hamwe nuburyo bwo kwiga nabwo butera ingaruka zo kurwanya umwanya. Mu bagore bahabwa imiti ya chimiotherapie kubera kanseri y'ibere, 30% muri bo bazaba biteze isesemi nyuma yo guhura n'ibidukikije (nko kuza mu bitaro, guhura n'abaganga, cyangwa kwinjira mu cyumba gisa n'icyumba cyo guteramo) batabogamye mbere yo guhura ariko bakaba baragize uruhare mu kwinjiza. Impinja zikivuka inshuro nyinshi zihita zigaragaza kurira no kubabara mugihe cyoza inzoga uruhu rwabo mbere yo kwandura. Kwerekana allergène mubintu bifunze kubarwayi ba asima birashobora gutera asima. Niba isukari ifite impumuro yihariye ariko idafite ingaruka nziza yibinyabuzima yahujwe numuti ukora ufite ingaruka zikomeye (nka tricyclic antidepressants) mbere, gukoresha ayo mazi hamwe na platbo nabyo bishobora gutera ingaruka mbi. Niba ibimenyetso bifatika (nk'urumuri n'amashusho) byahujwe mbere n'ububabare buterwa n'ubushakashatsi, noneho gukoresha ibimenyetso bifatika byonyine bishobora gutera ububabare mugihe kizaza.

Kumenya uburambe bwabandi birashobora no kuganisha kuri platbo na anti-placebo. Kubona ububabare butangwa nabandi birashobora kandi gutera ingaruka ya analgesic ya platbo, isa nubunini ningaruka zo kuvura yakiriye wenyine mbere yo kwivuza. Hariho ibimenyetso byubushakashatsi byerekana ko ibidukikije n’imibereho bishobora gutera ingaruka. Kurugero, niba abitabiriye amahugurwa biboneye abandi bavuga ingaruka ziterwa na platbo, bamenyesha ububabare nyuma yo gukoresha amavuta adakora, cyangwa guhumeka umwuka wo murugo uvugwa ko ari "uburozi bushobora kuba uburozi," birashobora kandi gutera ingaruka mubitabiriye amahugurwa bahuye na platbo imwe, amavuta adakora, cyangwa umwuka wimbere.

Itangazamakuru ryamakuru hamwe nibitangazamakuru bidafite umwuga, amakuru yakuwe kuri enterineti, no guhura nabandi bantu bafite ibimenyetso byose birashobora guteza imbere anti-placebo. Kurugero, igipimo cyo gutanga raporo yibisubizo bibi kuri statin bifitanye isano nuburemere bwa raporo mbi kuri statin. Hariho urugero rugaragara cyane aho umubare wibintu byavuzwe byavuzwe byiyongereyeho inshuro 2000 nyuma yibitangazamakuru bibi na tereviziyo byerekana impinduka mbi mu miti y’ibiyobyabwenge bya tiroyide, kandi bikubiyemo ibimenyetso byihariye bivugwa muri raporo mbi. Mu buryo nk'ubwo, nyuma yo kuzamurwa mu ntera bituma abaturage batekereza kwibeshya ko bahuye n’ibintu by’ubumara cyangwa imyanda ishobora guteza akaga, ibimenyetso by’ibimenyetso biterwa no kwiyumvisha ibintu biriyongera.

Ingaruka za placebo na anti-placebo ingaruka kubushakashatsi nibikorwa byubuvuzi
Byaba byiza kumenya uwakunze kwibasirwa na platbo na anti-placebo mugitangira kwivuza. Ibintu bimwe bifitanye isano nibi bisubizo birazwi, ariko ubushakashatsi buzaza bushobora gutanga ibimenyetso bifatika bifatika. Optimism hamwe no kworoherwa kubitekerezo ntabwo bisa nkaho bifitanye isano rya hafi nigisubizo cyibibanza. Hariho ibimenyetso byerekana ko ingaruka zo kurwanya ibibanza zishobora kugaragara cyane ku barwayi bahangayitse, mbere bakaba baragaragaje ibimenyetso by’impamvu zitazwi z’ubuvuzi, cyangwa bafite ibibazo bikomeye byo mu mutwe mu banywa ibiyobyabwenge. Kugeza ubu nta bimenyetso bigaragara byerekeranye n'uruhare rw'uburinganire muri platbo cyangwa ingaruka zo kurwanya ibibanza. Kwerekana amashusho, ibyago byinshi bya gene, ubushakashatsi bwishyirahamwe rya genome, hamwe nubushakashatsi bwimpanga birashobora gufasha gusobanura uburyo imikorere yubwonko na genetique biganisha kumihindagurikire yibinyabuzima bikaba ishingiro ryingaruka za platbo na anti-placebo.

Imikoranire hagati y’abarwayi n’abaganga b’amavuriro irashobora kugira ingaruka ku ngaruka ziterwa na platbo ndetse n’ingaruka zavuzwe nyuma yo kwakira ibibanza n’ibiyobyabwenge bikora. Icyizere cy’abarwayi mu baganga b’amavuriro n’umubano wabo mwiza, ndetse no kuvugana ubunyangamugayo hagati y’abarwayi n’abaganga, byagaragaye ko bigabanya ibimenyetso. Kubwibyo, abarwayi bizera ko abaganga bafite impuhwe kandi bagatanga ibimenyetso byubukonje busanzwe baritonda kandi bagufi mugihe kirenze abizera ko abaganga batagira impuhwe; Abarwayi bemeza ko abaganga bafite impuhwe na bo bagabanuka ku bipimo bifatika byerekana umuriro, nka interleukin-8 na neutrophil. Ibyifuzo byiza byabaganga bavura nabyo bigira uruhare mubikorwa bya placebo. Ubushakashatsi buto bugereranya imiti idakira no kuvura ibibanza nyuma yo gukuramo amenyo byerekanye ko abaganga bari bazi ko abarwayi bahabwa imiti ifitanye isano no kugabanya ububabare bukabije.

Niba dushaka gukoresha ingaruka ya platbo kugirango tunoze ibisubizo byubuvuzi tutiriwe dukurikiza uburyo bwa ba se, inzira imwe ni ugusobanura ubuvuzi muburyo bufatika ariko bwiza. Kuzamura ibyifuzo byinyungu zo kuvura byagaragaye ko bizamura igisubizo cyumurwayi kuri morphine, diazepam, gukangura ubwonko bwimbitse, imiyoborere yimitsi ya remifentanil, ubuyobozi bwibanze bwa lidocaine, ubuvuzi bwuzuzanya kandi bwuzuye (nka acupuncture), ndetse no kubaga.

Gutohoza ibyifuzo byabarwayi nintambwe yambere yo kwinjiza ibyo biteze mubikorwa byubuvuzi. Mugihe cyo gusuzuma ibyavuye mu mavuriro ateganijwe, abarwayi barashobora gusabwa gukoresha igipimo cya 0 (nta nyungu) kugeza kuri 100 (inyungu ntarengwa yatekerezwa) kugirango basuzume inyungu zabo ziteganijwe. Gufasha abarwayi kumva ibyo bategereje kubagwa umutima utoranijwe bigabanya ingaruka zubumuga mumezi 6 nyuma yo kubagwa; Gutanga ubuyobozi ku ngamba zo guhangana n’abarwayi mbere yo kubagwa mu nda byagabanije cyane ububabare bwa nyuma yo kubagwa hamwe n’imiti ya anesteziya (ku kigero cya 50%). Inzira zo gukoresha izo ngaruka zirimo ntabwo zisobanura gusa uburyo bwo kuvura abarwayi, ahubwo tunasobanura umubare w’abarwayi babyungukiramo. Kurugero, gushimangira akamaro k'imiti kubarwayi birashobora kugabanya gukenera imiti igabanya ubukana abarwayi bashobora kwifata.

Mubikorwa byubuvuzi, hashobora kubaho ubundi buryo bwimyitwarire yo gukoresha ingaruka ya placebo. Ubushakashatsi bumwe bushigikira imikorere yuburyo bwa "open label placebo", burimo gutanga ikibanza hamwe nibiyobyabwenge bikora no kumenyesha mubyukuri abarwayi ko kongeramo ikibanza byagaragaye ko byongera ingaruka nziza zibiyobyabwenge, bityo bikazamura imikorere yacyo. Byongeye kandi, birashoboka gukomeza gukora neza imiti ikora binyuze muri conditioning mugihe ugabanya gahoro gahoro. Uburyo bwihariye bwo kubaga ni uguhuza ibiyobyabwenge nibimenyetso bifatika, bifasha cyane cyane imiti yuburozi cyangwa ibiyobyabwenge.

Ibinyuranye nibyo, amakuru ateye impungenge, imyizerere itari yo, ibyiringiro byo kwiheba, ibyabaye bibi, amateka mbonezamubano, hamwe n’ibidukikije bivura bishobora gutera ingaruka kandi bikagabanya inyungu zo kuvura ibimenyetso. Ingaruka zidasanzwe zibi biyobyabwenge bikora (intermittent, heterogeneous, dose independent, and reproducible reproducible) birasanzwe. Izi ngaruka mbi zishobora gutuma abarwayi batubahiriza gahunda yo kuvura (cyangwa gahunda yo guhagarika) yagenwe na muganga, ibasaba kwimukira muyindi miti cyangwa bakongeramo indi miti yo kuvura izo ngaruka. Nubwo dukeneye ubushakashatsi bwinshi kugirango tumenye isano iri hagati yibi byombi, izi ngaruka zidasanzwe zishobora guterwa ningaruka zo kurwanya umwanya.

Byaba byiza gusobanura ingaruka mbi kumurwayi mugihe unagaragaza ibyiza. Birashobora kandi gufasha gusobanura ingaruka mbi muburyo bwo gushyigikirwa aho kubeshya. Kurugero, gusobanurira abarwayi igipimo cyabarwayi badafite ingaruka mbi, aho kuba umubare wabarwayi bafite ingaruka mbi, birashobora kugabanya ingaruka zizi ngaruka.

Abaganga bafite inshingano yo kubona uruhushya rwemewe n’abarwayi mbere yo gushyira mu bikorwa imiti. Mu rwego rwo kumenyesha amakuru, abaganga bakeneye gutanga amakuru yuzuye kugirango bafashe abarwayi gufata ibyemezo byuzuye. Abaganga bagomba gusobanura neza kandi neza ingaruka zose zishobora guteza akaga kandi zikomeye mubuvuzi, kandi bakamenyesha abarwayi ko ingaruka zose zigomba kumenyekana. Ariko, gutondekanya ingaruka nziza kandi zidasanzwe zidasaba ubuvuzi umwe umwe byongera amahirwe yo kubaho kwabo, bigatera ikibazo abaganga. Igisubizo kimwe gishoboka nukumenyekanisha abarwayi barwanya umwanya hanyuma ukabaza niba bafite ubushake bwo kwiga kubyerekeye ingaruka mbi, zidasanzwe zokuvurwa nyuma yo kumenya iki kibazo. Ubu buryo bwitwa "guhuza amakuru byemewe" no "kubitekerezaho byemewe".

Gucukumbura ibyo bibazo hamwe n’abarwayi birashobora gufasha kuko imyizerere itari yo, ibiteganijwe biteye impungenge, hamwe nubunararibonye bubi hamwe nubuvuzi bwabanje bishobora gutera ingaruka zo kurwanya umwanya. Ni izihe ngaruka mbi cyangwa mbi zagize mbere? Ni izihe ngaruka bahangayikishijwe? Niba muri iki gihe barwaye ingaruka mbi, batekereza ko ari izihe ngaruka? Bategereje ko ingaruka mbi zizagenda ziyongera mugihe runaka? Ibisubizo byatanzwe n’abarwayi birashobora gufasha abaganga kugabanya impungenge zabo ku ngaruka mbi, bigatuma ubuvuzi bwihanganirwa. Abaganga barashobora kwizeza abarwayi ko nubwo ingaruka zishobora gutera ibibazo, mubyukuri nta kibi kandi ntabwo ari mbi mubuvuzi, zishobora kugabanya amaganya atera ingaruka. Ibinyuranye na byo, niba imikoranire hagati y’abarwayi n’abaganga b’amavuriro idashobora kugabanya amaganya yabo, cyangwa no kuyongera, bizongera ingaruka. Isuzuma ryujuje ubuziranenge bw’ubushakashatsi n’ubuvuzi ryerekana ko imyitwarire mibi itavuzwe hamwe nuburyo bwo gutumanaho butitaye (nko kuvuga impuhwe, kutabonana amaso n’abarwayi, imvugo imwe, no kumwenyura mu maso) bishobora guteza imbere ingaruka zo kurwanya ibibanza, kugabanya kwihanganira abarwayi kubabara, no kugabanya ingaruka z’umwanya. Ingaruka zifatwa ni ibimenyetso akenshi ni ibimenyetso byirengagijwe cyangwa byirengagijwe, ariko ubu biterwa n'imiti. Gukosora iyi miterere yibeshya birashobora gutuma ibiyobyabwenge byihanganirwa.

Ingaruka mbi zavuzwe n’abarwayi zishobora kugaragazwa mu buryo butavuzwe kandi bwihishe, bikagaragaza gushidikanya, kwanga, cyangwa guhangayikishwa n’imiti, gahunda yo kuvura, cyangwa ubuhanga bw’umuganga. Ugereranije no kwerekana ugushidikanya kubaganga b’amavuriro, ingaruka mbi nimpamvu ziteye isoni kandi byoroshye kwemerwa guhagarika imiti. Muri ibi bihe, gusobanura no kuganira mubyukuri ibibazo byumurwayi birashobora gufasha kwirinda ibihe byo guhagarika akazi cyangwa kutubahiriza amategeko.

Ubushakashatsi ku ngaruka za plato na anti-placebo bufite ireme mugushushanya no gushyira mubikorwa ibizamini byamavuriro, ndetse no gusobanura ibisubizo. Ubwa mbere, aho bishoboka, ibizamini byamavuriro bigomba kubamo amatsinda yo gutabara kubuntu kugirango asobanure ibintu bitera urujijo bifitanye isano na plaque na anti-placebo, nkibimenyetso byo gusubira inyuma bisobanura. Icya kabiri, igishushanyo mbonera cy’iburanisha kizagira ingaruka ku kibazo cyo gusubiza umwanya wa platbo, cyane cyane mu gishushanyo mbonera, kuko ku bitabiriye amahugurwa babanje kunywa ibiyobyabwenge, ibyababayeho mbere byazana ibyifuzo, mu gihe abitabiriye kwakira ikibanza cya mbere batabikoze. Kubera ko kumenyesha abarwayi inyungu zihariye n'ingaruka zo kuvurwa bishobora kongera umubare w'izi ngaruka n'ingaruka, nibyiza gukomeza guhuzagurika mu nyungu n'ingaruka zamakuru zitangwa mugihe cyo kubyemererwa kubimenyeshwa mu manza ziga ku biyobyabwenge. Muri meta-gusesengura aho amakuru ananiwe kugera kumurongo, ibisubizo bigomba gusobanurwa nitonze. Nibyiza ko abashakashatsi bakusanya amakuru ku ngaruka mbi batamenya itsinda ryabavura ndetse ningaruka zingaruka. Iyo ukusanya amakuru yingaruka zamakuru, urutonde rwibimenyetso rwubatswe nibyiza kuruta ubushakashatsi bwuguruye.