Accepting placebos
Over at the Neuroethics and Law Blog, Adam Kolber argues that we should embrace the use of placebos:
Should a doctor stop prescribing antidepressants to a particular patient when the doctor believes that antidepressants will be no better for the patient than placebos? After recent changes in the American Medical Association’s Code of Medical Ethics, the doctor may have little choice but to stop. In November 2006, the AMA prohibited doctors from intentionally administering substances that they believe will only have placebo effects, unless they disclose to patients that they are doing so.
To most effectively use placebos in clinical practice, however, doctors cannot reveal their placebo nature. While placebo deception is a gray area of the law, the AMA’s prohibition makes it increasingly likely that doctors risk professional sanctions and legal liability when they use placebos without obtaining informed consent to do so.
Given our limited knowledge of placebo effects and patient preferences, the AMA prohibition is premature. While placebo deception should be rare, it sometimes promotes patients’ best interests. A rational patient might very well prefer to be deceived in some cases, if it means receiving a cheap and effective therapy with little risk of side effects. Even if a doctor believes that antidepressants will have no more than a placebo effect on a patient, we ought to allow the doctor to continue the therapy as before.
A "placebo positive" practice might face interesting challenges in getting informed consent -- if "informed" is the right word to use in this case. A patient would be consenting to possibly being lied to in the future. That's a lot of trust to place in your doctor.
And one more thing: if a doctor successfully treats a patient with a placebo, would it be ethical to eventually tell the patient that, yes, what you've been taking is just a sugar pill (or its equivalent)? Revealing that info could render the "treatment" ineffective and deprive the patient of whatever relief he or she has enjoyed.
-Greg Dahlmann
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Many studies have shown that placebo use in clinical practice is widespread and that in most cases it consists of using an "active placebo", i.e., an antibiotic, sedative, or other drug that the doctor knows will have no biological effect on the patient's illness, but if the patient believes it will help it might nonetheless make him feel better.
I think both that type of placebo use and the "sugar pill" variety constitute deception and should be legally actionable. I want to know what I'm being prescribed, and I routinely read both the manufacturers' data sheets and the results of published peer-reviewed research before taking a drug.
- by Peter Nelson on Sep 11, 2009 at 12:37 PM | link