Responses: Ethics of Placebos
--So, I’ll throw out a question to that question – if the intervention (drug/procedure/whatever) works regardless of the intent, is it really a placebo?
--Historically, people doing ethics have railed against the use of placebos as being deceptive and corrosive to the physician/patient relationship.
I raised all kinds of arguments with my colleagues who served with me on the Institute of Medicine committee to study the state of pain care in the US. In Chapter 3 of our report, Relieving Pain in America, there is a note on the use of placebos. I encourage people to go online and review the entire report.
We note in the report that there is a lot of interesting discussion about the use of placebos. Since its publication last June, there was an article in the New Yorker talking about the beneficial impact of placebos.
My view after reading it is that the point is really about the importance of the therapeutic relationship. If a patient is told that the treatment is a placebo by a physician they trust it still has a positive impact. Also, interestingly, if the medication is topical, it is less beneficial than if it is ingested, which is less beneficial that if it is injected.
The power of relationships and expectations of patients are both significantly important to consider.
Myra J. Christopher
Kathleen M. Foley Chair
Center for Practical Bioethics