Doctoring the Evidence: The Case Against Lying to Patients about Placebos

University of California, San Diego, School of Medicine, San Diego, CA, USA.
The American Journal of Bioethics (Impact Factor: 5.29). 12/2009; 9(12):34-6. DOI: 10.1080/15265160903244242
Source: PubMed
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    ABSTRACT: Is it ever right to prescribe placebos to patients in clinical practice? The General Medical Council is ambivalent about the issue; the American Medical Association asserts that placebos can be administered only if the patient is (somehow) 'informed'. The potential problem with placebos is that they may involve deception: indeed, if this is the case, an ethical tension arises over the patient's autonomy and the physician's requirement to be open and honest, and the notion that medical care should be the primary concern. This paper examines the case of depression as an entry point for understanding the complexities of the prescription of placebos. Recent important meta-analyses of antidepressants claim that they are not significantly more effective in a clinical setting than placebos. Given that antidepressants have numerous adverse side effects and are hugely expensive, this provocative research has serious potential ethical and practical implications for patients and medical providers. Should placebos be prescribed in place of antidepressants? The case of depression highlights another important issue which medical ethical codes have hitherto overlooked: well-being is not synonymous with being realistic about oneself, one's circumstances and the future. While severely depressed individuals are unduly pessimistic about themselves and the world around them, treatment of depressed individuals can be deemed successful when patients have successfully attained those positive illusions that are indicative of psychological health. This is exactly what successful psychological treatments of depression seem to achieve. It is therefore possible that there may be a limited unavoidable role for deception in medicine.
    No preview · Article · Oct 2010 · Journal of medical ethics
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    ABSTRACT: No regulations govern placebo composition. The composition of placebos can influence trial outcomes and merits reporting. To assess how often investigators specify the composition of placebos in randomized, placebo-controlled trials. 4 English-language general and internal medicine journals with high impact factors. 3 reviewers screened titles and abstracts of the journals to identify randomized, placebo-controlled trials published from January 2008 to December 2009. Reviewers independently abstracted data from the introduction and methods sections of identified articles, recording treatment type (pill, injection, or other) and whether placebo composition was stated. Discrepancies were resolved by consensus. Most studies did not disclose the composition of the study placebo. Disclosure was less common for pills than for injections and other treatments (8.2% vs. 26.7%; P = 0.002). Journals with high impact factors may not be representative. Placebos were seldom described in randomized, controlled trials of pills or capsules. Because the nature of the placebo can influence trial outcomes, placebo formulation should be disclosed in reports of placebo-controlled trials.
    Full-text · Article · Oct 2010 · Annals of internal medicine
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    ABSTRACT: The study aimed to assess the attitudes of laypeople toward clinical placebo use. One of three imaginary stories was presented randomly in a popular news portal and participants (6,404 individuals) were asked to rate nine statements about it. In the stories, placebo therapy was used in a deceptive way. Following the success of the treatment, the patient was informed that the remedy contained no active substances. Along with self-report of attitudes, questionnaires measuring dispositional optimism, somatosensory amplification and beliefs about the scientific validity of complementary and alternative medicine and holistic health were also completed. According to participants' ratings, helping patients is more important than avoiding deception. They did not think that they would have felt deceived in the described situation or that treatment would have been successful in a fully informed case. Patients' attitude toward deceptive placebo use appears to be more pragmatic than has been previously supposed.
    No preview · Article · Jul 2012 · Evaluation & the Health Professions