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The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

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Abstract

Recent research into the placebo effect has implications for the ethics of shared decision-making (SDM). The older biomedical model views SDM as affecting which therapy is chosen, but not the nature or likelihood of any health outcomes produced by the therapy. Research indicates, however, that both the content and manner in which information is shared with the patient, and the patient’s experience of being involved in the decision, can directly alter therapeutic outcomes via placebo responses. An ethical tension is thereby created between SDM aimed strictly and solely at conveying accurate information, and “outcome engineering” in which SDM is adapted toward therapeutic goals. Several practical strategies mitigate this tension and promote respect for autonomous decision-making while still utilizing the therapeutic potential of SDM.

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Acknowledgments

We are grateful to several anonymous reviewers for their detailed and helpful comments. The opinions expressed are those of the authors and do not necessarily reflect the position or policy of the National Institutes of Health, the Public Health Service, or the Department of Health and Human Services.

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Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Institute for the Medical Humanities and Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA

    Howard Brody MD, PhD

  2. National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, USA

    Luana Colloca MD, PhD

  3. Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, USA

    Franklin G. Miller PhD

Authors
  1. Howard Brody MD, PhD
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  2. Luana Colloca MD, PhD
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  3. Franklin G. Miller PhD
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Corresponding author

Correspondence to Howard Brody MD, PhD.

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Brody, H., Colloca, L. & Miller, F.G. The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making. J GEN INTERN MED 27, 739–742 (2012). https://doi.org/10.1007/s11606-011-1977-1

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  • DOI: https://doi.org/10.1007/s11606-011-1977-1

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