Journal of General Internal Medicine

, Volume 27, Issue 6, pp 739–742 | Cite as

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

  • Howard Brody
  • Luana Colloca
  • Franklin G. Miller
Original Research


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.


Back Pain Irritable Bowel Syndrome Placebo Effect Irritable Bowel Syndrome Patient Placebo Response 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Funding Source


Conflict of Interest

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


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Howard Brody
    • 1
  • Luana Colloca
    • 2
  • Franklin G. Miller
    • 3
  1. 1.Institute for the Medical Humanities and Department of Family MedicineUniversity of Texas Medical BranchGalvestonUSA
  2. 2.National Center for Complementary and Alternative MedicineNational Institutes of HealthBethesdaUSA
  3. 3.Department of BioethicsClinical Center, National Institutes of HealthBethesdaUSA

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