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Placebos in clinical practice: an ethical overview

Placebos dans la pratique clinique : un aperçu éthique

  • Literature Review / Revue de la Littérature
  • Published:
Douleur et Analgésie

Abstract

The use of placebos in clinical settings raises a host of important ethical issues. On the one hand, ethical guidelines tend to categorically prohibit the clinical use of placebos because they require deception. On the other hand, a growing series of empirical studies has revealed that placebos can be clinically effective and are still widely used by health professionals. In this article we provide a synthetic overview of the ethical debate discussing: 1) the ethics of deceptive placebos; 2) the ethics of placebos without deception, and 3) the ethics of eliciting placebo responses without administering a traditional placebo.

Résumé

L’utilisation de placebos dans les milieux cliniques soulève plusieurs questions éthiques importantes. D’une part, les lignes directrices éthiques ont tendance à interdire catégoriquement l’utilisation clinique des placebos, car ils nécessitent la tromperie. D’autre part, de plus en plus d’études empiriques ont révélé que les placebos peuvent être cliniquement efficaces et qu’ils sont encore largement utilisés par les professionnels de la santé. Dans cet article, nous proposons un aperçu synthétique du débat éthique en abordant : 1) l’éthique de placebos avec tromperie ; 2) l’éthique de placebos sans tromperie et 3) l’éthique de déclencher des réponses placebo sans l’administration d’un placebo traditionnel.

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References

  1. Asai A, Kadooka Y (2013) Reexamination of the ethics of placebo use in clinical practice. Bioethics 27:186–93

    Article  PubMed  Google Scholar 

  2. Grünbaum A (1989) The placebo concept in medicine and psychiatry. In: Non-Specific aspects of treatment. Sheperd M, Sartorius N (eds) Hans Huber, Bern, pp 7–38

    Google Scholar 

  3. Louhiala P, Puustinen R, Hemilä H (2013) Impure placebo as an unsound concept and other problems in the paper by Howick et al PLoS One doi:10.1371/journal.pone.0058247

    Google Scholar 

  4. Miller F, Brody H (2011) Understanding and harnessing placebo effects: clearing away the underbrush. J Med Philos 36:69–71

    Article  PubMed Central  PubMed  Google Scholar 

  5. Jefferson T (1898) The writings of Thomas Jefferson. Putnam, New York

    Google Scholar 

  6. Pepper O (1945) A note on the placebo. Am J Pharmacol 117:409–12

    Google Scholar 

  7. Faden R, Beauchamp T (1986) A history and theory of informed consent. Oxford University Press, New York

    Google Scholar 

  8. Benedetti F (2009) Placebo effects: understanding the mechanisms in health and disease. Oxford University Press New York

    Google Scholar 

  9. Tilburt J, Emanuel E, Kaptchuk T, et al (2008) Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists. BMJ 337:a1938

    Article  Google Scholar 

  10. Howick J, Bishop FL, Heneghan C, et al (2013) Placebo use in the United Kingdom: results from a National Survey of Primary Care Practitioners. PLoS One 8:e58247

    Article  Google Scholar 

  11. Fassler M, Meissner K, Schneider A, Linde K (2010) Frequency and circumstances of placebo use in clinical practice: a systematic review of empirical studies. BMC Med 8:15

    Article  PubMed Central  PubMed  Google Scholar 

  12. American Medical Association Code of Ethics Opinion 8.083 (2006) Placebo use in clinical practice. http://www. ama-assn.org/ama/pub/physician-resources/medical-ethics/codemedical- ethics/ opinion8083.shtml

    Google Scholar 

  13. Brody H (1982) The lies that heals. Ann Intern Med 97:112–8

    Article  CAS  PubMed  Google Scholar 

  14. Jackson J (2001) Truth, trust and medicine. Routledge, London and New York

    Google Scholar 

  15. Beauchamp T, Childress J (2009) Principles of biomedical ethics. Oxford University Press, New York and Oxford

    Google Scholar 

  16. Bok S (1978) Lying: Moral choices in public and private life. Ed. 1999. Vintage Books, New York

    Google Scholar 

  17. Bok S (2002) Ethical issues in use of placebo in medical practice and clinical trials. In: The science of the placebo. Guess H et al (eds) BMJ Books, London, pp 53–74

    Google Scholar 

  18. Brody H (1995) “Placebo”. In: Encyclopedia of Bioethics. Reich W (ed) Simon & Schuster Macmillan, New York, pp 1951–3

    Google Scholar 

  19. Cohen S, Shapiro H (2013) “Comparable placebo treatment” and the ethics of deception. J Med Philos 38:696–709

    Article  PubMed  Google Scholar 

  20. Foddy A (2009) A duty to deceive: placebos in clinical practice. Am J Bioethics 9:4–12

    Article  Google Scholar 

  21. Gold A, Lichtenberg P (2014) The moral case for the clinical placebo. J Med Ethics 40:219–24

    Article  PubMed  Google Scholar 

  22. Kolber A (2007) A limited defense of clinical placebo deception. Yale Policy Rev 26:75–134

    Google Scholar 

  23. Justman S (2013) Deceit and transparency in placebo research. Yale J Biol Med 86:323–31

    PubMed Central  PubMed  Google Scholar 

  24. Lynöe N, Mattsson B, Sandlum M (1993) The attitudes of patients and physicians towards placebo treatment — a comparative study. Soc Sci Med 36:767–74

    Article  PubMed  Google Scholar 

  25. Hull S, Colloca L, Avins A, et al (2013) Patients’ attitudes about the use of placebo treatments: telephone survey. Brit Med J 346: f3757

    Article  Google Scholar 

  26. Cabot R (1903) The use of truth and falsehood in medicine: an experimental study. Am Med 5:3444–49

    Google Scholar 

  27. Kaptchuk T, Friedlander E, Kelley J, Sanchez N (2010) Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS One 5:e15591

    Article  Google Scholar 

  28. Krueger G, Elewski B, Papp K, et al (2006) Patients with psoriasis respond to continuous open-label etanercept treatment after initial incomplete response in a randomized, placebo-controlled trial. J Am Acad Dermatol 54:S112–9

    Article  Google Scholar 

  29. Sandler A, Bodfish J (2008) Open-label use of placebos in the treatment of ADHD: a pilot study. Child Care Health Dev 34:104–10

    Article  CAS  PubMed  Google Scholar 

  30. Kam-Hansen S, Jakubowski M, Kelley J, et al (2014) Altered placebo and drug labeling changes the outcome of episodic migraine attacks. Sci Translat Med 6:218ra5

    Article  Google Scholar 

  31. Kelley J, Kaptchuk T, Cusin C, et al (2012) Open-label placebo for major depressive disorder: a pilot randomized controlled trial. Psychother Psychosom 81:312–4

    Article  PubMed  Google Scholar 

  32. Amanzio M, Pollo A, Maggi G, Benedetti F (2001) Response variability to analgesics: a role for non-specific activation of endogenous opioids. Pain 90:205–15

    Article  CAS  PubMed  Google Scholar 

  33. Colloca L, Sigaudo M, Benedetti F (2008) The role of learning in nocebo and placebo effects. Pain 136:211–8

    Article  CAS  PubMed  Google Scholar 

  34. Miller F, Colloca L (2011) The placebo phenomenon and medical ethics: rethinking the relationship between informed consent and risk-benefit assessment. Theor Med Bioet 32:229–43

    Article  Google Scholar 

  35. Wells R, Kaptchuk T (2012) To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. Am J Bioethics 12:22–9

    Article  Google Scholar 

  36. Haake M, Müller H, Schade-Brittinger C, et al (2007) German acupuncture trials (GERAC) for chronic low back pain. Arch Intern Med 167:1892–8

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Scienze della Salute, University of Milan & Department of Experimental Oncology, IEO, Istituto Europeo di Oncologia, Via Adamello 16, 20139, Milan, Italy

    M. Annoni

  2. Department of Bioethics, National Institutes of Health, 10 Center Drive, Building 10, Room 1C118, Bethesda, MD, 20892-1156, USA

    F. G. Miller

Authors
  1. M. Annoni
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  2. F. G. Miller
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Correspondence to M. Annoni.

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Annoni, M., Miller, F.G. Placebos in clinical practice: an ethical overview. Douleur analg 27, 215–220 (2014). https://doi.org/10.1007/s11724-014-0400-1

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  • DOI: https://doi.org/10.1007/s11724-014-0400-1

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