The Ethics of placebos

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In a recent column for WebMD, Dr. Roy Benaroch considers the perpetually fraught question of prescription placebos. Should doctors be able to legally prescribe sham treatments?

As Benaroch points out, there is no question that placebos work. Studies have confirmed that placebos can drastically and consistently reduce pain, anxiety, and blood pressure, he writes. They can even improve diabetes control, help treat ear and sinus infections, improve school performance, and improve the confidence and performance of public speakers.

But, after noting that a physician s expected honesty with his patient is at odds with the level of deceit required for a placebo to work, Benaroch points out an interesting phenomenon. Doctors ¦prescribe placebos, every day, he says. The fact, of course, is that, whether knowingly or not, doctors often prescribe treatments that have been proven to essentially be a placebo.

To unravel the undeniably complicated question of the doctor-prescribed placebo, Benaroch examines a number of instances when a placebo can be genuinely effective. While he acknowledges that a genuinely effective and safe medicine, when available, will always trump a placebo, he raises a number of thoughtful questions about the practice, which, he asserts doctors and patients ought to be asking themselves.

The ACSH staff itself is divided on the issue. While Dr. Gilbert Ross agrees with many of Benaroch s points, observing that there are a number of conditions that respond favorably to the psychological effects of a placebo, Dr. Josh Bloom is more skeptical: It s only in retrospect that a doctor can know whether a placebo is a viable option, he says. And ACSH scientific advisor Dr. Chic Schissel believes that placebos should be used in appropriate situations but as opposed to what so often occurs with alternative healers, a doctor should know if he is using a placebo!

To decide for yourself, read Dr. Benaroch s column in full here.