Ethics of Placebos

Colloca, Luana

doi:10.1016/b978-0-12-801238-3.00182-3

Cited by 2 publications

(1 citation statement)

References 51 publications

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“…Whether placebos can be prescribed to achieve similar or better outcomes compared with usual medical care, whether and how physicians may recommend treatments that lack any specific efficacy remains controversial (Colloca, 2014; Comaroff, 1976; Henriksen & Hansen, 2004). …”

Section: Discussionmentioning

confidence: 99%

Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Colloca

Howick

2018

International Review of Neurobiology

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Scientific research indicates that open-label and dose-extending placebos (that patients know are placebos) can elicit behavioral, biological, and clinical outcome changes. In this chapter, we present the state-of-the-art evidence and ethical considerations about open-label and dose-extending placebos, discussing the perspective of giving placebos with a rational, as dose extension of active drugs, or expectancy boosters. Previous comprehensive reviews of placebo use have considered how to harness placebo effects in medicine and the need to focus on elements of the clinical encounter as well as patient–clinician relations. Here, we illustrate the similarities and differences between standard (deceptive) placebos, open-label placebos and dose-extending placebos. We conclude that placebos without deception would override ethical barriers to their clinical use. This paves the way to future large-scale, pragmatic randomized trials that investigate the potential of ethical open-label and dose-extending placebos to improve patients’ outcomes, and reduce side effects.

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Section: Discussionmentioning

confidence: 99%

Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Colloca

Howick

2018

International Review of Neurobiology

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Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey

2016

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ObjectivesTo examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients.Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown.SettingMembers of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months.Participants853 women (61%) and men, white (58%) and non-white participants aged 18–75 years.Primary and secondary outcomesQualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables.ResultsPrior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; p<0.024). Of the minority of respondents who judged it never acceptable for doctors to recommend placebo treatments, the most often referenced rationale was obligation of the doctor to do more (n=102, 48.3%). Additional themes emerged around the issue of whether a doctor was transparent about placebo use, including honesty, patient's right to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; p<0.002).ConclusionsParticipants seem to appreciate and understand the lack of harm and potential benefit associated with placebo treatments, while valuing the role of the physician and the patient in its implementation.

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Ethics of Placebos

Cited by 2 publications

References 51 publications

Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Placebos Without Deception: Outcomes, Mechanisms, and Ethics

Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey

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