The role of placebos in family medicine: Implications of evidence and ethics for general practitioners

Abstract

Charlotte R Blease Background Placebo use is prevalent in primary care. A wealth of discourse on the ethical use of placebos in clinical contexts invariably assumes that placebos oblige practitioners to peddle in deception. However, the recent surge in empirical findings within the field of 'placebo studies' provides a very different perspective: namely, that placebos may yet prove to be both effective and ethical. Objective The aim of this article is to synthesise state-of-the-art scientific and bioethical research to provide up-to-date recommendations on placebo use for general practitioners. Discussion After disambiguating placebo concepts, this article outlines experimental studies into placebo effects and explores the ethical and evidence-based arguments for prescribing placebos. Evaluating the latest research into 'open-label placebos', it can be surmised that there are not yet persuasive grounds to incorporate these treatments into routine clinical care. Notwithstanding, the quality of physician interactions may go some way to harnessing remedial placebo effects among patients.

Effects of open-label placebos in clinical trials: a systematic review and meta-analysis

“…However, this does not mean that the use of OLPs is free from ethical problems. Two recent publications 48,49 have pointed to other ethical issues in the use of OLPs such as self-stigmatization, testimonial injustice and the risk of a medicalization of issues that are more socially or environmentally determined. Nevertheless, even if the current body of research on OLP treatments does not yet allow for clinical recommendations, it supports the conclusion that it is a promising approach that is worth pursuing.…”

“Placebo by Proxy” and “Nocebo by Proxy” in Children: A Review of Parents' Role in Treatment Outcomes

“…To date attention has focused on research studying the placebo effect (PE), the biopsychosocial process, which engages perceptual and cognitive processes that lead to therapeutic benefits associated with the administration of a placebo in the context of individuals being treated (2). These include the impact of factors such as learning, conditioning and the clinical encounter, which affect outcomes, typically via the individual (3)(4)(5)(6).…”

“…In contrast, the placebo effect needs to be distinguished from the placebo response, which includes all health outcomes that follow administration of an inactive treatment (7). The placebo response is widely considered a phenomenon underlying a positive treatment response to both the administration of active medication and treatment with an inert substance (placebo) in a randomized controlled trial, and is related among others to spontaneous remission, regression the mean and the Hawthorne effect (i.e., the effect of being observed) (2).…”

Placebos Are Part of the Solution, Not the Problem. An Exemplification of the Case of Antidepressants in Pediatric Chronic Pain Conditions

“…Given the often large and clinically significant effects of placebos, an important question is how these effects can be harnessed in clinical practice within an ethical framework and without the use of deception (21,22). Here, the idea of open-label placebo (OLP) treatment, i.e., full disclosure of the placebo being nothing but a placebo, might seem counterintuitive to the common perception of placebos, but has received increased scientific interest in the last decade.…”