Ethical Considerations of Placebo Treatment

Treatment recommendations are one of the most challenging aspects of physicians ’ work; no treatment is without its risks and moreover, many therapies have side effects that are very serious, and even more frightening, sometimes unknown. The recent discovery that continuous use of rofecoxib (Vioxx®) increases a patient’s risk of cardiovascular disease is but one example in which treatments are prescribed without the full appreciation of the risks.1 In contrast, one therapy has been known to have some efcacy and lack many of the adverse effects of other treatments—the placebo. A placebo is “an inert substance or inactive treatment given instead of a therapy that is evaluated.”2 Research has shown that placebos can be expected to generate a positive outcome in 30 % of patients and up to 70 % if the physician believes in the expected outcome as well.3 In fact, this phenomenon, the placebo effect, is so signicant that the “gold standard” of research design is the double-blind, placebo-controlled study.4 In light of the signicant outcomes of placeboes, the question thus arises whether placeboes should be used therapeutically; as inactive substances, placebos have the added benet in that it poses little to no risk of any adverse effects. In the proposed case, Amir, a 27-year-old patient, is suffering from chronic pain. The usual analgesics have been increasingly less effective and thus, his attending physician is considering other treatment options to manage his pain. Amir’s physician is reluctant to prescribe narcotics, likely because of its many side effects, and instead, proposes to prescribe niacin for its placebo effect. Yet, this proposes a dilemma as the placebo effect relies on the oblivion of the patient to the inert quality of his/her treatment. This paper will asses the ethical considerations prescribing placeboes i