Placebos: little white lies

Placebos have always been an ethical dilemma in terms ofusing them in clinical trials and modern medicine. Cathal Gallagher, principallecturer at the University of Hertfordshire, describes how using placebos inclinical trials may mean that, although society will benefit from the new drug,the participants on the placebo drug, which can be used as a control, maysuffer as they will not receive any therapeutic benefits. However, depending onthe reasons as to why the patient wants to be involved in the study, eg whetherthe patient is using the trial as a method of treatment or if they want to helpimprove healthcare for the greater society, it may not necessarily be unethicalto use placebos. Also as Dr Gallagher says “It’s worth considering from theperspective of the patient, particularly if the patient had the best existingtreatment and it failed, is there any difference to them in getting a tic tacand the best available medicine that is already known”. Additionally, using aplacebo does have a significant scientific advantage over using an activecontrol as it allows you to identify whether or not the drug has a therapeuticeffect.

Professor Irving Kirsch, associate director of the programmein placebo studies and lecturer in medicine at Havard Medical School, went onto show how placebos are beneficial in studies related to antipsychotics andhow they can be therapeutically equivalent to such drugs.

Professor Kirsch has conducted several studies to show thatantipsychotics do not have a significant benefit over placebos in the treatmentof depression and that all methods of treating depression have similar success rates.However, patients who remained on a waiting list were far less likely to getbetter. This is an unusual finding as those on a placebo had a better chance ofgetting better and so this shows that “you need to give patients some treatmentbut it doesn’t matter what,” said Professor Kirsch.

Suggesting that placebos have a place in modern medicinewill inevitably result in a debate regarding how ethical it is. Lying to apatient goes against the principle of autonomy. However, with German cliniciansalready prescribing them, it may influence other prescribers to look into theuse of placebos for psychiatric disorders, irritable bowel syndrome and otherconditions, where the benefit of the treatment comes not from the therapeuticeffect but from actually being treated.

By Rukeya Begum