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Placebos have always been an ethical dilemma in terms of using them in clinical trials and modern medicine. Cathal Gallagher, principal lecturer at the University of Hertfordshire, describes how using placebos in clinical 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, may suffer as they will not receive any therapeutic benefits. However, depending on the reasons as to why the patient wants to be involved in the study, eg whether the patient is using the trial as a method of treatment or if they want to help improve healthcare for the greater society, it may not necessarily be unethical to use placebos. Also as Dr Gallagher says “It’s worth considering from the perspective of the patient, particularly if the patient had the best existing treatment and it failed, is there any difference to them in getting a tic tac and the best available medicine that is already known”. Additionally, using a placebo does have a significant scientific advantage over using an active control as it allows you to identify whether or not the drug has a therapeutic effect.
Professor Irving Kirsch, associate director of the programme in placebo studies and lecturer in medicine at Havard Medical School, went on to show how placebos are beneficial in studies related to antipsychotics and how they can be therapeutically equivalent to such drugs.
Professor Kirsch has conducted several studies to show that antipsychotics do not have a significant benefit over placebos in the treatment of 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 get better. This is an unusual finding as those on a placebo had a better chance of getting better and so this shows that “you need to give patients some treatment but it doesn’t matter what,” said Professor Kirsch.
Suggesting that placebos have a place in modern medicine will inevitably result in a debate regarding how ethical it is. Lying to a patient goes against the principle of autonomy. However, with German clinicians already prescribing them, it may influence other prescribers to look into the use of placebos for psychiatric disorders, irritable bowel syndrome and other conditions, where the benefit of the treatment comes not from the therapeutic effect but from actually being treated.
By Rukeya Begum