clinical pharmacology
Placebos
Ethical considerations
In clinical studies, the ethical consideration is whether a placebo should be given at all. When effective treatment exists (eg, opioid analgesics for severe pain), it is typically considered unethical to deprive study participants of treatment by giving a placebo; in such cases, control groups are given an active treatment. Because participants acknowledge in advance that they may be given a placebo, there is no concern about deception. However, when a placebo is given in medical practice, patients are not told they are receiving an inactive treatment. This deception is controversial. Some clinicians argue that it is prima facie (Latin for “at first view”) unethical and, if discovered, may damage the clinician-patient relationship. Others suggest that it is more unethical to not give something that may make patients feel better. Giving an active treatment solely for placebo effect may be further considered unethical because it exposes patients to actual adverse effects (as opposed to nocebo adverse effects). 