The permissible use of placebo

Abstract

Whilst we agree with Professor Ernst that there is scant original research supporting the use of the placebo test (JRSM 2007;100:165),1 we maintain that it is useful. Provocation, cessation or amelioration of seizures2 and movement disorders3 with placebo use is often a diagnostic criterion (amongst others) for psychogenic disease. In addition, placebo therapy has been used to treat psychogenic diseases.3 Our work highlighted the potential diagnostic or therapeutic benefits of placebo use whilst emphasizing the ethical concerns mitigating against its casual use (JRSM 2007;100:60-61),4 but we acknowledge its potentially deceptive nature.1,2 We advocate that physicians managing patients with psychogenic disease practice knowledge framing,4 providing a neurobiological explanation for the disease, including the possibility of a psychological basis for the patients' attacks.2 As doctors are not averse to using placebos5—even while they publicly decry them—we feel that it is timely that we reach a consensus on the acceptability and utility of placebo use.