The thinking doctor's guide to placebos

doi:10.1136/bmj.39564.454502.C2

BMJ 2008;336:1020 (3 May), doi:10.1136/bmj.39564.454502.C2

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The thinking doctor’s guide to placebos

Rudiger Pittrof, consultant in integrated sexual health and HIV¹, Ian Rubenstein, general practitioner²

¹ Department of Reproductive and Sexual Health Care, Town Clinic, Enfield, Middlesex, ² Eagle House Surgery, Ponders End, Enfield

Correspondence to: R Pittrof rudiger.pittrof@enfield.nhs.uk

The first 150 words of the full text of this article appear below.

Discussion of the planned use on patients of the placebo effectis long overdue. For many years it has been medicine’s"dirty little secret." Clinicians have found it to be an embarrassmentthat needs to be factored in when planning randomised controlledtrials. Ethically its use has always been considered dubious.Recent high profile publications suggesting the lack of efficacyof selective serotonin reuptake inhibitors (SSRIs) in mild tomoderate depressive illness have shown that clinicians routinelymake use of the placebo effect—but from a position ofignorance rather than intention.¹

Whatever one’s ethical stance, this state of affairs cannotbe a good thing for our patients, our relationship with ourpatients, or the public purse. We outline a third way wherebyclinicians can use the placebo knowingly yet still stay withinthe ethical constraints of modern medical practice.

Drugs given to conscious patients have at least three effects:one . . . [Full text of this article]

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Placebolotherapy: Nick J Woodhead
bmj.com, 2 May 2008 [Full text]
An excellent and innovative perspective on placebo: Robert W Leckridge
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Re: Placebolotherapy: D B Double
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The placebo effect put into context: David E Linden
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Will patients given placebos be expected to benefit from a placebo effect?: Peter J Flegg
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Reply to rapid responses: Rudiger UJ Pittrof, et al.
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