Placebo: from deception to a new alliance in general practice
Nitzan and Lichtenberg’s article(1) evokes the debate concerning the
ethical risk tied to treachery in using placebos.
Actually, many contemporary drugs are effective because they deceive
nervous receptors. This means we must distinguish the misleading
interpersonal relationship from the tricky techniques within an agreed
therapeutic alliance. The first must be discouraged, while the second
must be controlled, yet not stopped; otherwise we’ll see more and more
paradoxes.
For example, while today it is allowed to prescribe, even on a long-
term basis, hazardous Non-steroidal anti-inflammatory drugs (NSAID’s)and
Cox-2 inhibitors (Coxib) drugs, the legislation and medical praxis does
not yet supply efficient strategies for explicit agreements with patients,
on the use of placebos, in pain syndromes where, even if among doubts, its
biological plausibility remains strong (2).
The GPs, that continuously visit patients with chronic pain, could be
the major users and major researchers of placebos. Maybe a change would
take place, if there were a major increase in general practice of
participation in trials, which in many cases establish the use of
placebos.
The achievement of a friendly and shared science, between doctors and
patients in general practice, could be the necessary condition for a
correct and extensive “informed consent” that could include the use of
placebos in medical practice.
1.Nitzan U, Lichtenberg P. Questionnaire survey on use of placebo.
BMJ 2004:329: 944-6
2. Tor D. Wager, James K. Rilling, Edward E. Smith, Alex Sokolik,
Kenneth L. Casey, Richard J. Davidson, Stephen M. Kosslyn, Robert M. Rose,
and Jonathan D. Cohen Placebo-Induced Changes in fMRI in the Anticipation
and Experience of Pain. Science 2004; 303: 1162-1167
Rapid Response:
Placebo: from deception to a new alliance in general practice
Nitzan and Lichtenberg’s article(1) evokes the debate concerning the
ethical risk tied to treachery in using placebos.
Actually, many contemporary drugs are effective because they deceive
nervous receptors. This means we must distinguish the misleading
interpersonal relationship from the tricky techniques within an agreed
therapeutic alliance. The first must be discouraged, while the second
must be controlled, yet not stopped; otherwise we’ll see more and more
paradoxes.
For example, while today it is allowed to prescribe, even on a long-
term basis, hazardous Non-steroidal anti-inflammatory drugs (NSAID’s)and
Cox-2 inhibitors (Coxib) drugs, the legislation and medical praxis does
not yet supply efficient strategies for explicit agreements with patients,
on the use of placebos, in pain syndromes where, even if among doubts, its
biological plausibility remains strong (2).
The GPs, that continuously visit patients with chronic pain, could be
the major users and major researchers of placebos. Maybe a change would
take place, if there were a major increase in general practice of
participation in trials, which in many cases establish the use of
placebos.
The achievement of a friendly and shared science, between doctors and
patients in general practice, could be the necessary condition for a
correct and extensive “informed consent” that could include the use of
placebos in medical practice.
Del Zotti Franco- general practitioner
Corso Porta Nuova 3 –Verona (Italy)- delzotti@libero.it
1.Nitzan U, Lichtenberg P. Questionnaire survey on use of placebo.
BMJ 2004:329: 944-6
2. Tor D. Wager, James K. Rilling, Edward E. Smith, Alex Sokolik,
Kenneth L. Casey, Richard J. Davidson, Stephen M. Kosslyn, Robert M. Rose,
and Jonathan D. Cohen Placebo-Induced Changes in fMRI in the Anticipation
and Experience of Pain. Science 2004; 303: 1162-1167
Competing interests:
None declared
Competing interests: No competing interests