Placebo and the ethics of deception in brain research and clinical care

The placebo effect is powerful in many neurological and psychiatric disorders and clinical trials often use placebos when developing and testing new treatments. Some people question the ethics of including a placebo group in research, while others would argue that to not do so is ethically fraught. In some cases, estimating the placebo effect and uncovering its underlying mechanisms may depend upon the use of deception, but this may be in conflict with basic principles of autonomy.

Deception requires careful thought as to whether it is necessary, and if so, how it will be managed in an ethically acceptable manner. While there have been advances showing that genetic factors that may contribute to the placebo effect, the idea that placebo responders should be excluded from clinical trials may be scientifically unsound and may further violate the principle of social justice. The use of placebos in clinical care is more controversial and while there may be benefits, there may be risks and additional ethical challenges. Health care providers need to be sensitive to the impact of deception not only on their own relationship with patients, but also on potential effects on trust of the profession as a whole.