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J R Soc Med. 2007 September; 100(9): 396.
PMCID: PMC1963397

The permissible use of placebo

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.

Notes

Competing interests None declared.

References

1. Ernst E. Placebo management of psychogenic disease. J R Soc Med 2007;100: 165. [PMC free article] [PubMed]
2. Devinsky O, Fisher R. Ethical use of placebos and provocative testing in diagnosing nonepileptic seizures. Neurology 1996;47: 866-70 [PubMed]
3. Lim EC, Ong BK, Seet RC. Is there a place for placebo in management of psychogenic movement disorders? Ann Acad Med Singapore 2007;36: 208-10 [PubMed]
4. Lim EC, Seet RC. What is the place for placebo in the management of psychogenic disease? J R Soc Med 2007;100: 60-1 [PMC free article] [PubMed]
5. Nitzan U, Lichtenberg P. Questionnaire survey on use of placebo. BMJ 2004;329: 944-6 [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press