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Use of Placebo in Clinical Practice

The use of placebo, when consistent with good medical care, is distinct from interventions that lack scientific foundation.
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Code of Medical Ethics Opinion 2.1.4

A placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect on the condition being treated. The use of placebo, when consistent with good medical care, is distinct from interventions that lack scientific foundation.

A placebo may still be effective if the patient knows it will be used but cannot identify it and does not know the precise timing of its use. In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.

Physicians may use placebos for diagnosis or treatment only if they:

(a) Enlist the patient’s cooperation. The physician should explain that it can be possible to achieve a better understanding of the medical condition by evaluating the effects of different medications, including the placebo.

(b) Obtain the patient’s general consent to administer a placebo. The physician does not need to identify precisely when the placebo will be administered. In this way, the physician respects the patient autonomy and fosters a trusting relationship, while the patient may still benefit from the placebo effect.

(c) Avoid giving a placebo merely to mollify a difficult patient. Giving a placebo for such reasons places the convenience of the physician above the welfare of the patient. Physicians can produce a placebo-like effect through the skillful use of reassurance and encouragement, thereby building respect and trust, promoting the patient-physician relationship, and improving health outcomes. 

AMA Principles of Medical Ethics: I, III, V, VIII

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