Authorized Deception: An Approach to the Effective and Ethical Use of Placebo Research

mathias-sager-psychology-placebo-research
Thanks to frolic somepl (pixabay.com)

Regarding the ‘cost’ and ‘benefit’ consideration in deception used in placebo research, Miller, Wendler, and Swartzman (2005) are concluding that an appropriate balance between research value and ethical protection of research participants should and can be found and approved by the Ethics Committees.

Rather than looking at a specific amount of deception, a solution that is allowing using deception as a necessity to test the placebo effect effectively in an ethical manner is suggested by Miller et al. (2005) and called ‘authorized deception.’ Blease, Colloca, and Kaptchuk (2016) are calling the same approach ‘open -label placebo’ that is based on the disclosure of the possibility to research participants that deception can be used regarding the administration of true treatments or placebos. Such an approach has a big advantage that fully informed consent can be ensured (Miller et al., 2005). According to Martin and Katz (2010), participants in an experimental pain study were responding to the same extent to the placebo effect, whether they were left unaware of possible deception or not. Furthermore, patients seem to value informed consent over not being warned about the use of placebo (Martin & Katz, 2010). As recent study results indicate that open-label placebos are an effective research method (Petkovic et al., 2015), it is to hope that it will be used more frequently to protect participants from any unnecessary distress and researchers from ethical dilemmas damaging the reputation of research teams and the scientific field overall.

 

References

Blease, C., Colloca, L., & Kaptchuk, T. J. (2016). Are open-Label Placebos Ethical? Informed Consent and Ethical Equivocations. Bioethics, 30(6), 407-414. doi:10.1111/bioe.12245

Martin, A. L., & Katz, J. (2010). Inclusion of authorized deception in the informed consent process does not affect the magnitude of the placebo effect for experimentally induced pain. Pain, 149208-215. doi:10.1016/j.pain.2009.12.004

Miller, F. G., Wendler, D., & Swartzman, L. C. (2005). Deception in Research on the Placebo Effect. Plos Medicine, 2(9), 853-859. doi:10.1371/journal.pmed.0020262

Petkovic, G., Charlesworth, J. G., Kelley, J., Miller, F., Roberts, N., & Howick, J. (2015). Effects of placebos without deception compared with no treatment: protocol for a systematic review and meta-analysis. BMJ Open, 5(11), e009428. doi:10.1136/bmjopen-2015-009428

  • Hi Jonathan. Thanks for your addition! Leaving it unknown to participants and researchers who is in the control and who in test group (double-blindness) should avoid bias, I agree. Keeping the use of placebo secret though doesn’t seem to add more to the placebo effect, therefore it is ethically and from a research benefit perspective appropriate to disclose the possibility of placebo involvement in any case.

  • Being a clinical study assistant in the past, I know in medical research placebo’s are used frequently and indeed to add a level of objectivity. Objectivity seems to me very important to get valuable results. At the same time, there have been done already a lot of research; if it is indeed the case that in specific areas/studies people are more distressed, then I think we should find new research methods.