Wednesday, May 16
16:15 - 17:00
Placebo Therapy as an Ethical Alternative
Irving Kirsch, PhD
Associate Director, Program in Placebo Studies and the Therapeutic Encounter
Harvard Medical School
Beth Israel Deaconess Medical Center, Boston, MA, USA
Professor Emeritus, University of Hull & University of Connecticut
The ethics of using placebos in clinical trials and in clinical practice have been challenged. The challenge to clinical trials is based on the concern that effective treatment is being withheld from patients given placebos. In fact, effective treatment may be withheld from patients given the active drug in clinical trials. Were this not a possibility, there would be no need for the trial. More important, giving a placebo may be more ethical than giving the active drug in a clinical trial. This is the case when placebo effects are substantial for the condition being treated, when the effects of existing drugs are not much better than those of placebo, and when the active drug produces side effects and other risks that are not produced by placebo. Clinical trials of antidepressants are examined as an exemplar of this situation. In clinical practice, the ethical concern is based on the presumption that effective administration of placebos requires deception. Three ways of overcoming this obstacle to clinical exploitation of the placebo effect are explored. First, recent data indicate that placebo pills can be given to patients openly, without either explicit or implicit deception, and can still produce substantial clinical benefits. Second, placebo effects can be elicited without the use of placebos by enhancing the therapeutic relationship and increasing patient confidence in the effectiveness of the treatment. Third, hypnosis can be used as a non-deceptive placebo to enhance therapeutic outcome.
Irving Kirsch is Associate Director of the Program in Placebo Studies at the Harvard Medical School and Professor Emeritus at the University of Hull and the University of Connecticut. He has published 10 books and more than 200 scientific journal articles and book chapters on placebo effects, antidepressant medication, hypnosis, and suggestion. His meta-analyses on the efficacy of antidepressants were covered extensively in the international media and influenced official guidelines for the treatment of depression in the United Kingdom. His book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, which has been published in English, French, and Japanese, was shortlisted for the prestigious Mind Book of the Year award. It was the topic of a 5-page cover story in Newsweek, and was favorably reviewed in the New York Review of Books by Marcia Angell, former editor-in-chief of the New England Journal of Medicine.