Is prescribing a placebo ethical? This article from a professor of philosophy at the London School of Economics looks at the recent decision by Britain's National Health Service to ban the prescribing of homeopathic preparations by NHS practitioners.
"[L]et me be clear: I do not 'believe in homeopathy' – the theory behind homeopathy is as pseudoscientific as can be; and, so far as whether or not it works is concerned, there is no evidence that homeopathy outperforms placebo. However, homeopathic treatments, of course, do no worse than (acknowledged) placebo; and there is evidence for a real placebo effect for conditions like mild-to-moderate depression, irritable bowel syndrome (IBS), the common cold and (especially) pain (though also Parkinson’s Disease and some other neurological conditions). So, while you certainly do not want to be taking homeopathic preparations if you are unlucky enough to have lung cancer, or congestive heart failure or any other major, non-neurological disease, there is evidence that those preparations can be effective if you suffer from one of the limited range of conditions I just cited (depression, IBS, pain …); and so, contrary to a widely held view, prescribing placebos, in particular homeopathic placebos, is not (always) the equivalent of doing nothing. But, even if homeopathic treatments can be effective, why should it be NHS practitioners who prescribe them? Why shouldn’t patients be required to access those treatments via a private homeopath instead? Well, for one thing, a properly qualified NHS practitioner is much more likely than a homeopath to spot conditions that will not respond to a placebo and so more likely to ensure proper treatment of such conditions. But the central part of my earlier argument depends on an interesting, and again evidence-based, fact about placebos: that the effect of taking a placebo is, in general, greater if you don’t know that what you are taking is a placebo. This is because a major part of the placebo effect is caused by expectations of recovery – expectations that activate the body’s internal pharmacopeia (principally via discharge of endogenous opiates into the bloodstream). Patients who already have some degree of belief that homeopathic treatments are not simply placebos may have those expectations raised, and hence may experience a better result, if the treatment is prescribed, under the NHS, by an authoritative fully-qualified doctor."
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