RT Journal Article
SR Electronic
T1 Uncomfortable implications: placebo equivalence in drug management of a functional illness
JF Journal of Medical Ethics
JO J Med Ethics
FD BMJ Publishing Group Ltd and Institute of Medical Ethics
SP 635
OP 638
DO 10.1136/jme.2006.019703
VO 33
IS 11
A1 H M Evans
A1 A P S Hungin
YR 2007
UL http://jme.bmj.com/content/33/11/635.abstract
AB Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both (a) a drug fails to out-perform placebo and (b) the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which (in equivalent conditions of transparency and information) is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug.