Placebos Are Pharmacologically Inert Even If They Generate a Placebo Effect

摘要

In the article “Telling the Truth About Pain: Informed Consent and the Role of Expectation in Pain Intensity” (Gligorov 2018), the author challenges the current consensus that the use of placebos is deceptive and unethical. The basis of the author’s argument is that a possible physiologic response to a placebo, or placebo effect, justifies characterizing placebos as biochemically active. However, such a possible physiologic response does not change the biochemical inertness of the placebo. Rather, the placebo effect is a host response due to the cognitive modulation of pain. The author’s erroneous conflation of pharmacology and physiology in this article underlies the argument for the nondisclosure of a placebo as inert. While the article does not overturn the current consensus on placebos, it does open the door to a debate on the ethics of the utilization of cognitive modulation of pain as an adjunct to pain management strategies.