Online research in philosophy

The current debate in medical ethics on placebos focuses mainly on their use in health research. Whereas this is certainly an important topic the discussion tends to overlook another longstanding but nevertheless highly relevant question, namely if and how the placebo effect should be employed in clinical practice. This paper describes the way the placebo effect is perceived in modern medicine and offers some historical reflections on how these perceptions have developed; discusses elements of a definition of the placebo effect; and suggests some conditions under which making use of the therapeutic potential of the placebo effect can be ethically acceptable, if not warranted.

We review three possible theoretical mechanisms for the placebo effect: conditioning, expectancy and endogenous opiates and consider the implications of the first two for clinical research and practice in the area of pain management. Methodological issues in the use of placebos as controls are discussed and include subtractive versus additive expectancy effects, no treatment controls, active placebo controls, the balanced placebo design, between- versus within-group designs, triple blind methodology and the double expectancy design. Therapeutically, the possibility of shaping negative placebo responses through placebo sag, overservicing and the use of placebos on their own are explored. Suggestions for using conditioned placebos strategically in conjunction with nonplacebos are made and ways of maximizing the placebo component of nonplacebo treatments are examined. Finally, the importance of investigating the placebo effect in its own right is advocated in order to better understand the long-neglected psychological aspects of the therapeutic transaction.

The essence of a mental event such as self-deception lies in its function – its place in the life of an animal. But the function of self-deception corresponds to that of interpersonal deception. Therefore self-deception, contrary to Mele's thesis, is essentially isomorphic with interpersonal deception.

This title gathers together essays on deception, self-deception, and the intersections of the two phenomena, from the leading thinkers on the subject.

Mele's study of philosophical and psychological theories of self-deception informatively links the conceptual and dynamic aspects of self-deception and explicates it without positing mutually inconsistent beliefs, such as those occurring in two-person deception. It is argued, however, that he does not do full justice to the dissociation characteristic of self-deception and does not sufficiently distinguish self-deception from self-caused deception.

The American Medical Association prohibits physicians from giving placebos to their patients unless the patients are informed of and agree to the use of placebos.1 This prohibition, and the ethics of placebo treatment more generally, have been discussed in numerous recent papers (Finniss, Kaptchuk, Miller, et al. 2010; Shaw 2009; Foddy 2009; Miller and Colloca 2009; Kolber 2007; Blease 2010). Though some bioethicists support the AMA prohibition, others challenge it, arguing that using placebos without patients’ knowledge and consent—that is, using placebos deceptively—can be ethical (Kolber 2007; Foddy 2009). This paper is about a specific ethical objection to use of placebos by physicians: deceptive ..

This response addresses seven main issues: (1) alleged evidence that in some instances of self-deception an individual simultaneously possesses “contradictory beliefs”; (2) whether garden-variety self-deception is intentional; (3) whether conditions that I claimed to be conceptually sufficient for self-deception are so; (4) significant similarities and differences between self-deception and interpersonal deception; (5) how instances of self-deception are to be explained, and the roles of motivation in explaining them; (6) differences among various kinds of self- deception; (7) whether a proper conception of self-deception implies that definitive ascriptions of self-deception to individuals are impossible.

Robin Nunn has argued that we should stop using the terms ‘placebo’ and ‘placebo effect’. I argue in support of Nunn’s position by considering the logic of why we perform placebo comparisons. Like all comparisons, placebo comparison is just a case of comparing one thing with another, but it is a mistake, I argue, to think of placebo comparison as a case where something is compared to ‘a placebo’. Rather, placebo comparison should be understood as a situation which sets-up the treatment and control groups in a particular way; not as a case involving objects or procedures called ‘placebos’ employed in order to control for ‘placebo effects’.

Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be administered in an honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment.While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive.