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Uncomfortable implications: placebo equivalence in drug management of a functional illness

Evans, H.M.; Hungin, A.P.

Authors

H.M. Evans

A.P. Hungin



Abstract

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.

Citation

Evans, H., & Hungin, A. (2007). Uncomfortable implications: placebo equivalence in drug management of a functional illness. Journal of Medical Ethics, 33(11), 635-638. https://doi.org/10.1136/jme.2006.019703

Journal Article Type Article
Publication Date Nov 1, 2007
Deposit Date May 23, 2012
Journal Journal of Medical Ethics
Print ISSN 0306-6800
Electronic ISSN 1473-4257
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 33
Issue 11
Pages 635-638
DOI https://doi.org/10.1136/jme.2006.019703