Whilst we agree with Professor Ernst that there is scant original research supporting the use of the placebo test (JRSM 2007;100:165),
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we maintain that it is useful. Provocation, cessation or amelioration of seizures
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and movement disorders
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with placebo use is often a diagnostic criterion (amongst others) for psychogenic disease. In addition, placebo therapy has been used to treat psychogenic diseases.
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Our work highlighted the potential diagnostic or therapeutic benefits of placebo use whilst emphasizing the ethical concerns mitigating against its casual use (JRSM 2007;100:60–61),
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but we acknowledge its potentially deceptive nature.1,2 We advocate that physicians managing patients with psychogenic disease practice knowledge framing,
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providing a neurobiological explanation for the disease, including the possibility of a psychological basis for the patients’ attacks.
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As doctors are not averse to using placebos
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—even while they publicly decry them—we feel that it is timely that we reach a consensus on the acceptability and utility of placebo use.
Competing interests None declared.
