January 18, 1980

Placebo Therapy

Author Affiliations

Margate, NJ

JAMA. 1980;243(3):229-230. doi:10.1001/jama.1980.03300290013005

To the Editor.—  I read with many shared concerns the article by Tomas J. Silber, MD (242:247, 1979), discussing the use of placebos. He makes a laudable attempt to classify the different ethical issues involved in trying to place an a priori label of good or bad on the use of placebos based, in the main, on the intentions of the prescriber.My difficulty with their use stems from other ethical issues. Implicit in the physician's choice to use a placebo is his knowledge that the drug is inherently worthless. However, for the placebo effect to occur, the patient must believe that the drug is potent and working to his benefit.Furthermore, the physician should display ample enthusiasm about the drug to enhance the intensity and longevity of the placebo effect.A fascinating chronicle of the uses of placebos in the treatment of angina, by Benson and McCallie,1 demonstrates