Author Affiliation: Division of Research, Kaiser Permanent Northern California, Oakland.
I appreciate Dr Marcus's comments and thank him for the opportunity to clarify any misunderstandings associated with my Editorial.1
In response, I agree that placebo is not the only intervention for which we have an incomplete understanding of the mechanism of action. But few such interventions provoke as much controversy or debate as placebos. Second, while considerable literature exists on the placebo effect, our understanding of its fundamental nature, mechanism, and effects is still far from complete, a situation common to numerous other physiologic and pathologic processes. Indeed, if, as the writer appears to claim, we have a robust understanding of placebo physiology, how could the clinical use of placebo be viewed as “deceptive” if prescribing a placebo results in a benefit for patients through a well-characterized physiologic mechanism?
Avins AL. Clinical and Ethical Aspects of Placebos in Clinical Practice—Reply. JAMA Intern Med. 2013;173(8):711-712. doi:10.1001/jamainternmed.2013.90