Placebo effect. Ethics of consent versus effect?

Question

Often the effects of psychiatric drugs are determined by comparisons with a placebo group. You may for example have a result that there were 40% responders to placebo and 50% responders to the drug.
You do seem to have a moral and ethical dilema here. For if you informed each user of a drug about the placebo effect , the percent responders may decrease.
Even though the placebo effect is so large compared to the combined effect you would never hear a doctor talk about this. On the other hand, you would hear a doctor talk about the active substance in the drug and neurotransmitters.
The person is not correctly informed about the treatment he or she is recieving. And on the other hand, this information itself may decrease the benefit to the patient.

What is your opinion?
Is the health of the patient more important than informed information?

I understand the general placebo effect is usually lower 20-30% ??

Answer 1

I've often wondered about the ethics of placebo treatment as well -- obviously the health of the patient is the most important thing, so I'm not sure how placebos are ethical

Answer 2

I Have personally Wondered About the Validity of this and Other Things, I Still Have Questions.

You May Find this to Be of Interest:

http://www.washingtonpost.com/ac2/wp-dyn/A42930-2002May6?language=printer
Against Depression, a Sugar Pill Is Hard to Beat

Placebos Improve Mood, Change Brain Chemistry in Majority of Trials of Antidepressants

By Shankar Vedantam

Washington Post Staff Writer

Tuesday, May 7, 2002; Page A01

After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills.

A new analysis has found that in the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as -- or better than -- antidepressants. Companies have had to conduct numerous trials to get two that show a positive result, which is the Food and Drug Administration's minimum for approval.

What's more, the sugar pills, or placebos, cause profound changes in the same areas of the brain affected by the medicines, according to research published last week. One researcher has ruefully concluded that a higher percentage of depressed patients get better on placebos today than 20 years ago.

Placebos -- or dud pills -- have long been used to help scientists separate the "real" effectiveness of medicines from the "illusory" feelings of patients. The placebo effect -- the phenomenon of patients feeling better after they've been treated with dud pills -- is seen throughout the field of medicine. But new research suggests that the placebo may play an extraordinary role in the treatment of depression -- where how people feel spells the difference between sickness and health.

The new research may shed light on findings such as those from a trial last month that compared the herbal remedy St. John's wort against Zoloft. St. John's wort fully cured 24 percent of the depressed people who received it, and Zoloft cured 25 percent -- but the placebo fully cured 32 percent.

The confounding and controversial findings do not mean that antidepressants do not work. But clinicians and researchers say the results do suggest that Americans may be overestimating the power of the drugs, and that the medicines' greatest benefits may come from the care and concern shown to patients during a clinical trial -- a context that does not exist for millions of patients using the drugs in the real world.

"The drugs work, and I prescribe them, but they are not what they are cracked up to be," said Wayne Blackmon, a Washington psychiatrist whose practice largely comprises patients who suffer from depression. "I know from clinical experience the drugs alone don't do the job."