![]() ![]() The more ambiguous the definition of a foundational term like placebo, the greater the possibility of misunderstanding and miscommunication. Why are multiple definitions a problem? Unlike our past or rather because of it, in biomedical research today, safety of patients is sacrosanct. A recent review (4) helpfully collated different definitions of placebo used by many world-renowned biomedical research organizations and health policy-making bodies.From 4Ironically, even different institutes within the same organization, the US-based NIH, have multiple definitions. I wrote one definition implying there are many and therein lies one of several ethical issues about placebos. One definition of placebo is 'An inert substance usually prepared to look as similar to the active product investigated in a study as possible' and the placebo effect is 'any (usually beneficial) changes that occur within a group ‘treated’ with placebo' (3). Rather there are many.The word placebo derives from the Latin word, 'placere' meaning 'I will please' or 'I will do good', a word opposite to nocebo derived from the Latin word 'nocere' meaning 'I will harm'. What's the ethical dilemma of placebos in clinical trials? To understand this we need to examine the history of informed consent, and understand what's a placebo, where it stands in current biomedical research and how its use creates an ethical dilemma.The problem starts with the definition of placebo. Arguably the most prescribed drug in human history (1), the history of medicine is in large part the history of the placebo (2). ![]() Placebos are used in both clinical trials and general practice. ![]()
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