In 1803, Thomas Percival, a respected physician at the Manchester Infirmary in England, published the first modern code of medical ethics. Percival recognized the power of the placebo effect and explained in his code that the doctor should give patients hope and comfort and “counter the depressing influence of the disease.” Critics who read Percival`s work urged him to limit the obligation to convey hope only “to the extent that truth and sincerity are admitted,” but Percival believed that if a physician was motivated by the desire to do good instead of deceive, a falsehood was not a lie, but commendable.5 The first American Medical Association (AMA) code of ethics in 1847 was heavily influenced by Percival`s medical ethics. In fact, the code states: “The life of a sick person can be shortened not only by actions, but also by the words or manner of a doctor. It is therefore a sacred duty to protect oneself carefully in this regard and to avoid anything that tends to discourage the patient and depress his mind. 6 Such laws are also almost certainly unconstitutional because federal law generally trumps state law when the two are in conflict, although the FDA has yet to test this in court. Critics of the right to try laws have also raised ethical concerns, warning that laws could undermine clinical trials and that at-risk patients have little or no information about the effectiveness of a treatment, and that they may be exposed to drugs so early in testing that toxicities and side effects have not yet occurred. While most studies of placebo pain effectiveness look at patients` self-reports on pain measurement, a conclusive 2001 study also looked at patient behavior. This theory, known to economists as a revealed preference, examines the actions of subjects and not just their reports. The study involved 38 patients recovering from thoracic surgery for lung cancer in the operating department of an Italian hospital. Patients were given an unknown solution that was actually saline by intravenous infusion. They were allowed to ask for buprenorphine, an analgesic.

Patients were divided into three groups: the first group learned nothing about the unknown solution, the second group was informed that saline was either a strong analgesic or a placebo, and the third group was informed that saline was a potent analgesic. The researchers measured both the amount of buprenorphine requested and self-reports of pain intensity. The third group needed the weakest buprenorphine, followed by the second or first group. However, all three groups reported about the same level of pain. The patients` desire to relieve pain was therefore based less on their own determination of pain than on their belief in the painkiller they believed they were receiving. The researchers concluded that the placebo effect of the proposal given to the third group was equivalent to four additional doses of buprenorphine over 70 hours.16 The actual amount of therapeutic use of placebo in the United States is somewhat unknown, but may be more common than is generally thought. A 1979 survey examined the use of pure placebos in 60 doctors and 39 nurses during their postgraduate training. The reviewers found that 78% of doctors and 82% of nurses ordered or administered at least one placebo to relieve pain.10 In several cases, placebos were used to check whether patients simulated their symptoms. In a 1999 survey of 74 interns at a new York Community Hospital, 64 percent of trainees were aware of the use of a placebo only in clinical practice, and 16 percent ordered placebo to be given during their internships.11 In about half of the situations in which interns ordered placebos, treating physicians were aware of this and no one objected. In 2007, 466 physicians from the departments of internal medicine at three Chicago medical schools were interviewed. The results showed that 231 of the doctors responded, and 45% of these doctors reported prescribing or administering a placebo.

The survey also found that 96% of respondents thought placebos could have therapeutic effects, and only 12% thought that the use of placebos in medical care should be categorically banned.12 The effectiveness of a drug is measured by the extent to which it is better than a placebo. Not all the benefits of drugs come from the pharmaceutical compound itself. With many medications, part of the benefit depends on the patient`s beliefs. Doctors and medical ethicists have recognized throughout history that a positive emotional state in relation to treatment is associated with a better response to that treatment. .