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To the Editor: We agree with Dr Miller and colleagues¹ that any therapy should be evaluated by the most rigorous and feasible methods possible. We do not entirely agree, however, with their assertion that therapies might be considered legitimate entirely by virtue of their placebo effect. The authors argued that the basis of using placebo controls has to do with demonstrating risk-benefit ratio. In fact, the primary reason for using placebo controls has to do with establishing a specific causal relationship between a therapy and outcome; ie, whether an intervention has scientific veracity. Placebo controls account for other factors that influence outcomes.

It remains unclear exactly which factors contribute to a placebo effect² or even whether placebos have any significant clinical effects.³ With more evidence, it might be ethically appropriate to combine any identifiable placebogenic factors with already proven specific therapies. This would mean using factors that promote nonspecific healing . . . [Full Text of this Article]

Ted J. Kaptchuk, OMD
ted.kaptchuk@hms.harvard.edu
Osher Institute
Harvard Medical School

Anthony Lembo, MD
Beth Israel Deaconess Medical Center
Boston, Mass

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