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In Reply: Drs Cantor and Malani claim that placebo effects can be demonstrated by comparing a pair of 2-arm trials of active treatment vs placebo that have different proportions of participants randomized to receive active treatment. This is an interesting speculation; however, we are unaware of any data to support this claim or to indicate that this design is just as able, or more able, to discriminate placebo effects than would be a 3-arm trial comparing active treatment, placebo, and no treatment. Their alternative design may suggest placebo effects but still leaves open the critical question of whether either the active treatment or placebo-control is better than no treatment.

Dr Jonas and colleagues question who determines the social value of CAM research and advocate for public input. For biomedical research in general, the public's position on an approach is expressed through participation on institutional review boards, data and safety monitoring . . . [Full Text of this Article]

Franklin G. Miller, PhD; Ezekiel J. Emanuel, MD, PhD
Department of Clinical Bioethics
National Institutes of Health

Donald L. Rosenstein, MD
Office of the Clinical Director
National Institute of Mental Health

Stephen E. Straus, MD
sstraus@nih.gov
National Center for Complementary and Alternative Medicine
National Institutes of Health
Bethesda, Md