The Placebo:Lying to the Patient-A Skillful Use of Reassurance and Encouragement?

The American Medical Association (AMA) has a policy regarding the use of placebos in clinical practice and here it is:

H-140.869 Placebo Use in Clinical Practice


A placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated. In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.

Physicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use. A placebo may still be effective if the patient knows it will be used but cannot identify it and does not know the precise timing of its use. A physician should enlist the patient’s cooperation by explaining that a better understanding of the medical condition could be achieved by evaluating the effects of different medications, including the placebo. The physician need neither identify the placebo nor seek specific consent before its administration. In this way, the physician respects the patient’s autonomy and fosters a trusting relationship, while the patient still may benefit from the placebo effect.

A placebo must not be given merely to mollify a difficult patient, because doing so serves the convenience of the physician more than it promotes the patient’s welfare. Physicians can avoid using a placebo, yet produce a placebo-like effect through the skillful use of reassurance and encouragement. In this way, the physician builds respect and trust, promotes the patient-physician relationship, and improves health outcomes. (CEJA Rep. 2, I-06)

Thoughtful and empathetic communication from the physician to the ill patient is a therapeutic tool. In fact from the above AMA policy: "Physicians can avoid using a placebo, yet produce a placebo-like effect through the skillful use of reassurance and encouragement. In this way, the physician builds respect and trust, promotes the patient-physician relationship, and improves health outcomes."

My question: What if the reassurance and encouragement is to the physician clinically unrealistic? However this is unknown to the patient. Nevertheless, to the physician, at this point, such reassurance would be considered as theraputic and beneficent. Would that misrepresenation to the patient of the patient's clinical condition be considered "a placebo of a 'placebo-like' effect"? A placebo of a placebo? Does lying to the patient represent "skillful use" of reassurance and encouragement? And is that consistent with AMA's ethics policies? ..Maurice.