Placebo and the Ethics of Deception in Brain Research and Clinical Care: Annual Neuroethics Distinguished Lecture

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Overview:
The placebo effect is powerful in many neurological and psychiatric disorders and clinical trials often use placebos when developing and testing new treatments. Some people question the ethics of including a placebo group in research, while others would argue that to not do so is ethically fraught. In some cases, estimating the placebo effect and uncovering its underlying mechanisms may depend upon the use of deception, but this may be in conflict with basic principles of autonomy.

Deception requires careful thought as to whether it is necessary, and if so, how it will be managed in an ethically acceptable manner. While there have been advances showing that genetic factors that may contribute to the placebo effect, the idea that placebo responders should be excluded from clinical trials may be scientifically unsound and may further violate the principle of social justice. The use of placebos in clinical care is more controversial and while there may be benefits, there may be risks and additional ethical challenges. Health care providers need to be sensitive to the impact of deception not only on their own relationship with patients, but also on potential effects on trust of the profession as a whole.

A. Jon Stoessl, CM, MD
Dr. A. Jon Stoessl is Professor and immediate past Head (2009-2023) of Neurology at the University of British Columbia (UBC). He was previously Director of the Pacific Parkinson’s Research Centre and Parkinson’s Foundation Centre of Excellence (2001-2014). Dr. Stoessl was Co-Director (2014-2019), then Director (2019) of UBC’s Djavad Mowafaghian Centre for Brain Health. He previously held a Tier 1 Canada Research Chair in Parkinson’s Disease. Dr. Stoessl is Editor-in-Chief of Movement Disorders, has served on numerous other editorial boards including Lancet Neurology and Annals of Neurology, previously chaired the Scientific Advisory Boards of Parkinson’s Canada and the Parkinson’s Foundation, is Past-President of the World Parkinson Coalition. He was Chair of the Local Organizing Committee and Co-Chair of the Congress Scientific Program Committee for the 2017 MDS Vancouver Congress.

Dr. Stoessl uses positron emission tomography to study chemical changes in the brain with the objective of gaining a better understanding of the causes and complications of Parkinson’s disease (PD) and its treatment, as well as how PD can be used as a model to better understand dopamine functions in the brain. He has published more than 300 papers and book chapters, and has been cited more than 31,000 times in the scientific literature with an ­h-index of 79 (Google Scholar).

Dr. Stoessl is a Member of the Order of Canada and was recognized by the Queen Elizabeth Jubilee Medal. He is a Fellow of the Canadian Academy of Health Sciences.