Informed consent and the ethics of placebo-based interventions for migraine in clinical practice

In this chapter we explore the ethics of informed consent with respect to the prescription of effective treatments, like acupuncture, that according to evidence-based standards have a prevalent placebo component. First, we review empirical studies demonstrating that placebo effects may significantly modulate symptoms in highly prevalent conditions, taking migraine as our case in point. Next, we chart the ethical implications of prescribing interventions that have been found slightly more effective than placebos and yet significantly better than no treatment--a class of remedies that we label as "placebo-based interventions." We argue that, provided certain conditions are met, doctors may ethically prescribe placebo-based interventions in nondeceptive ways. By contrast, we contend the prescription of placebo treatments is incompatible with informed consent unless the true nature of the remedy is transparently disclosed to patients.