"Placebos Used Instead of Effective Treatment "
The second misperception is that patients will receive placebos in place of effective treatment or without disclosure. Placebos are ethically allowed, but are only used in very specific clinical trial situations. Placebos (sugar pills or sugar water injection) allow trials to be double blinded (neither patient or physician knows who is receiving placebo or study drug). Double blinded placebo controlled trials are the best statistical means to prevent human bias, maintain objective scientific methodology, and accurate result interpretation.
Placebos are often used in cancer prevention trials. The informed consent must indicate if a placebo may be used on the trial. However, most cancer treatment trials do not use placebos because cancer drugs may be too toxic to be blinded. It would be unsafe and unethical to give a toxic drug in a blinded fashion. Placebos may be allowed in cancer trials if the study drug is relatively nontoxic (such as a hormone pill or vaccine) and when there is no accepted standard of care to test the study drug against. A unique clinical setting in which a placebo arm on adjuvant trials may be considered is a tumor vaccine trial where there is no known standard of care treatment options (such as recurrent melanoma that has been surgically resected). A placebo arm will never take the place of a known effective standard of care treatment.
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