• M Oskar van Deventer.
• Hannie Schaftstraat 62, DL Leidschendam, Netherlands. m.o.vandeventer@planet.nl
• Med. Hypotheses. 2008 Sep 1; 71 (3): 335-9.

AbstractFake treatments work. That is a well established medical fact. This is why the golden standard of evidence-based medicine requires double-blind testing. Both real and fake (also known as placebo) treatments are administered in order to be able to distinguish the effects of the treatment-under-test from the placebo effect. Given the medically proven fact that fake treatments work, doctors could include fake treatments in their medical repertoire. However, this poses an ethical dilemma. On the one hand the doctor does not want to lie to his patient. On the other hand, the effect of the fake treatment would diminish if the patient knows it is fake. For this reason, fake treatments are typically left to practitioners of so-called alternative medicine who are often not even aware of the ethical dilemma. The central hypothesis of this article is that the doctor does not have to lie, and that truthfully administering fake treatments would not render these ineffective. A proper term for this type of treatment "meta-placebo". The placebo effect is based on the healing belief of getting administered a real treatment. The meta-placebo effect is based on the healing belief that even fake/placebo treatments have positive effects. That is, if both the doctor and the patient believe in the healing powers of the fake treatment, it does not matter that both know the treatment is fake. If the meta-placebo effect exists, it would solve several of the doctor's dilemma's. First of all, he would not have to lie to the patient when applying a fake treatment. Secondly, by having fake treatments in his medical repertoire, the doctor could keep patients in the regular medical circuit and keep monitoring the patient's syndrome. Thirdly, the doctor could keep the patient away from the medical and financial risks associated with alternative medicine. Unlike the well-established placebo effect, the meta-placebo effect is still a medical hypothesis. The hypothesis shall have to be tested experimentally, before "meta-placebo" treatments can become evidence-based medicine. Such validation involves several medical philosophical complications. How can the hypothesis be tested following the golden double-blind standard? What syndrome would be suited for a meta-placebo-experiment? What would a treatment in a meta-placebo experiment look like? How can meta-placebo be distinguish from placebo? What ethical aspects do meta-placebo's have? This article discusses these questions in detail.

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