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Abstract

A recent systematic review found that almost half of participants who take placebos in clinical trials experience drug related adverse events (AEs), with 5% of participants dropping out due to ‘drug related’ intolerance. However the placebo per se cannot be the cause of these adverse events. Instead, there are two overlapping likely explanations:

  1. Misattribution. A patient may have an underlying condition whose natural history produces some event (such as a headache), then the patient misattributes the event to the placebo.
  2. Nocebo effects. Having been warned about side effects in the patient information sheets, the patient may expect an adverse event. This negative expectation could then produce the event.

Nocebo effects may be caused—at least partly—by sharing information about AEs in the wrong way. This causes a tension between the ethical requirements of autonomy and non-maleficence. On the one hand, autonomy demands that patients be fully informed about treatment (adverse events). On the other hand, non-maleficence demands that patients be informed about AE’s in the right way. Ethical discussions of informed consent have focused almost exclusively on autonomy and may therefore been violating the requirement to do no harm. I will discuss ways in which autonomy and non-maleficence can be balanced in future clinical trials and ethical debates.

Forthcoming events

Richard Doll Seminar: Design and analysis of prevalence surveys in low-resource settings

Tuesday, 25 February 2020, 1pm to 2pm @ Richard Doll Lecture Theatre, Richard Doll Building, Old Road Campus, OX3 7LF

WEH/Ethox Seminar: Negligence and abortion - doctors' duty of care challenges and potentials in light of Montgomery v Lanarkshire Health Board

Wednesday, 26 February 2020, 11am to 12.30pm @ Seminar room 0, Big Data Institute, Old Road Campus, OX3 7LF

HERC Seminar: Learning healthcare systems for cost-effective precision oncology.

Thursday, 27 February 2020, 12pm to 1pm @ Seminar room 0, Big Data Institute, Old Road Campus, OX3 7LF

The Global Response to the Novel Coronavirus (SARS-CoV-2) Outbreak

Thursday, 27 February 2020, 2.30pm to 4pm @ Seminar rooms, Big Data Institute

Richard Doll Seminar: The Risk of Everything – using linked electronic health records to develop and validate risk prediction tools for use in clinical care

Tuesday, 03 March 2020, 1pm to 2pm @ Richard Doll Lecture Theatre, Richard Doll Building, Old Road Campus, OX3 7LF

WEH/Ethox Seminar: Building research capacity through North-South Partnerships: some ethical reflections and a social justice agenda

Wednesday, 04 March 2020, 11am to 12.30pm @ Seminar room 0, Big Data Institute, Old Road Campus, OX3 7LF