title: The validity and ethics of giving placebo in a randomized nonpharmacologic trial was evaluated.
abstract: OBJECTIVE
  When studying the effects of a non-pharmacologic intervention, the choice of a control group is often difficult. In a study on the effectiveness of increased water intake on voiding dysfunction in elderly men we used an unusual design. This article addresses the internal validty and ethics of this design.
  
  
  METHODS
  The randomized trial we evaluated had a 6-month follow-up period and was carried out among 141 elderly men with moderate lower urinary tract symptoms. The experimental group was given the instruction to drink more water, the control group received placebo medication. The participants were not informed that there was a 50% chance of receiving placebo. We measured whether the prior expectations and preferences were comparable for the two study groups, whether blinding was preserved throughout the study period, and whether the participants considered this design ethical.
  
  
  RESULTS
  Prior to randomization, patients had higher expectations for the experimental intervention, but there was not statistically significant difference in their preference. During the study period, two out of 71 patients in the control group unmasked the placebo. In general, both groups fully agreed with the informed consent procedure.
  
  
  CONCLUSIONS
  This design can be considered when the effects of a non-pharmacologic interventions are studied.
authors.affiliation: Department of General Practice, University of Maastricht, Research institute Caphri, P.O. Box 616, 6200 MD Maastricht, The Netherlands. m.spgt@hag.unimaas.nl
authors.forename: M G
authors.initials: MG
authors.lastname: Spigt
authors.forename: P G
authors.initials: PG
authors.lastname: Knipschild
authors.forename: C P
authors.initials: CP
authors.lastname: van Schayck
authors.forename: J A
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000368:Aged; D004326:Drinking; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D010919:Placebos / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic / Q000941:ethics*; D015203:Reproducibility of Results; D012107:Research Design; D016896:Treatment Outcome; D014555:Urination Disorders / Q000628:therapy*
chemical_list: D010919:Placebos