[The PLACEBO effect: Definition, theories of action, ethical considerations].
The placebo effect (from latin placere=to please), i.e. the nonspecific psychological therapeutic  effects of a substance or procedure, remains one of the biggest challenges encountered by modern  medicine, as a therapeutic means with unquestionable and yet unappreciated, global and yet  uncontrollable, efficacy. The history of medicine largely intersects the history of placebo effect, as  the first scientifically proven non-placebo drug only appeared in the 17th century. Today, placebos  have themselves become an object of investigations aiming to clarify the mechanisms of mind-body  interactions. Moreover, placebos occupy an important place as methodological tools in modern  medical research; randomized double-blind, placebo-controlled studies have been established  as  the  golden  standard  in  the  evaluation  of  new  therapies.  However,  the  use  of  placebos  raises  a number of important ethical issues, as it comes in contrast to the two most basic principles of  medicine, beneficence and autonomy. Therefore, the use of placebos in clinical research should  always  include  measures  that  ensure  minimization  of  any  risk  associated  with  delay  of  active  treatment,  as  well  as  preser vation  of  the  patients'  interests.  In  clinical  practice,  physicians  should  be aware of psychological dimensions of treatment, of the meaning that the patient ascribes to it,  as well as of the influence of the doctor-patient relationship, so that they can use these beneficial  nonspecific (i.e. placebo) effects of treatment in the best interest of their patients.
1st Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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