title: Should we reconsider the routine use of placebo controls in clinical research?
abstract: BACKGROUND
  Modern clinical-research practice favors placebo controls over usual-care controls whenever a credible placebo exists. An unrecognized consequence of this preference is that clinicians are more limited in their ability to provide the benefits of the non-specific healing effects of placebos in clinical practice.
  
  
  METHODS
  We examined the issues in choosing between placebo and usual-care controls. We considered why placebo controls place constraints on clinicians and the trade-offs involved in the choice of control groups.
  
  
  RESULTS
  We find that, for certain studies, investigators should consider usual-care controls, even if an adequate placebo is available. Employing usual-care controls would be of greatest value for pragmatic trials evaluating treatments to improve clinical care and for which threats to internal validity can be adequately managed without a placebo-control condition.
  
  
  CONCLUSIONS
  Intentionally choosing usual-care controls, even when a satisfactory placebo exists, would allow clinicians to capture the value of non-specific therapeutic benefits that are common to all interventions. The result could be more effective, patient-centered care that makes the best use of both specific and non-specific benefits of medical interventions.
authors.affiliation: Northern California Kaiser-Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA. andrew.avins@ucsf.edu
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Avins
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: Harley
authors.initials: H
authors.lastname: Goldberg
authors.forename: Alice
authors.initials: A
authors.lastname: Pressman
mesh_terms: D018849:Controlled Clinical Trials as Topic / Q000941:ethics / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D015990:Placebo Effect; D010919:Placebos; D012107:Research Design
chemical_list: D010919:Placebos