the placebo effect

Something that has been rolling around in my brain for a few months is the concept of a placebo and how ethical it is to use or not to use. There is deception involved, but it could be argued that the placebo effect is positive. Is the risk to damaged trust worth it, though?

The placebo effect is known to be real in medicine. It goes beyond that, though. An expensive placebo is more effective than an inexpensive one. If you pay a dime for a sugar pill you think is going to cure what ails you it will work, but not as well as if you pay a couple of dollars for it. Placebo surgery has even been found to be effective.

The question I have is, how ethical would it be for a doctor to prescribe medicine for a patient that he or she knows only has value as a placebo? What if there is no good medicine and the placebo really is the best option? Would requiring the patient to pay a lot for it, since that will make the placebo more effective, be acceptable? How do you measure the rightness or wrongness of the deception in that case? What about surgery? Is going under the knife as part of a mental game wrong if it is done for the right reasons?

What makes this scenario so perplexing is that it contradicts the freedom to choose that is so ingrained in American culture. In this situation, once you have the information necessary to decide whether you want the placebo it is going to be worthless to you. You know that the medicine has no specific physical benefit, so the placebo effect disappears. So, by its nature, placebo medicine has to be forced on those who have not given consent.

What do you think? Does the benefit of a placebo outweigh the risk? How does the potential loss of trust if the patient finds out about the placebo factor in? Are the patients being taken advantage of here, or is ignorance bliss?