Placebo is incompatible with informed consent so it is hard to find justification within clinical ethics (there might be exceptions in extreme cases - like famous example with lack of anaesthetics in battlefield surgery), also it is additionally problematic due to abuse of trust to medical professionals. So it's possibly harmful not only on personal but also on societal level. I don't have a good paper on deception in clinical ethics, but you might find this one on research ethics of placebos interesting:

Miller, Franklin G., David Wendler, and Leora C. Swartzman. “Deception in Research on the Placebo Effect.” PLoS Medicine 2, no. 9 (2005): e262. doi:10.1371/journal.pmed.0020262.

 Thank you Mr Jakub. I will go through the article 

Dear Murugavel, I am since 1978 LBP treatment practizing.Placebo can be used, But you need a good psychologist and that is not always easy to find. To my experience these patient almost 100% are starting to suffer again after a while and they are quite disapointed and don`t trust any therapist anymore. I can say treating LBP is actually very simple with the right method. I myself was suffering for more than 25 years, looking for help and seeing specialists in many countries without good results. Therefore I started studying the problem. I designed a long term traction method. First trial was 2000 patients during a period of 4 years at a Hospital in Villingen near Freiburg in Germany. After closing the study I presented the results internationally. 1988 I presented my method to the Ministry of Heath in Moscow and a russian team of back pain specislists started once more to test the possibilty to treat patients, because of the good results the method was registered for all Hospitals. Since then about 2000 institutions only in Russia are using the method in dayly practice with the result of mor than 3 000 000 patients been succesful treated of back pain. The method is most costeffective without any negative effects. An inxpensive equipment is needed, no electricity,no maintenance,no belts or weights,no stress to the patient. Traction is not new, Hippocrate already used it. The problem still is the time of one seance is to short and psychological stress is always developed when you hang patients by the feet or fix them to a table by belts. If you do water traction with a patient who can`t swim like children or old people they always get scared and stress is developing, same with Glisson treatment. Our patients are lying on the back on the Therapy Mat without belts and without any stress for 45 minutes only after this time-period rehydadration of discs is possible. If you want to know more about the method, feel free to contact me.E-Mail: [email protected]

www.detensor.co.at     www.detensor.ru     www.avazo.com 

Sincerly

Leonhard Kurt Kienlein

 Thank you for your answer Mr Leonhard. I think my question is not regarding treatment options available for back pain.

Murugavel,

Most of the ethics literature on placebos focuses on their use in research. This is probably because their use in clinical practice appears contrary to the accepted medical ethics principles of veracity, autonomy, and informed consent. But the fact that placebos can have a beneficent effect, makes their use in practice an interesting and meaningful ethical question. Most of the limited literature on this question then seems to say "yes" or "maybe" with some severe restrictions, like, as in its research use, letting pts. know the possibility of a placebo being used. Here are a couple articles that tackle the problem:

Lichtenberg, Heresco-Levy, and Nitzan, "The Ethics of the Placebo in Clinical Practice." The Journal of Medical Ethics, 2004, 30, 551-554.

Miller and Colloca, "The Legitimacy of Placebo Treatments in Clinical Practice: Evidence and Ethics." The American Journal of Bioethics, 2009, 9(12).

In addition, this may be of limited or only theoretical relevance to you, but the American Medical Association has published a statement on this question:

http://academicdepartments.musc.edu/humanvalues/pdf/Placebo.useinclinicalpractice.pdf

 Thank you Mr Michael.  Your article links will be useful for me.  As you mentioned it is vastly used in research purposes to compare the effectiveness of treatment and this query came into my mind after seeing many studies comparing interventions with placebo and also concludes it remains same or slightly better than placebo.  Though ethically more restrictions there to apply it as standalone treatment.  I believe that future research might be helpful to explore more about this topic