If your question goes beyond the sensible policy above, and you are interested in the debate itself, there is a significant literature discussing the ethics behind the use of placebos in clinical trials. Here are some of the most recent papers:

http://www.cancer.gov/ncicancerbulletin/050311/page7

Bero, Lisa. "Industry Sponsorship and Research Outcome A Cochrane Review Industry Sponsorship and Research Outcome." JAMA internal medicine 173.7 (2013): 580-581.

Chan, An-Wen, et al. "SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials." BMJ: British Medical Journal 346 (2013).

Emsley, Robin, and Wolfgang W. Fleischhacker. "Is the ongoing use of placebo in relapse-prevention clinical trials in schizophrenia justified?." Schizophrenia research (2013).

Olliaro, Piero, et al. "Methodology of clinical trials aimed at assessing interventions for cutaneous leishmaniasis." PLoS neglected tropical diseases 7.3 (2013): e2130.

Thank you all for your valuable contribution..

I keep this debate continue with another question

If subjects volunteer them self or give valid informed consent to take part in placebo controlled trials, then such trials are ethically valid ?

Levine 1999,

Placebo arms of clinical trials are ethically acceptable provided that patients receiving placebo are not at risk for serious harm and give informed consent

Franklin G. Miller argued that absolute ethical prohibition of placebo-controlled trials in psychiatric disorders for which standard, effective treatments exist is unsound because

1. it is based on a flawed conception of research ethics, which inappropriately applies the normative framework of clinical medicine to clinical research.

2. it ignores important contextual factors characteristic of psychiatric research, including the limited efficacy and often-intolerable side effects of standard treatments

and the high rates of placebo responses in clinical trials.

3. the alternative of active-controlled trials comparing experimental with standard drugs without placebo controls could lead to the approval and use of new medications that appear equivalent in efficacy to standard treatments but may be no more effective than placeb

So... is it ethical to allow an informed patient (does the patient have a right) to elect into a placebo controlled trial, all knowing that there is a marginally effective alternative treatment (the good, the rights, of the individual)? Is this really a selfish choice that harms others? Is it ethical for the hospital ethics review board to deny this option to this patient (communitarian, utilitarian, the good of the society)? Does this choice harm anyone? Who?

There is a commonly posed rhetorical question that in spite of its simplicity does get to the heart of the matter. Would you kill one person to save a hundred? A thousand? A million? With that persons' consent? Many people who consider this question fall back on situational ethics, not entirely satisfactory in my mind.

I don't believe that we own ourselves to the extent that we can make selfish descisions that in any way harm the society. Under some circumstances we do, I think, own ourselves where we do no harm to others, and in this respect, the patient has a right to make this kind of choice, particulary if the outcome may actually help the many.

If informed consent cannot be obtained, the clinical researcher, on the other hand, is in a more difficult position for a variety of reasons. As we should know, the use of an efficatious treatment in leu of a placebo can make the outcome uncertain to the point where we learn nothing, possibly at the cost of harm to the society.

I have heard of a situation where participants of a pharmaceutical cancer trial got together in a room following a group informed consent session and combined their meds and then divided them out so that all the members of this group would have an equal fraction of the active ingredient. This is possible for rare diseases where members are part of a support network. Perhaps this says something about a flawed information session process (although the research scientist was a very reputable scientist in the RCT arena), but it is also an interesting comment on peoples need to do something that might give them an advantage with their disease.

I guess the question is whether there are any alternative options to a placebo controlled trial that might still provide useful information. Does one need to wonder that if the difference from the current best treatment is so small for a new drug that it cannot be ascertained that it is really worth pursuing, unless there are other benefits such as reduced side effects? I am not an expert in RCT, but that would be my question. Would not selection bias also be a problem if those responding to conventional therapy are less likely to risk missing out on this to go on a placebo controlled trial versus patients who are not responding to normal therapy, who are more willing to try for any chance of improvement.