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James van der Walt
Pretoria
South Africa

Social Entrepreneur, Ugesi Gold

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I have an ethical question. Is it wrong to use placebos?

I'm starting a rural business. Most of these people are very poor and even cynical about their situation. Now I have a plan to start businesses and learning but I first have to get past the mind set. If I were to offer a placebo pill that helps with "your finances and success" would that be wrong?

The idea is that with the business plans I want people to think that they CAN do this. To fight the ideas of "That this is too complicated or that it's just going to fail anyway". Placebo works on the mind but it's power lies in deceit or believe (maybe even faith). So is it wrong to tell people that this pill will help them get out of this bad situation (together with the community projects I have in mind)

Related Talks:

Closing Statement from James van der Walt

Thank you all for a very good discussion to get a clearer view of what a placebo means. Also thank you Sietse Sterrenburg for the article you posted. I think it shows clearly what this discussion was about.
http://www.ted.com/conversations/6494/i_have_an_ethical_question_is.html

So in conclusion. A placebo is a trick to make your mind think you are being healed which then enables your to heal naturally. But this effect is based in deceit which is not ethical. It is much better to train people to use the power of their mind to get the same effect. The placebo has nothing to do with you getting better after all. Rather embrace the truth and enable people to help themselves.

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Eva Koudela
- 0
Oct 22 2011: My question. How is this different from using hypnosis, or Ericksonian therapy, or advertising, or coaching, or giving a speech or anything that changes the way people relate to themselves, without actually raising their level of awareness of why they do what they do.

People influence people all the time without questioning how ethical it may be.

Also people all over the world suffer from various 'I can'ts' which are not true. They are in a trance telling themselves they can't do something. You're altering their trance. I would suggest the only thing with true integrity (and so ethical from my point of view) is to enable people to come out of the trance.
Jorgen Klaveness
- 0
Oct 22 2011: A clear case of fraud ... BUT you could go as far as to say "Lots of people seem to think that there is an effect here, but it hasn't been supported by science, and there's no way to say for sure whether it works or not. On the other hand, we can guarantee that there are absolutely no side effects, ... unless you are suffering from diabetes".
cynthia larson
- +1
Oct 22 2011: Presentation is everything here so as to not make this deceitful. Perhaps if you approach this community and tell them "this is an experiement and some of you will get the real thing and some of you get the placebo" ?, or something like this that would be the most honest way you could apporach these people and still try to provide the help it seems like you're intending.

Frankly, I think placebos are great--alot less side-effects and they show the true power of the mind!
Humble Polymath
- +2
Oct 22 2011: Yes, it is wrong if you actually misrepresent what the pills are and what they can do. However, if you pass out multivitamin tablets, and tell them something along the lines of, "These pills contain vital elements that are known to help with cognition, and strength, and health, and vitality, which can help prepare you for prosperity", then you have told the truth about the vitamins, and given them something to pin their bigger hopes and dreams on.
Brian Parkinson
- 0
Oct 22 2011: It's wrong to use the term "placebo" in this context. The placebo effect works at the interface of mind and matter and is the most important mystery of the human condition.
Jaime Lubin 10+
- +1
Oct 22 2011: Dear Debra where are you....nice to see you again.

The placebos is a field so complex because the theraphy is done (in some cases and for some illness) very effective...certainly in others situations are usless and the real intervention from surgeons and doctors are unavoidable. Placebos and faith cames together. But touch the ethical field if the placebo is a dirty and cheap trick.

We have to be aware to see de real difference betwen placebos, remedies, natural medicine and alopathy.
Narendra Raykar
- 0
Oct 22 2011: Ethics is also related to being honest with one's beliefs since there is nothing like absolute ethics. if one truly believes using placebo will most likely help others where no personal gain involved other than mental happiness. then using placebo is as ethical action as any other.
Jamin Davey
- +1
Oct 22 2011: I see no ethical issue here. If you say "take this pill and you'll be able to do X", and then because of the experience they take the pill and do X, surely you have delivered the product you promised. I don't see why you would need to explain every aspect of how the product works if doing so would reduce its effectiveness.
- cynthia larson
  - +2
  Oct 22 2011: and if they're not able to do X?, what then?
cesar martinez
- +1
Oct 21 2011: In these days i worry less about the potential good that a placebo can do than i do about how some companies try to debunk good medicines that actually do work. We now live in a time where doctors and patients understancd that some medicines have side effects but are still forced to face the very real questions of "Quality of life" vesus "Quantity of life". However, when one company exploits that situation, spurred by news sound bytes, to bring about litigation or even the hint of it....then thats, to me, is more reprehensible than the relief that a placebo could potentially bring.
cesar martinez
- 0
Oct 21 2011: Efficacy by any other name...still works!
Sam Orbwell
- 0
Oct 21 2011: A pill by itself - whether placebo or anything else - will never cure an illness, it's just a means to support a healing process.

And a healing process is not about pills. It's about communication, developing an understanding for the situation, development of a solution, accompanying during the implementation of the solution and drinking a beer together after the problem is solved.

If you feel the need to throw in a pill from time to time into the implementation part, because a specific person thinks that they can't do without one, then you can choose to do so to give a temporary positive effect.

But the pills are not your product. The healing process should be. As maybe these community projects which you have in mind,
Cory _
- 0
Oct 21 2011: Using a placebo can be a valid practice provided it's priced reasonably for what you're doing. If you have an ethical issue with using mental tricks to get your patients' bodies to heal themselves, then donate the profit margin of those placebos to a good charity.

Telling people their bodies are capable of fixing certain issues without assistance doesn't usually work because people often doubt such things subconsciously, so the alternatives to using placebos are (1) sell them something expensive and dangerous or (2) let them continue making themselves sick. Allowing a person to harm him/herself can be construed as doing harm in some forums, after all.
- Stuart Gall
  - +1
  Oct 22 2011: The problem with what you are suggesting is that there is evidence that the placebo effect is reduced if the placebo is less believable. I read that in medical trials they use placebos with mild side effects because patients with such placebos have an enhanced placebo effect. So if the actual treatment under test has side effects you must have the same level of placebo effect. Otherwise you can't be sure that it wasn't just an enhanced placebo effect.
  
  The same goes for economic placebos, the more a person pays the more likely it is to work (Unfortunately)
Stuart Gall
- +1
Oct 21 2011: I think there are many examples of the power of the mind to overcome obstacles with the use of a placebo. There is definitely evidence of placebos helping medical conditions possibly by reducing stress and allowing the body to better cure its self.
So I would ask the opposite question. If you have a placebo and by some means you could be sure that the placebo would help cure a person. Or in your question if a person has a negative outlook and you know that some placebo will help them.

Is it ethical NOT to give the placebo. Because if the belief is something is what a person needs, and a placebo will achieve that. Then in actual fact it is not really a placebo. It is a device to effect a physical or mental change by unconventional means.

Say a person is taking a homeopathic medicine and getting better from a serious illness. You prove to this person that homeopathy is a scam, they lose their belief, get depressed, and they get ill again. Was that ethical?

I believe that many alternate treatments work because they give the patient hope and that allows the bodes own healing to work more effectively.

At the end of the day if what a person needs is to believe in something, so that they can believe in themselves I say give them what they need.

Successful people often cary a rabbits foot, or a lucky dime, or some other amulet that gives them strength.
Dainius Jurkša
- 0
Oct 21 2011: I find myself leaning to the side of Carolyn Karnes, Michael Eskenazi and MA Boyd. I believe this question is not about whether placebo works or not. If it was, why not, for example, just pump them with antidepressants? (Your question was about what's ethical, not what's economical)

Giving a pill is very condescending, because you are basically treating those people as being stupid. And from my experience with people, living in poverty, in most cases - however cynnical they would be and however self-perpetuating their mindset that's keeping them in poverty would be - they are not stupid. To do something like that could completely jeopardize your relations with those people and trust (as I understand it - you plan to keep communicating with them, as you will have a business there), either immediatelly or in the future, when they find that the lucky charm you sold them is just a peace of glass. And they WILL find out, and they will not sympathize with your sentiment.

This is fundamentally dishonest and unfair to them, regardless of whether the pill would work for some or not. Because this is not about medicine - this is not pain relief, this is about empowerment, right?

I'm afraid I cannot give you any specific advice in your sittuation - in our project for people in extreme poverty, we tried to show people the world outside their normal environment, to SEE with their own eyes, that it IS possible, but in your case this might be difficult.

However, what I can say is, that it is not only 'unethical' (whatever that might mean) to sell them a success pill, but in the end, it will fail, as these people are not idiots, and you will not empower them by treating as such.
maureen lloyd-james
- 0
Oct 21 2011: ABSOLUTLEY!! Even better that poluting ones body with drugs! "What the mind can conceive and belive, it can achieve"!
Bryn Morgaine
- +2
Oct 21 2011: This is the magic feather syndrome from "Dumbo" and it is an totally appropriate way to proceed. The fact is, we have this theme in our stories ("You had the power all the time Dorothy") in every culture for a reason. The linear mind can only imagine what it has already seen to be true, and the best and simplest way to bypass that predjudice is to introduce a "magical" agent.
It is true that the same tool can be used for "evil" and in fact, pyramid schemes and get quick rich shemes are largely based on the same proposition. Even "housing prices always go up" could be argued as dependent on this principal. But so long as you are employing your placebo to assist others in gaining thier OWN dreams and goals and not enslaving them to your dreams or goals, I would say you are in the moral clear.
Sietse Sterrenburg 10+
- +3
TED Translator

Oct 21 2011: Actually you can be open about it being a placebo and it will probably still have the same effect. At least that's what I expect based on the study that showed exactly that: http://blogs.plos.org/neurotribes/2010/12/22/meet-the-ethical-placebo-a-story-that-heals/
- Debra Smith 200+
  - 0
  Oct 21 2011: Dear Sietse, Thanks so much for posting such an interesting and really relevant article. It really illuminated the issues better than anything else I have read on this subject so far. Please keep posting such high quality information!
Kevin Hughes
- 0
Oct 21 2011: Belief CAN be good. Getting people to believe in themselves is the key, not that they believe in a ‘pill’, or that solutions to their problems can be medicated. (Obviously if the problem is medical, than a pill can work).
This is a link for a BBC report about child sacrifice in Uganda.
http://www.bbc.co.uk/news/world-africa-15267792
Now I’m not saying that your placebo and child sacrifice are the same, but it is the same mentality; success (in whatever form) can come from outside myself. That it is someone (something) else’s gift, wither it’s a placebo, child sacrifice or a lucky rabbits paw.
I would think that ‘deception’ is not the best way to engender self belief and confidence.
Wayne Davis
- +1
Oct 21 2011: Morality is subjective. Morality changes from place to place, culture to culture, religion to religion and changes over time. Morality is normative and relative.

You might be able to use the model of utilitarianism, in that what does the most good for the most amount of people could be used as an argument for a moral action.

You could use the theory of consequentialism whereby the morality of an action is based upon the good outcome of that action. If the consequences are "good" then it doesn't matter what the action is per se. What is "good" though? Good for who?

My own personal belief is that as long as you do not profit from this and no one gets hurt, as long as your intentions are pure and will benefit the people who are taking the placebo, then it is not an immoral action by my definition. However as I mentioned from the start, morality is normative and relative which you have to ascertain from your own society, social mores and culture.
Codrut S
- 0
Oct 21 2011: just adding my logic: it's ethical as long as it's cheap enough to be accessible to everyone, but expensive enough to be credible; That means that you will not take material advantages from them.

The placebo effect is officially recognized, from what I know (statistically at least), so I would approve if it would be up to me.

To give a counter-argument to the idea that is better to teach them how business work... That would help too, but knowledge and self-confidence are two distinct things.. and business-mans around will correct me if I'm wrong, but YOU NEED BOOTH.

Good luck!
Justin Gotchall
- 0
Oct 21 2011: It really depends on a few things. You are asking whether it is ethical, so it depends on what ethical theory you subscribe to. The first question is whether or not you are taking profit from the placebos. If you are, then it turns to the question of what you do with this profit. If you are turning no profit from the placebos, then it is simply a matter of what value we place on your authority in this situation. If you are a doctor, I'd say it's unethical. Same goes if you are a scientist. But, as a 'Social Entrepreneur,' if you are turning no profit, there might be a gray area. It really depends on the ethical theory you subscribe to. Go from there. If you want, my opinion is that if you are selling these placebos, taking their money for it, then it's quite unethical. What is the purpose of selling the placebos is really a key issue in this question. If the whole point of your endeavor is to enact social change for the better, and help these people improve their lives, then this is a bad idea. You won't get a lot of good results. Even if you do, you know they will be ill-gotten. Or else you wouldn't be asking the question here. Likely, you already know the answer to your question, you just want a justification. I'd say take the hard route of the community projects you discussed. If the people are cynical, and you want to convince them they CAN do it, then show them they can and help them. It's ethical or unethical depending on how you view ethics. I simply think it is a bad idea.
- Olay Rullan
  - 0
  Oct 22 2011: if you need to "con" people into buying your idea, it's still fraud.
  
  come clean.
  
  set expectations straight.
  
  that's how people will genuinely believe & hopefully start to follow you.
  
  good luck!
ahishek chakraborti
- 0
Oct 21 2011: as long as the placebo has no adverse physical effect, we can just consider it to be a form of psychological medicine i suppose.studies have shown that placebos do have positive effects on the users in some conditions...the line between placebo and scam though is a very fine one, that's where a doctor comes in.since a placebo would lose its psychological effect if the user came to know about it, someone else with the knowledge to take an informed decision for him viz. his doctor. should be the final judge.
Quentin VK
- 0
Oct 21 2011: No and here is an example:

To make it short: POWER BRACELET have been doing exactly that and now they have been banned from some countries and in the end they have admitted that it was a scam (http://gizmodo.com/5723577/powerbalance-admits-their-wristbands-are-a-scam)

This is an illustration of what has happened to other people that had a similar idea (and an amazingly well build marketing plan...)
Anya Besharah
- +1
Oct 21 2011: I think you have answered your own question. The pill is the same as the religion analogy. It may seem well and good to teach people that they are good, special, and capable individuals. As you came to realize that religion, your pill, was full of flaws you rejected it for a different path. Ask yourself why you did that despite the benefits? Seems like that deciet was too big a pill for you to swallow.
You can't make a horse drink water no matter how much you think it needs it. You can't explain it to the horse as you speak different languages. The same it is with the people you are talking about. You don't speak their language, know their culture or really understand what they know and understand. If they are not ready to change then your job is to accept that and be there for them anyway.
Khalil KA
- +1
Oct 21 2011: I find it wrong and I think poverty is more often than not caused by a lack of opportunity. I would also try to understand the mindset first. If you want to help and do have the means trying to listen first, then to educate would probably bring more.
One good example: http://www.ted.com/talks/bunker_roy.html
Your business is more likely to flourish if it's based on trust.
Tobias Duncan 200+
- +1
Oct 21 2011: Fascinating question, I think about the placebo effect quite a bit as the whole alternative medicine industry runs on it.
You will have to lie.
Lying kills trust.
Dont do it.
Roodney Azor
- 0
Oct 21 2011: It is important in this case to consider what is truly motivating you to do that. Knowing that placebo can truly help them, the ethical question now is "do you truly have those people's best in your mind or are you just trying to fool them for egoistic interest?"

I think that as far as your goal isn't to take advantage of them, there's no more ethical question to be asked, because true help never cause ethical problem at all.
Pete Nilson
- +1
Oct 21 2011: Absolutely wrong. Placebos make people think something curative happened when it didn't. They will then turn down actual remedies. Having just been through heart surgery, I speak from experience. Compassion & attentiveness plus treatment. No bullshit.

http://www.guardian.co.uk/science/blog/2011/oct/11/placebos-reiki-cancer-patients-harm
- Debra Smith 200+
  - 0
  Oct 21 2011: Hi Pete!
  The article that Sietse posted above is really excellent for clarifying these issues and I think you might enjoy it.
Ashnur Nasir Pal
- 0
Oct 21 2011: Yes, great idea, let other people have our failed systems, maybe they find out how it supposed to work, so they can help us too!

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