The Ethics of Placebo-Controlled Trials

To the Editor: Emanuel and Miller (Sept. 20 issue) 1 characterize the current debate about placebo-controlled trials as a debate between two orthodoxies: placebo orthodoxy and active-control orthodoxy. We used the term “placebo orthodoxy” to describe the widely held but incorrect view that the use of a placebo control is always better than the use of an active control. 2 , 3 Labeling our position “active-control orthodoxy” wrongly suggests that we believe that “if an effective therapy exists, the use of a placebo should be prohibited” in all cases. 1 We do, however, represent a clinical-equipoise orthodoxy in believing that therapeutic interventions in research . . .