Informing the patient of the placebo option: an ethical necessity likely to reduce inappropriate psychotropic prescriptions?

The growing interest in deprescribing drugs highlights the importance of re-evaluating prescriptions, but also of limiting inappropriate prescribing. This paper reflects on the ethical use of a placebo as a way of limiting inappropriate prescribing. We focus on psychotropic drugs, but our reasoning may also concern other medical conditions. We analyze the conditions in which placebos are usually prescribed in medicine and analyze four situations to determine which would be best ethical. Although the use of placebos, whether pure (i.e., containing no active substance) or impure (i.e., containing active substances but used in a non-specific manner), is commonplace in medicine, patients are not duly informed: this practice respects neither patient autonomy nor freedom of choice. In contrast, the use of open-label placebos (i.e., prescribed to the patient in full transparency) solves this ethical problem. Importantly, informing the patient about the placebo does not seem to alter its therapeutic effect. Furthermore, the information given to the patient as part of the shared-medical decision generally does not mention the benefits that a placebo could bring to the patient in place of a pharmacologically active drug. However, scientific data on the efficacy of a placebo is available in randomized controlled trials or meta-analyses for almost all drugs. This effect is sometimes high under specific clinical conditions. We conclude that there is an ethical imperative to inform patients of the efficacy of a placebo in a clinical context where the prescription of a pharmacologically active drug is discussed. The open-label placebo option should become more systematic in medicine, particularly in psychological symptoms or conditions with a well-documented significant placebo effect. Aside from this ethical aspect, prescribing more placebos could be a way of combating overprescription, reducing inappropriate drug use and iatrogenia, and supporting the eco-responsible approach to prescribing in medicine.