Evans H M, Hungin A P S
Centre for Arts and Humanities in Health and Medicine, Durham University, School House, St Hild's Lane, Durham DH1 1SZ, UK.
J Med Ethics. 2007 Nov;33(11):635-8. doi: 10.1136/jme.2006.019703.
Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both (a) a drug fails to out-perform placebo and (b) the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which (in equivalent conditions of transparency and information) is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug.
本文通过一个虚构但具有代表性的全科医疗咨询案例展开论述，该案例涉及对一名肠易激综合征患者的诊断，患者因病情不适渴望得到缓解。本文认为，当（a）一种药物的疗效未超过安慰剂，且（b）所讨论的病症是一种没有可证明的潜在病理的功能性疾病时，那么该药物的作用不仅不比安慰剂好，而且与安慰剂也没有区别。本文还指出，在所描述的咨询情境中，引人注目的是，当前的管理规定认为从业者开处方药物或安慰剂在伦理上是合理的，这两者的有效性似乎都依赖于医生的某种程度的隐瞒，然而却认为从业者公开开一种无害且令人愉悦的物质是不道德的，而在同等透明度和信息条件下，这种物质可能与药物或安慰剂一样有效，而且可能比药物耐受性更好、成本更低。
