Table 2.

Emanuel and Miller's three ethical positions with respect to placebo-controls [18]

Active-control orthodoxy	Placebo orthodoxy	Middle ground
‘Whenever an effective intervention …exists, it must be used in the control group … placebo controls areinappropriate because the clinicallyrelevant question is … whether [a newdrug] is better than standard treatment’	‘When effective treatments exist, there mustbe compelling methodological reasons toconduct a placebo-controlled trial’	‘Without a placebo group to ensurevalidity, the finding that there is nodifference between the investigationaland standard treatments can bemisleading or uninterpretable’