Besides clinical and scientific value, the question of enhanced placebo effects raises complex ethical questions concerning what is “legitimate” healing. What should determine appropriate healing, a patient’s improvement from his or her own baseline (clinical significance) or relative improvement compared with a placebo (fastidious efficacy)? As one philosopher of medicine has asked, are results less important than method? Both performative and fastidious efficacy can be measured. Which measurement represents universal science? Which measurement embodies cultural judgment on what is “correct” healing? Are the concerns of the physician identical to those of the patient? Is denying patients with nonspecific back pain treatment with a sham machine an ethical judgment or a scientific judgment? Should a patient with chronic neck pain who cannot take diazepam because of unacceptable side effects be denied acupuncture that may have an “enhanced placebo effect” because such an effect is “bogus”? Who should decide?
— Ted Kaptchuk, The Placebo Effect in Alternative Medicine: Can the Performance of a Healing Ritual Have Clinical Significance?, The Placebo: A Reader