It's a common misconception that a placebo is necessary for a scientifically valid clinical trial. When they are not impractical or unethical, on Efforia, placebos are a nice to have, not a need to have. If you have to think about how you're going to design and/or produce a placebo for longer than a couple of minutes, it's probably not worth the effort.
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Most Efforia studies funded via citizen science participants. Ethically, it's problematic to charge participants for potentially receiving treatments, only to provide them with a placebo. This issue is even more pronounced in our citizen science model compared to traditional sponsored trials, where participants' dissatisfaction with receiving a placebo is already a concern.

Protocols can be scientifically sound and yield reliable results without the use of placebos. This article aims to clarify the role of placebos in clinical research, explore their ethical and practical considerations, and highlight alternative methods that ensure the scientific validity of trials conducted on the Efforia platform.

In clinical research, particularly in placebo-controlled trials, a "placebo" refers to a substance or treatment that mimics the actual treatment but is designed to have no therapeutic effect. Its purpose is to serve as a benchmark for comparison, allowing researchers to measure the effects of the real treatment against this neutral standard.

Placebos are used to maintain objectivity in trials. In a "double-blind" setup, neither the participants nor the researchers know who receives the real treatment and who receives the placebo. This approach helps eliminate bias and ensures the reliability of the trial results. On platforms like Efforia, where participants are relatively disconnected from providers or sponsors, trials are almost always blinded by default, as it takes extra effort to alert a provider or sponsor of who has treatment and who does not.

There are situations where the use of placebos is neither feasible nor ethical. Creating a convincing placebo for certain treatments like specific exercise routines, diet programs, or spa services can be challenging or impossible. Moreover, the ethical implications of withholding an active treatment in favor of a placebo must be carefully considered, especially when such withholding could be harmful to participants.

The absence of a placebo does not compromise the scientific integrity of a trial. Many studies on Efforia employ alternative approaches, such as having participants serve as their own control.

The Efforia default study design involves comparing the effects of treatment on participants at different time points—measuring their condition without treatment (baseline) against their condition while receiving active treatment. These methods are widely adopted across academic, pharmaceutical, and medical communities.

Not using a placebo does not undermine the scientific value of a trial. A scientifically valid protocol can be established through alternative comparison methods. These methods can provide robust and reliable data, sometimes even more suited to real-world applications than traditional placebo-controlled trials.

Placebos, while important in many clinical trials, are not universally necessary or applicable. Ethical considerations, practicality, and the nature of the treatment being tested are crucial in determining the use of a placebo. On Efforia, we support a variety of scientifically valid protocols that do not rely on placebos, offering valid and sometimes more appropriate approaches for conducting meaningful research.