Public and professional attitudes towards deceptive and open-label placebo in functional neurological disorder and wider neurological practice.

Background: Placebo effects are powerful and have been suggested to be particularly relevant in certain neurological conditions, including functional neurological disorder (FND). Methods: A survey on attitudes towards and current practice of deceptive placebo treatments and ethical alternatives, notably positive suggestion, trust and open-label placebo was performed among health professionals and lay people with and without neurological diagnoses. Results: 116 healthcare professionals and 631 lay people (176 FND, 332 with other neurological diagnoses, 61 with medical diagnoses, 62 healthy controls) completed the survey.71% of lay people but only 46% of healthcare professionals were in favour of deceptive placebo treatments. Among lay people, healthy individuals were most in favour (87%), and people with FND were least in favour (62%). All groups were sceptical towards open-label placebo, yet neurologists were most open to this practice.Placebo was considered more effective for functional than non-functional disorders by healthcare professionals, but not by patients. Healthcare professionals reported only rarely using placebo in clinical practice, and if so, mainly in the diagnosis or treatment of FND. Conclusions: This is the first survey on opinions and current practice of placebo treatments in neurological practice. The results show a mixed picture, with deceptive placebos being perceived as effective and acceptable by most lay people (though strongly opposed by some, particularly by some patients with FND) and mostly considered more negatively by healthcare professionals. Ethically acceptable alternatives of harnessing the power of placebo without deception were considered with scepticism by all respondents, but least so by neurologists.