Placebo is commonly used in clinical trials but it is also used in clinical practice. However, it is difficult to get informed consent for the placebo use from patients in clinical practice. Thus, placebo use in such occasion can lead to an ethical problem. We have previously reported the current use of placebo and the psychological conflict of doctors and nurses about the use of placebo treatments in the actual medical settings. However, to date, no study has reported the perception of pharmacists, some of whom prepare and explain the use of placebo medicines to patients, as their medication. We conducted a survey of the current use of placebo in clinical practice and the perception of pharmacists regarding its use in 3 hospitals based on anonymous self-report questionnaire as a pilot study prior to a nationwide survey. We administered the questionnaire to 92 pharmacists belonging to 3 hospital pharmacies between July 2 and 24, 2012. Of the 92 pharmacists, 84 (91.3%) returned the questionnaire, then we analyzed the data by descriptive statistics and a contingency table. Our results showed that 54.8% of the pharmacists had experience of placebo use in medical settings, and 9.9% of them had instructed on the use of placebo ; while 43.2% of them (answered that they feel uncomfortable with the use of placebos in clinical settings) tended to feel antipathy toward the use of placebos in clinical practice. While the use of placebos in medical setting may have a potential ethical issue, 66.7% of the pharmacists considered that placebo use in clinical settings is not necessarily unethical. Pharmacists who had previously discussed this issue with other staff thought that placebo use in clinical practice is unethical (p＝0.009).

Objective: The aim of this study was to identify the content and methods of ethics education for medical representatives as part of the continuing education program and to suggest a preferable supportive method of ethics education accordingly.
Method: A questionnaire was mailed to the medical representative education managers of all 214 companies, all members of the MR Education & Accreditation Center, Japan.  The questionnaire was carried out from 31st July 2009 to 25th August 2009, and data from this questionnaire survey was analyzed by simple and cross tables.
Results: Out of the 182 (response rate: 85.0%) who responded, we analyzed the 173 institutions for analysis as they responded as having the continuing education program.  In terms of education, “the fair competition code” was the most widely educated (82.6%).  Although “the fair competition code” required most time, “the ethics as a medical representative” was considered as the most important.  The simple kappa coefficient between actual educating item and important item was 0.29.  Answers were affected by whether he/she had experience as a medical representative.  As the method of ethics education, “lecture” style was most common (87.4% of respondents), “group work discussion” was considered the most effective (70.6%) for training a medical representative to think and learn by himself/herself.  The respondents of 82.2% referred to the continuing educations’ guidelines made by MR Education & Accreditation Center, and 81.0% respondents felt “training materials for lectures and/or discussions” necessary in the future.
Conclusion: The ethics education for medical representatives placed a disproportionate emphasis on the importance of “the fair competition code.” Dissociation was seen between the actual education and the education considered as important by the respondents.  Accordingly, there is a need for appropriate materials for training and for a more adequate curriculum, taking time and content of education into consideration, especially for contents which training ways aren’t built up.