To the Editor.
—In an article in the series Grand Rounds at the Clinical Center of the National Institutes of Health, Drs Pickar and Hsiao1 reported a selected patient who participated in a double-blind clinical trial showing that clozapine is effective in the treatment of refractory schizophrenia. The research protocol used placebos. While some authors attempt to justify the use of placebo controls in clinical trials for schizophrenia,2 others condemn placebo usage when effective treatment is known.3Although their case report is not intended to be a report of the research, their allusion to the study without citation raises some important questions. The authors report, "Placebo substitution was followed by rapid increases in symptoms of schizophrenia." Was this psychotic patient able to give valid consent? Did she clearly understand that she would be on no treatment for some period of time? How long was this patient's condition