But would that not then defeat the purpose of them?
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No not nessesarally, all patients would sign a wavier giving the physician the freedom to choose if and when a placebo was used. The patient would never need know until the treatment was over. Just like they do in medical trials.
Why would it?
When you sign up for your physician you sign one of two statements that they attach to the record.
1. When the physician feels the best course of action is a placebo they can prescribe it without telling me.
2. I do not want the physician to prescribe me placebo's regardless of circumstances.
If you sign 1. it is still the case that the vast majority of the time you get real medicine not placebo's, so you would not need to be suspicious of placebo's.