"The ethical question, obviously, is how a doctor (a real one, not the 'trained homeopath', whatever that means) can bring himself to recommend a sugar pill to a patient with a real suffering"
Yes. And you might well ask how a doctor can send a suffering patient away from his or her surgery empty handed and uncomforted after a 5 minute consultation, and yet it happens all the time.
People generally go to alternative and complementary practitioners when their GP has failed to provide them with anything to relieve their symptoms, and in my experience usually come away from their consultations with their alternative practitioner feeling a whole lot better.
"It's different when doctor might suspect the problem is a psychosomatic and decides to try a placebo"
A problem doesn't have to be psychosomatic to respond to the placebo effect, and the placebo effect can cause clinically measurable changes in the condition of the patient.
And GP's admit to rogue prescribing and using placebos: "A study of Danish general practitioners found that 48% had prescribed a placebo at least 10 times in the past year. The most frequently prescribed placebos were antibiotics for viral infections, and vitamins for fatigue. Specialists and hospital-based physicians reported much lower rates of placebo use. (Hróbjartsson & Norup 2003) A 2004 study in the British Medical Journal of physicians in Israel found that 60% used placebos in their medical practice, most commonly to "fend off" requests for unjustified medications or to calm a patient. Of the physicians who reported using placebos, only 15% told their patients they were receiving placebos or non-specific medications. (Nitzan & Lichtenberg 2004) An accompanying editorial stated, An accompanying editorial stated,
"The placebo effect, thought of as the result of the inert pill, can be better understood as an effect of the relationship between doctor and patient. Adding the doctor's caring to medical care affects the patient's experience of treatment, reduces pain, and may affect outcome. This survey makes it clear that doctors continue to use placebos, and most think they help."
"The editorial suggested there were problems with Hróbjartsson and Gøtzsche's methods and argued that their results show that placebos can't cure everything, but don't prove that the placebo effect cures nothing. The editorial concluded, "We cannot afford to dispense with any treatment that works, even if we are not certain how it does." (Spiegel 2004)"
Unlike GP's who so often prescribe antibiotics for conditions they know ab's are ineffective for, at least homeopaths aren't giving you a placebo that may result in you developing candida and a worrying vulnerability to antibiotic resistent infections.