Doctors often give their patients placebo treatments

By Geoff Michaels, | Health | 0 Comments

Placebo treatments often work because the patient expects them to. But how widespread is the practice of prescribing a placebo and do patients know what is going on? Medical ethics researchers have found that nearly half of doctors in a survey use vitamins, analgesics and other substances as placebos - and often they tell the patient it is a ‘real’, but unusual, treatment for their condition.

The placebo effect is well established in the practice of medicine. It involves giving the patient an inactive (placebo) treatment and any improvement is attributed to the expectation the patient has that the treatment will do them good. Therefore, there is often an element of deception involved - in that the patient may believe they are being given an active treatment, when they are not. Therefore, the practice of administering a placebo can be seen as ethically tricky, because the doctor may not be fully sharing information with the patient.

Before the 1960s, the use of placebos was widespread because there were far fewer effective drugs available. But now we do have drugs that work, many question whether placebos should still be used. Little seems to be known about doctors’ use of the placebo and their attitudes towards it.

Researchers at the Department of Bioethics at the National Institutes of Health and at the McLean Center for Clinical Medical Ethics, Chicago, surveyed a group of 679 internists and rheumatologists on their use of placebos. They asked about their attitudes towards the practice, what placebos they prescribed and what they told patients about them.

Around half of the doctors surveyed said they prescribed a placebo on a regular basis. Around 62 percent of the whole group said they thought placebos were ethically acceptable. Only a few percent used truly inert placebos, such as sugar pills or saline injections. More common was the use of over-the-counter analgesics, which was reported by 41 percent and vitamins, reported by 38 percent. Thirteen percent used antibiotics and 13 percent sedatives as placebo. When it came to what they told their patients, 68 percent described placebos as a potentially beneficial medicine for their condition which was not often used for it. Only five percent of the doctors actually described the placebo for what it actually was.

This survey shows how common prescription of placebo is and that most physicians consider it to be quite acceptable. The placebo often does produce an improvement, although the mechanisms by which it does so are not completely understood. For a patient with a chronic condition which has not responded to conventional approaches, maybe a placebo is the answer. And maybe revealing that a placebo is being given - which only a minority of doctors did - would destroy the impact of positive expectation that may lie at the heart of the therapeutic benefit. Nevertheless, there is an element of deception which could harm the relationship of trust that ought to exist between doctor and patient. Also concerning is the tendency to use more ‘active’ placebos like antibiotics and sedatives which, in themselves, could cause harm. The study raises many interesting questions and suggests that the practice of placebo administration ought to be investigated further.