Should physicians prescribe placebos to their patients?

by James Hubbard, M.D., M.P.H.

new study concludes that many physicians prescribe placebos to their patients.  The news, which made headlines all over the place late last week, was surprising to me.  But I think the study is a tad weak and misleading.

  1. The investigators sent a “cross-sectional, mailed survey” randomly to 600 general internists and 600 rheumatologists.  The questions were part of a complementary and alternative medicine survey.  Only 57 percent responded. Out of that number about 1/2 said they had prescribed placebos to patients.  I would argue that physicians might be more likely to respond to the survey if they leaned toward practicing this way, essentially trying to bolster, or argue, their position.  On the other hand, even if all who did not respond don’t prescribe placebos, that still leaves 1/4 of physicians who do—still a surprisingly high number, to me.
  2. The investigators’ definition of “placebo treatment” was a ”treatment whose benefits (in the opinion of the clinician) derive from positive patient expectations and not from the physiological mechanism of the treatment itself.”  That means it may help the symptoms, but we cannot scientific explain how, given the diagnosis.  For instance, some prescribed over-the-counter pain medications to fibromyalgia treatments.  The main disability of fibromyalgia is pain.  It seems a good treatment if it relieves symptoms even if it does not treat the underlying illness (which is poorly understood, anyway).  Antibiotics were a “placebo treatment,” I am assuming to appease patients, even if the physician thought the illness was viral.  Not good medicine, but not what I think of as a placebo.

To me, a placebo treatment is something that is totally inert, like a sugar pill. It has no active ingredients.  If this definition was used, 18 percent had used a sugar pill, 12 percent had used saline (salt water).  Forty-one percent had used a vitamin as treatment.

Even with the lower percentage, why would they prescribe this?  I can only surmise that they had run out of active treatments for chronic symptoms (pain, fatigue) and were trying relatively harmless (not always of course) remedies hoping the patients would feel better from the ”placebo effect.”  One problem, of course, is they were not disclosing this to the patients.

What do you think? Should we always disclose such information?  Do you think what they were doing was ethically wrong?   Have you ever experienced a placebo effect?

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7 Responses to “Should physicians prescribe placebos to their patients?”

  1. FatFighterTV Says:

    I have always been fascinated by the placebo effect. But I definitely don’t think it was right to use placebos in this way – I think it was ethically wrong.

  2. cathy Says:

    What a tricky situation. I can understand a doctor wanting to pull out every trick in the book to help a chronically ill patient, but it still seems unethical to not disclose to a patient exactly what he or she is being medicated with.

    Thanks for this post. I’ve read a little about this on other sites today, but you did a nice job explaining the intricacies of the study!

    cathys last blog post..A treat from Kraft – HFCS free Bullseye BBQ sauce!

  3. James Hubbard, M.D., M.P.H. Says:

    Thanks Cathy and FatFighterTV.

    It is a surprising that physicians deliberately trick patients. However the placebo effect is powerful, real and a treatment in itself.

  4. Liz S Says:

    Dr. Hubbard, thanks for sharing the nuances; I didn’t see the actual study and this does clarify things. Like you, I think of placebo as an inert substance so the fact that the study included agents unproven to work for a particular disease makes me think that the data have not been reported properly. Moreover, you said that they included alternative practitioners in the survey, which means that many of the agents that they frequently use are likely to be “unproven” or at least, have limited controlled evidence supporting their use. I don’t have an issue with this practice if this is the case. on the other hand, if they are prescribing sugar pills, I do think that it’s duplicitous and bad medicine.

  5. James Hubbard, M.D., M.P.H. Says:

    Thanks Liz S,

    The study is a bit confusing.

  6. Dr. J Says:

    My dad did an early study of placebos for TMJ pain. In his study, the patients were given actual prescriptions to be filled at the hospital pharmacy. The capsules contained an inert substance. He had over a 40% “cure” rate for the study!

  7. James Hubbard, M.D., M.P.H. Says:

    Dr. J, that is amazing.

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