US Doctors Use Placebo Treatments But Don't Always Inform Patients

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Main Category: Litigation / Medical Malpractice
Also Included In: Medical Students / Training;  Pain / Anesthetics
Article Date: 25 Oct 2008 - 0:00 PDT

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"Placebo treatments" are regularly prescribed by rheumatologists and internal medicine physicians, often without admitting the intention to the patients, according to a study released on October 24, 2008 on BMJ Online.

Placebo treatments are highly criticized because they require some deception on the part of the doctor, which ethically violates patients' rights to autonomy. However, many placebo treatment advocates have pointed out that the effect can still be harnessed, offering effective treatment for many chronic conditions, without deceiving patients. Presently, only limited research has been performed to elucidate the attitudes of doctors towards placebos and magnitude of placebos' use.

To investigate these issues, Dr Jon Tilburt of the National Institutes of Health and his colleagues conducted a confidential survey to 1,200 randomly selected, practicing physicians. All of the physicians had specialized in general internal medicine or rheumatology, which are both practices that often come into contact with patients with serious chronic, difficult to manage conditions.

Of the 679 responding physicians, half indicated that they prescribed "placebo treatments" on a regular basis. Most of them (62%) believed that this practice was acceptable from an ethical standpoint, and were happy to recommend or prescribe placebos.  Most commonly, these placebo treatments were over the counter painkillers (41%) or vitamins (38%). Some physicians also had used antibiotics (13%) and sedatives (13%) for this purpose, while a few had used sugar pills (3%.)

Among those respondents who did prescribe placebos, most also reported that they described placebo treatments as "a potentially beneficial medicine or treatment not typically used for their condition,” but very rarely referred to them as “placebos.”

The authors note that the study was limited by its relatively low survey response rate (57%), but that even with the most conservative analysis, this is still a remarkably common practice. While placebo use is controversial, they say, the doctors who responded to the survey did not indicate that they felt unethical about either the behavior or the lack of disclosure.

The authors note the ethical complexity of placebos in contemporary medicine. In conclusion they determine that harmless treatments like vitamins or over the counter painkillers to promote positive expectations may not create panic. However, the prescription of antibiotics or sedatives without clear medical justification could be harmful for individual patients and for the health of the public. "Whether, or under what circumstances, recommending or prescribing placebo treatments is appropriate remains a topic for ethical and policy debate,." they say.

Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists
Jon C Tilburt, Ezekiel J Emanuel, Ted J Kaptchuk, Farr A Curlin, Franklin G Miller
BMJ 2008;337:a1938
doi:10.1136/bmj.a1938
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Written by Anna Sophia McKenney
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