Opinion Pieces Address Placebo Study

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 17 Nov 2008 - 6:00 PDT

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Two newspapers recently published opinion pieces about a study published in the October issue of BMJ that found between 46% and 58% of physicians surveyed said they routinely prescribe placebos to their patients. Summaries appear below.

• John Concato, New Haven Register: The media coverage of the study "implied that the doctors' actions are immoral, but some patients might value feeling better over disclosure of all details as an absolute requirement," Concato, a Yale University School of Medicine professor and director of the Veterans Affairs Clinical Epidemiology Research Center, writes in a Register opinion piece. Concato discusses what he sees as flaws in the study's methodology. He writes that physicians "were asked if they would recommend a sugar pill for a patient 'if trials had shown such treatment to be superior to no treatment.' Most said they would do so," adding, "This would seem to show a competent, caring physician that we'd all like to have," but "doctors were criticized as favoring use of placebos, based on what might be called a trick question." He continues, "Perhaps we should admit that we don't know enough about what has been called the mind-body connection, including the fact that taking an inert substance (a placebo) can sometimes make patients feel better if they think the substance will work" (Concato, New Haven Register, 11/12).
  
  
• Sally Satel, Wall Street Journal: The revelations in the placebo study "seem disquieting, even unethical," and the media's portrayal of the study provided "further evidence that the cherished doctor-patient relationship is becoming a relic of the past," Satel, a psychiatrist and resident scholar at the American Enterprise Institute, writes in a Journal opinion piece. "The downside of deceptive placebo administration is obvious" by being "misleading: the patient risks feeling duped." However, Satel says, "The power of suggestion has long played an essential role in healing," which can be "elicited with placebo." She notes that the American Medical Association approves of prescribing a placebo if the patient "agrees to its use," but asks, "If a patient has been warned that he might receive a sham drug, will it still exert its placebo effect?" She continues, "Physicians who use placebos carefully recognize that the practical value of faith must neither be underestimated nor dismissed," adding, "If patients suffer less because a conscientious physician administers an effective, if inauthentic, 'medication' out of true caring, maybe they won't think that is so bad. It is worth finding out" (Satel, Wall Street Journal, 11/14).

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