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Doctors give placebos without telling patients

Study shows US doctors have no ethical problem giving placebos

OnMedica staff

Friday, 24 October 2008

Many US doctors are regularly prescribing placebo treatments without informing their patients, according to a study published today on the BMJ’s website.

A study of 679 rheumatologists and general internal medicine physicians in the US found that some regularly prescribe placebo treatments including active drugs such as sedatives and antibiotics, but rarely admit they are doing so to their patients.

Using placebo treatments in clinical practice has been widely criticised because it is claimed that the practice is deceptive and violates patients’ autonomy.

However, advocates of placebo treatments argue that they could offer effective treatment for many chronic conditions without necessarily deceiving patients.

Dr Jon Tilburt and colleagues from the National Institutes of Health as well as collaborators at Harvard and the University of Chicago studied attitudes and behaviours to placebo treatments in a national sample of general internal medicine physicians and rheumatologists in the US.

The researchers sent a confidential survey to 1,200 such doctors who commonly treat patients with debilitating chronic conditions that are difficult to manage medically.

They found that among the 679 physicians (57%) who responded to the survey, half said they prescribed placebo treatments on a regular basis. Most physicians (62%) believed the practice to be ethically acceptable and were happy to recommend or prescribe placebo treatments.

Most commonly used placebo treatments prescribed in the past year were over the counter painkillers (41%) or vitamins (38%). Some physicians reported using antibiotics (13%) and sedatives (13%) as placebos, and only 3% reported using sugar pills.

Among those who prescribed placebo treatments, most doctors (68%) said they typically described the placebo treatments to patients as “a potentially beneficial medicine or treatment not typically used for their condition”. Only rarely did they admit to explicitly describing them to patients as “placebos”.

The authors said that although there was only a moderate response rate to the survey (57%), even if all the non-responders never gave placebos, placebo prescribing was still surprisingly common.

The report says that while the use of placebos has been controversial, the physicians in the study did not believe they were behaving unethically by either using placebos or not being upfront with their patients about doing so.

However, they add that the prescription of antibiotics and sedatives when they are not medically indicated, “could have potentially important adverse consequences for both patients and pubic health.”

The report says: “US internists and rheumatologists commonly recommend ‘placebo treatments’. Physicians who use placebo treatments may not be fully transparent with their patients about their use. Whether, or under what circumstances, recommending or prescribing placebo treatments is appropriate remains a topic for ethical and policy debates.”

BMJ 2008;337:a1938

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