Should Doctors Prescribe Placebos?
U.K. Docs Often Prescribe Placebos To Patients, Study Finds
97 percent of U.K. doctors admitted to prescribing placebos to their patients — something one expert said hurts the doctor-patient relationship.
By Amir Khan
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WEDNESDAY. March 20, 2013 —Prescribing placebos to patients may seem unethical, but in the United Kingdom, the practice is widespread, according to a new study, published in the journal PLoS ONE. Researchers from the University of Oxford and the University of Southampton found that 97 percent of doctors have given placebos to their patients at least once in their career, with many doing it every day.
Placebos are medications, treatments or procedures used to treat an illness for which they have no scientifically validated healing properties. They often appear to work, a phenomenon known as the placebo effect, although it is not entirely known why. Researchers said the findings of the U.K. study show that doctors believe placebo use can make a difference in their patients’ lives.
“This is not about doctors deceiving patients,” Jeremy Howick, PhD, co-author of the study and research fellow at the University of Oxford, said in a statement. “The study shows that placebo use is widespread in the U.K., and doctors clearly believe that placebos can help patients.”
The researchers surveyed 783 doctors, and found that 97 percent have used “impure” placebos, such as antibiotics for viral infections and non-essential tests, to reassure patients. In addition, 12 percent admitted to using “pure” placebos, which are treatments such as sugar pills or saline injections.
Scott Drab, PharmD, associate professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy, said prescribing antibiotics for viral infections is dangerous, and even if it might mollify a patient, it could have repercussions throughout the healthcare field.
“Most common colds are caused by viruses, which are not treated by antibiotics,” he said. “The problem is that when we use antibiotics to treat viruses, we can create antibiotic-resistant bacteria. When these patients do need an antibiotic, many times the bug is resistant.”
And while pure placebo use was somewhat rare, 77 percent of doctors surveyed admitted to prescribing impure placebos daily or weekly, which Drab said hurts the doctor-patient relationship.
“Using placebos in treatment is an ethical dilemma,” he said. “We know that placebos are designed to utilize the brain’s role to create physical help. However, it introduces dishonesty and deception into the doctor-patient relationship.”
Can Your Doctor Prescribe You a Placebo?
The American Medical Association’s policy on placebos allows doctors to administer them to patients as long as the doctors tell patients that a placebo may be used. Doctors need to inform patients that they will be given either a medication with an active agent or a placebo, but are not required to reveal which type of medication is actually prescribed.
“If you prescribe multiple medications, you don’t have to identify which one is a placebo,” Drab said. “Most physicians will tell patients that they’re providing a cocktail of medications, and that one of them is a placebo. As long as he’s allowing the patient to know, it respects the patient’s autonomy and fosters trust, while still getting the placebo's benefit.”
But despite the AMA’s acceptance of prescribing placebos, Drab, who specializes in diabetes, said he would not prescribe them to his patients.
“It’d be easy in my field,” he said. “All I’d have to do is tell someone they have to lose weight, and that I’m giving them a pill to help. I just think that’s dishonest.”
But Sripal Bangalore MD, an assistant professor in the department of medicine at NYU Langone Medical Center, said placebos help patients feel better, which should be a doctor’s main goal.
“What happens with placebos is that you set an expectation for the patient that they are going to feel better,” he said. “I’ve never prescribed a sugar pill, but I do what I can to make them feel better.”
George Lewith, co-author of the U.K. study and professor of health research with the University of Southampton, said that it’s clear many U.K. doctors believe in placebos, and that the stigma surrounding their use needs to go away.
“This latest study with the University of Oxford demonstrates that doctors are generally using placebos in good faith to help patients,” he said in a statement. “In my opinion the stigma attached to placebo use is irrational, and further investigation is needed to develop ethical, cost-effective placebos.”
Dr. Bangalore agreed, saying that the stigma attached to placebos gets in the way of what is best for the patient.
Video: What doctors don't know about the drugs they prescribe | Ben Goldacre
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