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Doctors Often Use Placebo Treatments For Patients

Posted on: Friday, 24 October 2008, 15:35 CDT

Nearly half of American doctors reported regularly giving their patients placebo treatments, typically vitamins or harmless drugs such as pain relievers disguised as medical treatments, according to a new survey released Thursday.

Many doctors do not disclose the use of placebo treatments to their patients, contradicting American Medical Association guidelines that recommend doctors only use the such treatments if the patient is informed and consents.

"In the clinical setting, the use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient," an AMA ethics panel said in 2006.

"A placebo must not be given merely to mollify a difficult patient, because doing so serves the convenience of the physician more than it promotes the patient's welfare."

The survey included responses from 679 primary care doctors and rheumatologists, with nearly half reporting they prescribe placebos at least two to three times a month.

"It's a disturbing finding," said Franklin G. Miller, director of research ethics at the U.S. National Institutes Health (NIH) and one of the study’s authors.

“There is an element of deception here which is contrary to the principle of informed consent," he told the Associated Press.

"Nobody's really asked American doctors in a systematic way what they think about placebos," said Dr. Jon Tilburt of the Mayo Clinic in Rochester, Minnesota.  
"There was probably a time in medicine when (doctors) were using these more routinely in perhaps a more paternalistic era. I think there remains this general impulse among physicians to want to help and to promote the healing that comes from psychological expectations," said Tilburt, who worked at the NIH when the survey was conducted, in a telephone interview with Reuters.

Scientists have long been aware of the "placebo effect," in which patients who receive a fake or otherwise ineffective treatments report improvements in their condition. For the purposes of the survey, the definition of a placebo went beyond sugar pills typically used in medical studies. In this case, a placebo was defined as any treatment that wouldn't necessarily help the patient.

"Doctors may be under a lot of pressure to help their patients, but this is not an acceptable shortcut," said Irving Kirsch, a psychology professor at Britain’s University of Hull who has studied placebos.

NIH researchers sent surveys to a random sample of 1,200 internists and rheumatologists, and received 679 responses. Of those who responded, 62 percent found placebo treatments ethically acceptable, with half reporting the use of placebos several times a month. Of those who used placebos, 70 percent told patients the treatments were “a potentially beneficial medicine not typically used for your condition.” Just 5 percent of the doctors using placebos directly informed their patients of this fact.

Most doctors responding to the survey used actual medicines as a placebo treatment, with 41 percent using painkillers, 38 percent using vitamins, 13 percent used antibiotics, 13 percent using sedatives, 3 percent using saline injections and 2 percent using sugar pills.

Nearly 60 percent of respondents said they would use a sugar pill to treat patients with chronic pain if it were shown to be more effective than no treatment at all. Smaller studies conducted in Denmark, Britain and Sweden have shown similar results. Researchers believe most doctors reason that doing something is better than doing nothing.

The survey found that in some cases placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also dispensed antibiotics to patients with viral bronchitis, dismissing the fact that a virus is unreceptive to bacteria-fighting antibiotics. Such practices may ultimately prove harmful as experts believe the overuse of antibiotics fosters the development of drug-resistant strains of bacteria.

The study’s lead author, Jon Tilburt of the NIH's bioethics department, said he believes the respondents were representative of internists and rheumatologists across the nation. However, no statistical analysis was conducted to establish whether the results might apply to other medical specialties.

Some doctors believe placebos are a good treatment in certain situations, as the patients are made aware of the situation. Dr. Walter Brown, a professor of psychiatry at Brown and Tufts universities, said patients with conditions such as depression, insomnia or high blood pressure often respond well to placebo treatments.

"You could tell those patients that this is something that doesn't have any medicine in it but has been shown to work in people with your condition," he told the Associated Press.

However, experts aren’t sure if the placebo effect would be less if patients were made aware they were receiving a dummy pill.

While he personally hasn't prescribed sugar pills, Brown he has given extremely low doses of medication to  people with anxiety problems.

"The dose was so low that whatever effect the patients were getting was probably a placebo effect," he said.

Kirsch suspects it might be possible to get the psychological impact without using a dummy pill.

"If doctors just spent more time with their patients so they felt more reassured, that might help," he said.

However, some patients at a London clinic insisted that truth was paramount.

"I would feel very cheated if I was given a placebo," Ruth Schachter, an 86-year-old Londoner with skin cancer, told the AP.

"I like to have my eyes wide open, even if it's bad news.”

"If I'm given something without being warned what it is, I certainly would not trust the doctor again."

The study was funded by the NIH's bioethics department and the National Center for Complementary and Alternative Medicine. It is published online in Friday's issue of BMJ, formerly the British Medical Journal.

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On the Net:

• American Medical Association
• U.S. National Institutes Health

Source: redOrbit Staff & Wire Reports

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