Half of Doctors Routinely Prescribe Placebos

An article published on October 23, 2008 in the New York Times (summarized below) reveals that half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. Skip to next paragraphSurveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.


While the most common placebos the American doctors reported using were headache pills and vitamins, a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.

One of the authors of the study, Franklin G. Miller, director of the research ethics program in the department of bioethics at the National Institutes of Health, was among the medical ethicists who said they were troubled by the results, citing such reasons as informed consent and erosion of the doctor-patient relationship.


At least one doctor defended the practice when used to "treat" diseases like fibromyalgia that many doctors suspect are largely psychosomatic.

The American Medical Association discourages the use of placebos by doctors when represented as helpful. “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,” the group’s policy states.

However, controlled clinical trials have hinted that placebos may have powerful effects. Some 30 percent to 40 percent of depressed patients who are given placebos get better, a treatment effect that antidepressants barely top. Placebos have also proved effective against hypertension and pain. But despite much attention given to the power of placebos, basic questions about them remain unanswered: Are they any better than no treatment at all? Must people be deceived into believing that a treatment is active for a placebo to work?


Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in Galveston said that placebo use reinforces the deleterious notion that “when something is the matter with you, you will not get better unless you swallow pills.”

Dr. Ezekiel J. Emanuel, one of the study’s authors, thought doctors should not prescribe antibiotics or sedatives as placebos, given those drugs’ risks, but felt the use of less active placebos is understandable since risks are low. “Everyone comes out happy: the doctor is happy, the patient is happy,” said Dr. Emanuel, chairman of the bioethics department at the health institutes. “But ethical challenges remain.”

http://www.nytimes.com/2008/10/24/health/24placebo.html?_r=1&th&emc=th&oref=slogin)

I have to admit, I found this article more amusing than troubling. In the case of headache pills/ vitamins, as long as the doctor isn't foregoing a more useful treatment in favor of placebo (which this article does NOT suggest is going on) or conducting research on unwitting patients without consent (which, again, the article does NOT suggest is happening), I don't see the real harm.

I suppose the harm is lack of information, but when a doctor prescribes a non-placebo treatment, is the information any more extensive? Typically, the information that accompanies medication is a list of side-effects, other medications/foods to avoid, and directions for when to take it. It's not as if the doctor spells out in detail what exactly the medication will do once it's in the body. Presuming the doctor is informing the patient about side effect, etc. I think the harm is negligible. Sedatives and anti-depressants may be another story, however, given the risk of dependency and other more severe side effects.

I do wholeheartedly agree with the doctor from UT that placebo prescriptions foster an "only-a-pill-can-make-me-better" mentality, which I think is harmful. Still, at the end of the day, the doctor is doing what little he can do (in the case of a psychosomatic patient) to make them feel better.

Erin