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Placebo Treatments in Clinical Practice: Results of National Survey

Within the previous year, 55% of surveyed physicians had recommended at least one placebo treatment.

Use of placebo treatments in clinical practice is ethically controversial. Opponents argue that using placebos entails deception and therefore violates informed consent. Proponents argue that placebos can be effective treatments for a variety of illnesses. Yet, little is known about how U.S. physicians view placebo treatments and how commonly they use them. In this cross-sectional survey, investigators asked randomly selected U.S. internists and rheumatologists about prescribing of placebo, defined by the authors as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself; 679 physicians responded (response rate, 57%).

When asked about the appropriateness of recommending treatments primarily to promote patients’ expectations, 62% said this practice is permissible or obligatory. Indeed, within the previous year, 55% had recommended at least one placebo treatment, especially "active" placebos (e.g., over-the-counter analgesics, vitamins, sedatives, and antibiotics); fewer than 4% recommended "inert" placebos (e.g., saline and sugar pills). When asked how they typically describe placebos to patients, 68% said as "a medicine not typically used for your condition but might benefit you," 18% said "a medicine," 9% "a medicine with no known effects for your condition," and 5% said explicitly "a placebo." Physician age, sex, specialty, practice setting, and region were not significantly associated with recommending placebos.

Comment: Recommending placebo treatments is common among and viewed as ethically permissible by most U.S. internists and rheumatologists responding to this survey. These physicians, however, may not be fully transparent with patients about placebos. The authors speculate that the "perceived need to administer something in the absence of other proved effective treatments" might motivate physicians to recommend placebos. In addition, some clinicians may not view all "active placebos" as true placebos, because those agents do have pharmacologic effects.

— Paul S. Mueller, MD, MPH, FACP

Published in Journal Watch General Medicine October 30, 2008

Citation(s):

Tilburt JC et al. Prescribing "placebo treatments": Results of national survey of US internists and rheumatologists. BMJ 2008 Oct 23; 337:a1938. (http://dx.doi.org/10.1136/bmj.a1938)

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