What placebos say about the doctor-patient relationship

Doctors want to make their patients feel better. Got it. And sometimes a treatment that doesn't actually help -- a placebo -- will make patients feel better. Got that too. But ...

A study published today in the British Medical Journal found that many rheumatologists and internists in the U.S. seem to have few qualms about prescribing placebos to their patients. The study, based on a not-huge survey of 679 physicians, found that half prescribed placebos regularly. About 62% saw the practice as A-OK.

That's not to say that none of the placebo treatments did anything whatsoever, just that the treatments -- such as vitamins, over-the-counter painkillers, sedatives and antibiotics -- didn't actually treat the condition for which they were prescribed. (That's what we need -- more prescribing of unnecessary antibiotics.)

Said the authors in the abstract's conclusion:

Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed U.S. internists and rheumatologists.... Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.

The survey is garnering considerable attention.

From the Chicago Tribune: Mind over body: Half of doctors in U.S. use placebos, survey finds

From the New York Times: Half of doctors routinely prescribe placebos

From the Associated Press: Survey: Half of U.S. doctors use placebo treatments

The practice itself is increasingly coming out of the shadows, its powers and potential discussed more openly among physicians. As an L.A. Times story published earlier this year points out: "For decades, research physicians have furrowed their brows at the mysterious powers of a treatment known in many medical circles as Obecalp." (That's "placebo" spelled backward.)

That story, "Doling out the placebo effect," notes:

Physicians' growing belief in the connection between mental and physical health has caused many to acknowledge that sometimes patients can be made to feel better, and even get better, simply because their doctor did something to help them.

Maybe.

But if the doctor-patient relationship is gradually eroding, as some contend, might it erode further as patients start to wake up to the use of placebos? Wonder what the placebo treatment for that is....

-- Tami Dennis

Comments

[bill]

I think it's great if a doctor can help a patient cure themselves by means of taking a dose of flower and sugar or tye oy a mute or wart of a toad... but placebo in general has no noticeable effects what so ever, so what happens when a patient goes to a doctor with a mental disorder, perhaps being bordering on schizophrenia - and the doctor thinks it's all in his mind and prescribes a placebo and then the patient goes home, takes the pill and then starts hearing voices telling him to go shoot the mayor, or president etc etc etc...

[Tina]

This is criminal. These doctors should just be honest with their patients and try to help them if they believe the problem is psychosomatic. So what are patients paying for? Who is reaping the profits. I was bitten by a tick, had a huge rash and symptoms and may now have lyme disease. I paid $3-4 dollars each tablet out-of-pocket for antibiotitcs. What was I paying for.... sugar? I will never know. Outrageous. Another government supported pharmaceutical company scam.

[Andrew Lincicome]

I understand the concept, but do we get a placebo bill or the real thing? So if I pay my Doctor in placebo money will he be happy if I don't tell him its real? Its bull, if I pay for some crap, i better be getting it, its bad enough we eat the cost of medicine, but now we may not even be paying for that but sugar? come on!

[Mike]

Welcome to the world of Alternative Medicine. This how homeopathy, naturopathy, acupuncture and the rest work. With a doctor you at least know it won't cause harm and the doctor can continue monitoring you.

[Bill]

Doctors often treat diabetics with placebos to treat diabetes. A great resource for these studies can be found at http://diabetes.boomja.com. Duloxetine treatment was considered to be safe and well tolerated with less than 20 percent discontinuation due to adverse events.

[Mark]

Some people are mentally unstable, I'm not talking about people living in institutions. I'm talking about people working and living in society. You've probably met a few - they're crazy. So, when a mentally unstable patient demands a medication, and the doctor knows that the problem will resolve on its own, the doctor may prescribe something that doesn't do much but will keep the patient from freaking out. In this case, the doctor is actually treating the person's anxiety.

[PharmD]

I'm a pharmacist, and I've filled ONE placebo Rx ever.

This half number they speak of is a complete lie to make this story work.

Granted I've only been practicing for a few years, this regular prescribing process is hardly regular.

Other than that, the power of suggestion is VERY powerful and I have no problems with Docs prescribing lactose pills to ppl. Some patients won't leave until they have something prescribed to them even when nothing is wrong.

You can put some blame on DTCA (direct to consumer advertising), you all know what I'm talking about.

Viagra, Cialis etc etc leads the american public to belive that 95% of men over the age of 45 have erectile disfunction, of that 95% all of them should talk to their doctor about their "Going problem...."

[ohherewego]

Oh screw these "ethics" experts. Let them get real jobs. Besides, placebos are far more ethical that giving people medication they don't need. And like someone else pointed out, what they're treating patients' paranoia and anxiety.