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What placebos say about the doctor-patient relationship

October 23, 2008 |  6:43 pm

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

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