Doctors Prescribing Placebos

Posted by
Anthony Lee
Oct 25, 2008

A placebo is a fake treatment that a patient takes with the expectation that he or she will benefit from it. This is a method used in clinical trials to compare patients having the real treatment with patients having the placebo but not the real thing. In fact, the expectation for improvement can be so strong that it alone can be enough.

However, placebos can raise ethical questions in another context. The U.S. National Institutes of Health (NIH) conducted a study, published in BMJ (British Medical Journal), revealing that approximately half of internists and rheumatologists admit to prescribing placebos to their patients. Earlier this year, the Journal of General Internal Medicine published a similar kind of study by the Pritzker School of Medicine at the University of Chicago revealing that support for placebo prescriptions seems common among physicians.

There could be various reasons for this. Some doctors might strongly believe in a mind-body connection. Others might have patients with chronic incurable illnesses who demand some powerful treatment. Whatever the rationale, news of the recent NIH study does shock many patients and ethicists, especially when we all believe in the importance of trust in the doctor-patient relationship.

This surprises me, too. I myself have never seen doctors do this and certainly have never been taught to use placebo in a context outside of research. I cannot say what side I'm on because I see pros and cons of each. Discussions should continue and will no doubt continue in order to reach a consensus.

References

Tilburt, Jon C., et al. "Prescribing 'placebo treatments': results of national survey of US internists and rheumatologists." BMJ. 2008;337:a1938.
Sherman, Rachel and Hickner, John. "Academic physicians use placebos in clinical practice and believe in the mind-body connection." Journal of General Internal Medicine. 2008 Jan;23.1:7-10.