Many Doctors Prescribe Placebos

A new survey found that about half of internists and rheumatologists offer fake prescriptions, or placebos, to help their patients feel better. A placebo is any substance that is believed to have no pharmacological effect on the condition being treated.

 

Researchers surveyed 679 internists and rheumatologists. These specialty doctors often see patients who have long-term illnesses that are difficult to treat or cure. Sometimes a placebo has heath benefits, and when this happens, it’s called the placebo effect. The placebo effect is often attributed to the patient’s expectation or hope that the therapy will work. 

 

Of those who prescribe placebos, 68 percent said they usually tell their patients that it is "a medicine not typically used for your condition, but it might benefit you.” According to the study, the most commonly prescribed placebos are vitamins and over-the-counter pain relievers. Most doctors, 62 percent, said it was “ethically permissible” to prescribe placebos.   

 

According to the American Medical Association (AMA), prescribing a placebo without the patient’s knowledge may compromise the patient-physician relationship, possibly resulting in harm to the patient. Therefore, they recommend that placebos only be prescribed if the patient is aware of and agrees to its use.

“A physician should enlist the patient’s cooperation by explaining that a better understanding of the medical condition could be achieved by evaluating the effects of different medications, including the placebo," the AMA states. If the patient agrees, the doctor does not need to identify which medicine is the placebo and does not need to ask for specific consent before prescribing the placebo. “In this way, the physician respects the patient’s autonomy and fosters a trusting relationship, while the patient still may benefit from the placebo effect,” according to the AMA guidelines.

The AMA also states that placebos should not be prescribed to pacify a difficult patient.

Comments

[Tina]

I agree that patient should be well-informed about the doctor's course of action in their treatment. However, telling the patient that she is receiving a placebo defeats the purpose of a placebo. As the article states, placebo works because the patient expects or hopes the medication will work. It harvests the power of the mind to heal the physical body. Besides, why is there an assumption that the patient is not already aware of what placebo is?

[max]

It is a shock to find out a high percentage of clinicians prescribe placebo without patient’s knowledge. I hope these doctors know the consequences, especially when the placebos are prescribed for chronic diseases. These patients need to be managed accordingly to prevent the progression of the disease. Yet, they get the placebo!!! Talking about ethical and trusting relationship in your doctors.

[leah]

I think that doctors must be very careful when prescribing placebos to patients. In the pharmacy, I occasionally have doctors request that placebo medications be placed in bottles with labels that state a therapeutic drug name. This is considered mislabeling and is against the law. Just because a doctor orders it does not make it legal.

[Jane Rogers]

It's both alarming and shocking that any doctor or health specialist would prescribe a medication to a patient without his or her full knowledge of exactly what the prescription entailed and its potential side effects. If these doctors are prescribing pain relievers and vitamins without the patient's knowledge, how can they be sure the patient won't accidentally take too much pain reliever in a day, or over time? Same with vitamins. What if the patient is already taking vitamins or herbal supplements, and there's a reaction, or the patient ends up consuming an unhealthy or even toxic dose of the vitamin because he or she had no idea how much she was really taking? This practice of giving placebos without the patients knowledge seems unethical AND dangerous.

[Leo]

I disagree with you, Max. Doctors aren't prescribing placebos as a first-line of treatment. I imagine they're only prescribing them if 1) current therapy is not effectively managing the condition and 2) the placebo is something that's harmless. If I had a disease that was impossible to manage, and my symptoms were interfering with my quality of life, I would definitely want my doctor to try all possible (SAFE) treatments -- even if that meant no real treatment (placebo).

The brain has a very powerful influence on our health, and I believe your state of mind can be helpful (or in some cases, detrimental) in many medical conditions.

[Liz]

I don't think doctors are being irresponsible with placebos. It's not like doctors aren't telling their patients what they're taking. Instead, they're just saying the medication or vitamin is going to have a much greater effect than it's really supposed to.

[Elizabeth]

The patient is aware of it. If it’s autonomy that concerns you, a statement similar to “It is a medicine not typically used for your condition, but it might benefit you” (as mentioned in the article) would suffice, in my opinion. If the patient is aware of it, then how would the placebo effect work to its fullest potential? The reason why the placebo effect exists is because patients believed that they were taking a medication with active ingredients. They believed that the medication they were taking would have a beneficial effect and consequently, did feel better. It is the law of attraction!

[For those of you who’ve read The Secret] They believe something will happen, envisioned it and it does happen. If the patient now knows that there is no active ingredient and is instead only taking a sugar pill, then what benefit would the patient expect? The patient would expect nothing to change, and as the law of attraction shows itself, nothing will change.

[PK]

Regarding the fear that prescribing OTC analgesics or vitamins as placebos may lead to overdose -- when “active” placebos like these are prescribed, patients know that is what they are getting. What they are not being told is that there is no evidence to suggest that the prescribed product will treat their conditions. A well-informed patient would be able to determine that they were prescribed a placebo, but the majority of patients are not well-informed.

[john]

Although I recognize the importance of placebos in clinical drug trials, using placebos as a tool in real practice seems dangerous. Some doctors may currently only use placebos as a last resort for disease states difficult to treat now, but what about tomorrow? There may be a point in the future where it becomes more common to use placebo. You would have to be concerned about that type of trend.

[Becca]

Wow -- this is a topic I was not aware of. It's a little disturbing actually. I cannot imagine what it would be like to be an MD trying to treat a patient with a condition like rheumatoid arthritis, which is often difficult to manage. However, I don’t believe that it is ethical to give a patient a pill without having them know exactly what is it and what it can do for them. After all, it is our right, isn’t it?

I totally get that the MD is looking for that psychological fix that will help the patient to believe that they will be better when all else has failed, but it is not right not let a patient know what they are putting into their bodies.

Also, it disturbs me that antibiotics and sedatives would ever be used as placebo when they can both have multiple side effects on our bodies. Studies are showing that 60 percent of rheumatologists are saying that they believe using placebo is ethical. The FDA stated that placebos are useless and have no biological function whatsoever. The fact is MDs are looking for a way to make their suffering patients feel better by making them “think” it is working. The idea might sound nice, but I don't think it's right to hide anything from your patient who trusts you!

[Tamara.S]

I believe that prescribing a placebo without informing and explaining it to the patient involves deception, and therefore, violates patients' autonomy and informed consent.

[K Kelley]

I agree that prescribing a placebo may help patients feel better because a healthy body also includes a healthy state of the mind. If a patient believes the placebo may help them, they have more hope. I do take issue with doctors who prescribe vitamins as a placebo. These doctors need more training! Many patients who have difficult-to treat-diseases most likely also have an inflammatory imbalance. The use of vitamins can act as a part solution or a catalyst to the solution, and in fact, may help alleviate some of the symptoms. So, the vitamin may not just be a placebo but rather a functional component in improving their well being.

[Liz]

I agree with PK. Patients are getting vitamins or OTC pain relievers that can have actual effects or placebo effects. According to the article, 68 percent of the doctors tell their patients that what they are prescribing is not typically used for condition but might beneficial. I believe that those doctors should take it a step further in finding out if their patients are already taking vitamins or self treating with OTC to avoid overdose.

[SUMA]

After reading this study, the first thing that comes to my mind is why, if “conventional" physicians are so willing to prescribe placebos to patients, are they not willing to explore the possibilities that natural products (i.e. herbs) may offer their patients? I find it disturbing that physicians will prescribe antibiotics and sedatives to patients without their knowledge and agree with the authors that “recommending these drugs when they are not medically indicated could have potentially adverse consequences for patients.” This is especially concerning because if the patient does not know what medications they are taking, they are also completely unaware of the possibility of potential interactions with other medications. I do not find this to be “ethically permissible.”

I agree with the AMA’s statement that “placebos only be prescribed if the patient is aware of and agrees to its use.” This is a perfect example of the need for integrative medicine and the important role of complementary medicine. I believe this is also a perfect example of why more people seek out complementary treatment. I think it would be interesting to survey these same physicians to evaluate their views on complementary therapies for their patients and their willingness to pursue this type of treatment versus placebo.

[Grace]

Thanks for clarifying the fact that patients are made aware that they are taking something that has no evidence in treating their specific condition and are not completely in the dark about the placebo. I was confused and didn’t know whether patients were told what the placebo medication was or not, but what do you mean by a “well-informed patient” in this context? Do you mean that some patients would figure out that it was a placebo since it has no direct evidence in treating the condition or because it's a vitamin?

[Bob]

So, from reading the previous comments, I am somewhat confused here. Are doctors required to tell their patients exactly what the "active" placebo is? Do they just have to indicate that the treatment has shown no evidence in treating the condition and not inform the patient of the specific name of the drug?

[J. Shah]

If the placebo is not an active one, then would it be something like a sugar pill? I am also surprised about how often placebo is prescribed. Simply saying that placebo is “a medicine not typically used for your condition” might not suffice. I wonder if doctors have had to deal with many cases of side effects and interactions due to patients being ill-informed.

[jimmy]

The high percentage of doctors prescribing placebos should not be surprising since the purpose of placebo is to make patients believe they are being treated accordingly. However, placebos as I understand it, can only be given in a clinical trial (where the patients consent to be enrolled in), not as prescribed medications where patients can obtain from primary doctors. So if the placebos are given as prescribed medications to treat certain conditions, then it is wrong and dangerous, not to mention the violation of the law specifically mislabeling.

[nick]

I agree with Leo that the brain has a very powerful influence on our health. However, the placebos should only be used in a controlled environment (such as a clinical trial) so that the patients’ conditions can be monitored accordingly.

[jw]

If you want to read more about placebos and how they're used, check out this article: http://newsblogs.chicagotribune.com/triage/2008/10/whats-a-placebo.html

[Susan Wenger]

Tina is exactly right: prescribing placebos can do real harm to patients with chronic diseases. You can read a post from a victim of this practice here:

http://cfs-facts.blogspot.com/2008/10/half-of-doctors-give-placebos-for-real.html

(Scroll down past my reprinted letter to the editor to read the victim's response.)

[janice]

I was talking with a reiki practitioner. I ask the practitioner if patients really do feel the energy, or if they know that they’re supposed to feel something, and although they might actually not, still say, “Oh, I think I felt something.” She responded that it could be possible. She then told me that even if they don’t actually feel the energy fields but claim they feel better afterward, it’s worth it because it obviously was therapeutic for them. I think the same happens with placebo. Does it matter that there is no active ingredient and the patient thinks that it’s working? Does it matter what’s in the pill if the patient is actually getting better? I think not. If it works and there is no toxicity with placebo, it is useful.

[Deepa]

The patient’s autonomy is certainly important and is what’s essential for a doctor-patient relationship. It is highly respected. However, in certain situations, I think some things are worth not telling a patient. For example, my grandfather was diagnosed with colon cancer one year ago. One month ago, we were told that his cancer has metastasized to his lungs and kidneys. He is 88 years old and has diabetes, chronic kidney failure, anemia, etc. My family has chosen not to inform him of his prognosis, which is, five months. Why? The answer is quality of life. Many may disagree with my family’s decision but there’s much more to it than what I can post here. My point is, if placebo can improve a patient’s quality of life, what is the cost-effectiveness ratio here (cost being the autonomy)?

[FC]

I find it absolutely shocking to find that any doctor would offer a patient a fake prescription. People go to their doctors to get better, not to be “scammed.” Every patient wants complete trust and confidence in their doctors.

I agree with another person’s comment -- why would a doctor tell a patient that he/she is prescribing a placebo? Of course that is the honest thing to do, yet it defeats the whole purpose. I feel placebos should only be used in research studies, where patients know they may be given a real medication and also a placebo. I also agree with the last statement that a placebo should not be given to pacify a difficult patient. Unfortunately, while I worked in the medical industry I did see this happen quite often, and it was extremely upsetting.

[Shawn]

In response to Becca's comment: Are MDs really using sedatives and antibiotics as placebos? If they are, that changes the picture significantly. Using antibiotics for anything other than a bacterial infection leads to resistance, which can cause infections to be more difficult to treat in the future. Using sugar pills or vitamins as placebo is one thing, but using antibiotics as placebos can be much more dangerous.

[Anne]

My concern is for the patients who actually do require medical treatment and don’t receive the benefits of the placebo effect. How long do they keep hoping the "medicine" will work for them? It seems unfair to partake unwittingly in a Dr’s experiment, even though the intentions may be good. Moreover, even if the placebo effect is favorable, what about long-term effects? If the condition is chronic, surely a placebo could only provide short-term benefits, and therefore delay other avenues of treatments? I am interested in knowing exactly what conditions benefited from the placebo and exactly what the placebo is!

[Anna H.]

People who are sick look up to doctors for a cure or a relief in their illness. Prescribing a placebo without a patient's knowledge can be emotionally harmful; therefore, a doctor should be ethical and prescribe different kinds of medicines with the placebo, making it known to the patient. Some patients might think they are sick when they have no symptoms, but giving them hope that this pill (placebo) will help them would be ethical because the doctor is curing the patient. With the placebo, the patient is letting his brain know that he will be fine, and mentally he is curing his symptoms.

[Phil S.]

Jimmy, I hope what you are saying is the case everywhere. If doctors are prescribing placebos to patients in a clinical study, then I understand why patients are not informed about whether or not they are taking the placebo. When I first read this article, I assumed people were going to their doctors and getting prescribed placebos. I personally do not think it is right to give patients placebo without them knowing that it is a possibility in treatment.

[Shaily]

If someone is a "difficult" patient, then prescribing a placebo is not the next viable treatment option. I view it as a cop-out. If the patient is being difficult, then one would hope that the physician, out of respect for the relationship with the patient and their duty as a doctor, would maybe present other options or refer the patient to someone else. In this situation, placebo does not seem to be prescribed with intentions of bettering the patient’s quality of life, but more to relieve the doctor of dealing with such a patient.

[Allie]

The article states that the AMA is against prescribing placebos for the purpose of dealing with a difficult patient. Doctors should remember to keep the welfare of their patients a priority rather than just pacifying them. I believe that a patient's concerns should not be dismissed. If they feel something is wrong and you do not know how to help, then you should refer them to someone who can.

[June Russell]

Placebos are not required to be inert substances any more! Even drugs can now be used as placebos, and the drug companies are not required to divulge what they use as placebos. How can they claim studies are "evidence based???"

For references check out "Placebos" on www.jrussellshealth.org

[Samantha]

The article mentions talking to the patient first in order to maintain the patient-physician relationship. Even if the patient is unsure whether she/he is getting the placebo or an actual medication, the thought has been placed, which would affect the placebo effect. Placebo effect would only be truly valuable when the patient truly believes she/he is getting active therapy.

[Tanya]

Placebos are not technically medications. It’s an inert substance. However, sometimes placebos are used in clinical trials as a control to test against other study medications. It is always under the assumption that placebos would not have any effects on patients -- good or bad -- after the duration of the study. In this way, if the study groups were to exhibit any effects from the study medications at all, such said effects would be compared against the placebo groups.

And I find it’s very disturbing that such a high percentage of physicians think prescribing placebos to patients “ethnically permissible.” How can it be ethical when the prescribers know that the “medication” will not work, at least in a long run? What are these physicians going to do after a few weeks when the placebo stops working? Giving the patients another placebo pill? Placebos might work for a short time in the beginning thanks to patients’ enthusiasm and psyche or whatnot. But how is it ethical when the patients are under a different assumption or in the least being lied to by omission?

[Robert Montoya]

Placebo use in my opinion is completely justified. Of course, situations warrant actual pharmacological therapy, and depending on the disease state, it would be unethical to prescribe a mere placebo. However, a majority of mental illnesses and certain physical aliments can be caused by strongly influential psychosomatic factors. Patients become trapped in the mindset that they possess some disease or abnormality within themselves, and they struggle to grasp the possibility that it is all an internal manifestation. Placebos, in this case, can give patients the idea that they have a chance at improvement; a potential remedy that does in fact exist.

Unfortunately, Americans rely heavily on pharmacological therapies, believing that taking a drug is the only way to get better. This, of course, is not the truth or the reality of the matter, but it is this belief that gives placebos the chance to help patients without having to worry about the potential side effects and adverse events that go along with most pharmacological interventions.