Doctors Often Prescribe Placebos As Treatments
3 CommentsBy Ed Silverman // October 24th, 2008 // 1:40 pm
Docs in the US regularly prescribe placebo pills that are intended to have some kind of psychological effect, but, the placebos often aren’t the inactive substances used in controlled clinical trials, according to a new study in BMJ.
Only of the 679 docs surveyed, 3 percent reported prescribing sugar pills, but 41 percent used over-the-counter painkillers as placebos, 38 percent used vitamins, 13 percent used antibiotics, and 13 percent used sedatives. And only 5 percent prescribe a placebo treatment and describe it that way, while 68 percent describe it as a potentially beneficial medicine or treatment not typically used for the condition. And 62 percent view the practice to be ethically permissible.
“It’s a gray zone. It is not ethical to actively deceive patients. But when doctors give something which they think will help but don’t think it helpful to explain the full reasoning about why it will help, that’s a gray zone,” Farr Curlin, an assistant professor of medicine at the University of Chicago and one of the researchers, tells HealthDay News.
“There are times when I have said, ‘Yes, I think it might be helpful, why don’t you give it a try,’ when I don’t have confidence it will help their condition,” he continues. “What matters is that the treatment can help. The placebo effect is a real effect. People do feel better. To the extent that it can be mobilized in a way that is restful and not actively deceiving patients, I think it is acceptable.”
“The cornerstone of what treatment is acceptable is full disclosure for the patient,” Andrew Leuchter, associate dean of the school of medicine at the University of California, Los Angeles, tells HealthDay News. “If you explain to the patient what you are doing, and why you are doing it, that is right. If you mislead a patient, there is a serious problem with that.”
bcobert
This is a long-discussed and complex issue with much discussion about 5 years ago questioning whether placebo-controlled trials were ethical. Similar discussions over many years about use in the non-trial practice setting. I think the really big surprise and worry here is the choice of placebo used (antibiotics, sedatives, pain killers) all of which can produce real pharmacologic effects and, of course, adverse events. Use of such drugs could produce a “nocebo” effect - a well described negative response to a placebo. And there are reports in the literature of patient deaths on placebo. If something is to be used as a placebo it really should be as inert as possible (e.g. normal saline for an injection im or a true “sugar” pill for oral ingestion (in non-diabetics).
laurie
“I think the really big surprise and worry here is the choice of placebo used (antibiotics, sedatives, pain killers) all of which can produce real pharmacologic effects and, of course, adverse events. ”
Exactly!
Susan
It is hard to imagine how this can occur. If the patient was in the hospital or a nursing home where someone dispenses the placebo to them it could happen. If that is the case, medicaid should be paying the docs with Monopoly money.
Samples come in bubble packs for the most part. It seems that if a pharmacist slapped an incorrect label on a bottle- he could lose his license. How often does a doctor just hand someone a bottle of pills? The patient would be a fool to take them if they were not filled by a pharmacist. Then there is the insurance companies who are not going to pay an Rx cost for a vitamin.
I must have missed something. The legal implications seem endless.