Doctors Regularly Prescribe Placebos


Doctors Regularly Prescribe Placebos
Study Suggests Many Physicians Prescribe Drugs for Patient Peace of
Mind Alone
By AUDREY GRAYSON
ABC News Medical Unit
Oct. 24, 2008—


When you visit the doctor's office with a cold or other illness, you
may leave with a prescription that does more for your peace of mind
than it does for your actual ailment.

According to a new study published in the British Medical Journal,
U.S. doctors regularly give placebo treatments such as vitamins,
sedatives or even antibiotics to patients, even though in many cases
these doctors don't expect such treatments to help the patient's
underlying disease.

In a survey of 679 general internal medicine physicians and
rheumatologists, researchers from the National Institutes of Health
found that about half of the doctors admitted to prescribing placebo
treatments without informing the patient.

Moreover, most of the doctors, 62 percent, believed that the practice
of giving a patient a placebo without their knowledge is ethically
sound.

According to lead study author Dr. John Tilburt, staff scientist at
the NIH and assistant professor of medicine at the Mayo Clinic in
Rochester, Minn., this data reflects how the industrial model of
healthcare promotes the mentality that for every symptom you may
experience, there's a pill to make it all better.

"I think it's a deep-seated impulse in doctors today to promote
positive expectations even through a psychological mechanism," Tilburt
explained. "Doctors feel pressured to prescribe something in order to
show the patient that they are taking their symptoms seriously and
trying to do something about it, so they try to find creative ways to
make patients feel better, and will use any tool available, including
psychological benefits."

Still, many criticize the use of placebo treatments because they
believe that the practice is dishonest.

"I would hope that physicians were not using deceptive tactics to
treat their patients," said Dr. Ted Palen, an internist at the
Colorado Permanente Medical Group in Denver, Colo. "I believe
prescribing a placebo, without informing the patient of what your
intent is, involves deception and therefore violates patients'
autonomy and informed consent."


The Mystery of the 'Placebo Effect'
But advocates of placebo treatments argue that the placebo pills often
do help patients to get better, even if it is only the "placebo
effect" at work.

In fact, there have been several large studies in the past few years
indicating that the placebo effect is very real, and very effective.

The most recent study was published in the Journal of the American
Medical Association in March, which found that more patients reported
feeling less pain after taking an expensive placebo (which they were
told was a painkiller) compared to those patients taking an
inexpensive placebo.

Studies such as this go a long way in proving that a patient's
expectations to feel better after taking a prescription drug can be
just as valuable, if not more, than many other treatment options.

"It's not a medication that's being prescribed, it's a belief," said
Dr. Lee Green, professor in the Department of Family Medicine at the
University of Michigan. "Patients who feel bad want 'magic' to make
them feel better.

"This isn't about whether a drug is scientifically efficacious," Green
added. "Medicine is secondarily about providing technological
services, and primarily about meeting human needs."

The researchers also found that 41 percent of doctors reported using
over-the-counter pain relievers such as aspirin or acetaminophen, and
38 percent said they used vitamins as placebo treatments.

According to Green, the practice of prescribing patients over-the-
counter cough and cold medications disguised as a prescription-
strength antibiotic is not uncommon.

"The placebos that I commonly prescribe are cough medications and
decongestants," Green said. "Randomized controlled trials show they
don't really do anything, but for those patients who must have a
prescription -- they just don't think it's 'strong' if it's over-the-
counter -- they work."


A Safe Solution?
But the authors also wrote in the report that "a small but notable
proportion of physicians reported using antibiotics (13 percent) and
sedatives (13 percent) as placebo treatments."

While many experts said that the use of vitamins, sugar pills or even
over-the-counter painkillers as placebos is perfectly safe, many
believe using antibiotics and sedatives as placebos are a different
story.

According to some experts, prescribing antibiotics as a placebo could
be contributing to the issue of antibiotic resistance, or the ability
of bacteria to withstand the effects of antibiotic treatments.

"We do believe that treating infections with antibiotics when they are
not indicated may lead to increased resistance but that is not
entirely clear," said Dr. Barbara Yawn, director of research at the
Olmsted Medical Center, University of Minnesota.

Nonetheless, most experts agree that it is the over-prescribing of
antibiotics that has lead to such strong antibiotic resistance among
the population today.

"Of course, this kind of prescribing contributes to [antibiotic]
resistance," Michigan's Green said. "Placebos should be cheap and
safe."


When Patients Demand Pills
But Green said what drives many physicians to prescribe such placebos
is the demand of the patients themselves.

"If you try to tell [the patient], correctly, that an antibiotic won't
treat their virus, they either won't believe you or get angry," Green
said.

While Denver's Palen believes the answer to avoiding this scenario is
explaining to the patient "the reasons behind the... treatments you
advise [them] to undertake," many doctors say there is simply not
enough time in one doctor's visit to do so.

"Visits are now so short and for primary care ... that there is not
time to spend the five, 10, 15 or 20 minutes that are required to
explain why an antibiotic is not a good treatment for a viral
respiratory infection," researcher Yawn said.

But despite the barriers to properly informing each and every patient
about the treatment they are prescribed, many experts said the
practice of deceitfully prescribing placebos has no place in clinical
practice.

"There is no better or 'safer' way to prescribe a placebo," said Dr.
Gil Holland, a private practice physician in Chandler, Ariz. "Every
medication, even those that appear benign, have the potential for
harm.

"I think that the medical world at large needs to revert back to the
oath to 'above all else do no harm,' he said, "despite external
pressures."

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