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50% of Doctors Prescribe Placebos

Taking Advantage of 'Placebo Effect' Is OK, Most Doctors Say

Placebo Prescriptions: Right or Wrong? continued...

That last point seems tricky. How can a fake drug work if a patient knows it is fake?

The AMA policy says doctors should explain to patients that they can better understand their condition if they try different medicines, including a placebo. If the patient agrees to this, the doctor does not have to identify which medicine is fake, nor does the doctor have to get the patient's specific consent before giving the patient the fake treatment.

There's nothing wrong with this approach, says medical ethicist Arthur Caplan, PhD, professor of bioethics at the University of Pennsylvania, Philadelphia.

"It is ethical to use treatments that are low risk and have few side effects if you can relieve people's symptoms," Caplan tells WebMD. "Placebos are especially useful in the treatment of the psychological aspects of disease. Most doctors will tell you they have used placebos."

But doctors do often prescribe placebos the wrong way. In today's world, a doctor can't write a prescription for a sugar pill. The doctor has to prescribe something -- and every active medicine carries some risk of side effects.

"What you can use as a placebo is complicated. I have seen people dispensing antibiotics as placebo for mothers who want something for their kids' flu," Caplan says. "Not only does this not help, but it does build up drug resistance and may have some serious side effects for the child."

Most doctors use relatively harmless drugs, such as baby aspirin, as placebos. Clearly, great care must be taken to ensure that the placebo drug's risk is less than the benefit of the hoped-for placebo effect.

"We know it is wrong when doctors give potentially harmful medicines in a manner that may not be warranted," Tilburt says. "If I think it will actually have only a placebo effect, I should not give a patient a sedative. The compulsion by doctors to benevolently promote patient expectations can play out in a way harmful to patients."

In the end, Tilburt suggests, the effectiveness of a placebo treatment may well hinge on the trust patients have in their doctors.

"Maybe it isn't about taking a pill at all," he says. "Maybe it is the relationship between the doctor and the patient that makes the real difference."

Tilburt, formerly with the bioethics department of the National Institutes of Health, is now assistant professor of medicine at the Mayo Clinic, Rochester, Minn. The study appears in the Oct. 24 online first edition of the journal BMJ.


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