Jan. 3, 2008 -- A survey released Wednesday suggests many doctors give dummy pills or other placebos to their patients, furthering the debate about a practice that some experts consider unethical.
Nearly half the doctors surveyed at three Chicago-area medical institutions reported that they have used placebos in medical practice. While the survey was confined to about 230 doctors, the results closely track those of similar studies.
Doctors said they had administered a variety of placebos to patients, including vitamins, low-dose drugs, and in some cases simple sugar tablets. Almost 20% of doctors said they had used the pills to calm patients, 15% said they used placebos to satisfy patients' "unjustified" demands for treatment, and 6% to get patients to "stop complaining."
The ability of such treatments to ease suffering or alter body processes -- known as the placebo effect -- is well-documented. Doctors often learn in medical school that the mere act of administering treatment can affect patients even before an active drug has time to work.
"I think it's the very act of comforting a patient that may lead to the clinical benefits that are desired," says study researcher Rachel Sherman, a medical student at the University of Chicago Pritzker School of Medicine.
Experimental vs. Clinical Use
Placebos are widely used in research trials as a way to control for the influence of the placebo effect. In the case of drug trials, one study group may be given an active drug while another group gets identical treatment with only the active ingredient missing. In theory this lets researchers study only the active ingredient while canceling out the placebo effect.
But the use of placebos also raises questions. While study volunteers are usually told they could receive a placebo as part of the experiment's design, few patients are informed in this way. That's mainly because the mere knowledge that a pill is a placebo is usually enough to cancel out the placebo effect. And that lack of information could undermine a patient's right to informed consent, some experts say.
"I think it's unethical," says John Kusek, PhD, a senior scientific advisor at the National Institute of Diabetes and Digestive and Kidney Diseases who has studied the placebo effect and the use of placebos in clinical trials.
Even if placebo treatment works, it still represents a "slippery" ethical ground because patients are not told they're getting a placebo instead of a "real" drug, he says.
"There's still an honesty you have to have whether they're in a trial or they're a patient of yours," Kusek says.
In this study, 4% of the doctors told patients "it is a placebo" while 34% told patients that the placebo was "a substance that may help but will not hurt."
Many doctors surveyed said they believed that other placebos (defined as treatments with an unknown or nonspecific mechanism of action) such as meditation, prayer, or complementary medicine could have both a psychological and physiological benefit for patients. That suggests that "a growing number of physicians believe in the idea of a mind-body connection," the researchers concluded in the study, which is published today in the Journal of General Internal Medicine.
While the study suggested that many doctors have used placebos, there was little evidence that the practice was frequent. Less than 10% said they had used placebos more than 10 times.