Many Doctors Use Placebos on Patients

Chicago Survey: Nearly Half of Doctors Have Given Patients Dummy Pills or Other Placebos

Medically Reviewed by Louise Chang, MD on January 03, 2008
From the WebMD Archives

Jan. 3, 2008 -- A survey released Wednesday suggests many doctors give dummypills or other placebos to their patients, furthering the debate about apractice that some experts consider unethical.

Nearly half the doctors surveyed at three Chicago-area medical institutionsreported that they have used placebos in medical practice. While the survey wasconfined to about 230 doctors, the results closely track those of similarstudies.

Doctors said they had administered a variety of placebos to patients,including vitamins, low-dose drugs, and in some cases simplesugar tablets. Almost 20% of doctors said they had used the pills to calmpatients, 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 inmedical school that the mere act of administering treatment can affect patientseven before an active drug has time to work.

"I think it's the very act of comforting a patient that may lead to theclinical 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 theinfluence of the placebo effect. In the case of drug trials, one study groupmay be given an active drug while another group gets identical treatmentwith only the active ingredient missing. In theory this lets researchers studyonly the active ingredient while canceling out the placebo effect.

But the use of placebos also raises questions. While study volunteers areusually 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 knowledgethat 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 informedconsent, some experts say.

"I think it's unethical," says John Kusek, PhD, a senior scientificadvisor at the National Institute of Diabetes and Digestive and Kidney Diseaseswho has studied the placebo effect and the use of placebos in clinicaltrials.

Ethical Questions

Even if placebo treatment works, it still represents a "slippery"ethical ground because patients are not told they're getting a placebo insteadof a "real" drug, he says.

"There's still an honesty you have to have whether they're in a trial orthey'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 butwill not hurt."

Many doctors surveyed said they believed that other placebos (defined astreatments with an unknown or nonspecific mechanism of action) such asmeditation, prayer, or complementary medicine could have both a psychologicaland physiological benefit for patients. That suggests that "a growingnumber of physicians believe in the idea of a mind-body connection," theresearchers concluded in the study, which is published today in the Journalof General Internal Medicine.

While the study suggested that many doctors have used placebos, there waslittle evidence that the practice was frequent. Less than 10% said they hadused placebos more than 10 times.

Show Sources

SOURCES: Sherman, R. and Hickner, J. Journal of General Internal Medicine, January 2008; vol 1: pp 7-10. Rachel Sherman, medical student, University of Chicago Pritzker School of Medicine. John Kusek, PhD, senior scientific advisory, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

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