Half of Doctors Routinely Prescribe Placebos ... NY Times October 24, 2008

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http://www.nytimes.com/2008/10/24/health/24placebo.html?_r=1 & oref=slogin Half of Doctors

Routinely Prescribe Placebos By GARDINER HARRIS

NY

Times October 24, 2008 Half of all American

doctors responding to a nationwide survey say they regularly prescribe placebos

to patients. The results trouble medical ethicists, who say more research is

needed to determine whether doctors must deceive patients in order for placebos

to work. The study involved 679

internists and rheumatologists chosen randomly from a national list of such

doctors. In response to three questions included as part of the larger survey,

about half reported recommending placebos regularly. Surveys in

Denmark , Israel ,

Britain ,

Sweden and

New Zealand have found similar

results. The most common

placebos the American doctors reported using were headache pills and vitamins, but a significant number also

reported prescribing antibiotics and sedatives. Although these drugs, contrary

to the usual definition of placebos, are not inert, doctors reported using them

for their effect on patients’ psyches, not their bodies. In most cases, doctors

who recommended placebos described them to patients as “a medicine not

typically used for your condition but might benefit you,” the survey

found. Only 5 percent described the treatment to patients as “a

placebo.” The study is being

published in BMJ, formerly The British Medical Journal. One of the authors,

lin G. , was among the medical ethicists who said they were troubled

by the results. “This is the

doctor-patient relationship, and our expectations about being truthful about

what’s going on and about getting informed consent should give us pause

about deception,” said Dr. , director of the research ethics

program in the department of bioethics at the National Institutes of Health.

Dr. Schreiber,

an internist in Louisville ,

Ky. , at first said in an

interview that he did not believe the survey’s results, because, he said,

few doctors he knows routinely prescribe placebos. But when asked how he

treated fibromyalgia or other

conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber

changed his mind. “The problem is that most of those people are very

difficult patients, and it’s a whole lot easier to give them something

like a big dose of Aleve,” he said. “Is that a

placebo treatment? Depending on how you define it, I guess it is.” But antibiotics and

sedatives are not placebos, he said. The American Medical Association discourages

the use of placebos by doctors when represented as helpful. “In the clinical

setting, the use of a placebo without the patient’s knowledge may undermine

trust, compromise the patient-physician relationship and result in medical harm

to the patient,” the group’s policy states. Controlled clinical

trials have hinted that placebos may have powerful effects. Some 30 percent to

40 percent of depressed patients who are given placebos get better, a treatment

effect that antidepressants barely

top. Placebos have also proved effective against hypertension and pain. But despite much

attention given to the power of placebos, basic questions about them remain

unanswered: Are they any better than no treatment at all? Must people be

deceived into believing that a treatment is active for a placebo to work? Some studies have

hinted at answers, but experts say far more work is needed. Dr. Brody,

director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in

Galveston , said the

popularity of alternative medical treatments had led many doctors to embrace

placebos as a potentially useful tool. But, Dr. Brody said, doctors should

resist using placebos, because they reinforce the deleterious notion that

“when something is the matter with you, you will not get better unless

you swallow pills.” Earlier this year, a

land mother

announced that she would start selling dextrose tablets as a children’s

placebo called Obecalp, for “placebo” spelled backward. Dr. Ezekiel J.

Emanuel, one of the study’s authors, said doctors should not prescribe

antibiotics or sedatives as placebos, given those drugs’ risks. Use of

less active placebos is understandable, he said, since risks are low. “Everyone comes

out happy: the doctor is happy, the patient is happy,” said Dr. Emanuel,

chairman of the bioethics department at the health institutes. “But

ethical challenges remain.”