Doctors Regularly Prescribe Placebos

Many patients may be unaware that they are receiving placebos.

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."