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Posted: October 28, 2008

Most Doctors Commonly Prescribe Placebos, Say Fake Meds Ethically OK

How would you feel if you learned that, after visiting your doctor and describing your symptoms, she prescribed pills that turned out to be a placebo? Since a new survey shows more than half of responding US physicians do it, it may have already happened to you. 

The study of 1,200 doctors -- conducted by researchers from the National Institutes of Health, Harvard University and the University of Chicago and published in the British medical journal BMJ -- is based on the 679 physicians who responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis. 

Most physicians – 62% -- said they believed the practice to be ethically permissible. Few of the responding doctors reported using saline or sugar pills as placebo treatments, while large numbers reported using over-the-counter analgesics and vitamins as placebo treatments within the past year. 

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A small but notable proportion of physicians reported using antibiotics and sedatives as placebo treatments during the same period.

Specifically, the study found that the most commonly used placebo treatments prescribed in the past year were over-the-counter painkillers (41%) or vitamins (38%). Some of the physicians reported using antibiotics (13%) and sedatives (13%) as placebos, and only 3% reported using sugar pills.

And what do these doctors tell their patients? In most cases, the survey indicates physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition. Only rarely do they explicitly describe them as placebos, the authors write. 

“It’s a disturbing finding. There is an element of deception here which is contrary to the principle of informed consent,” said Franklin G. Miller, director of the research ethics program at the NIH and one of the study authors.

“It's a gray zone. It is not ethical to actively deceive patients. But when doctors give something which they think will help but don't think it helpful to explain the full reasoning about why it will help, that's a gray zone,” said Dr. Farr A. Curlin, an assistant professor of medicine at the University of Chicago, and a member of the team reporting the findings of the survey.

The American Medical Association clearly says that 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. AMA stipulates that physicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use.

Meanwhile, Dr. William Schreiber, an internist in Louisville, Kentucky, was quoted in the New York Times as having serious doubts about the report's accuracy. He said some doctors with "difficult" patients might prescribe an over-the-counter pain killer, but argued that might not qualify as a placebo in every case. 

( contributed to this article)

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