October 24, 2008

Many U.S. doctors give patients placebo treatment

Many American doctors give their patients a placebo, usually a relatively innocuous drug such as a pain reliever, in the guise of medical treatment and view the practice as ethical, researchers said on Thursday.

Among 679 primary-care doctors and rheumatologists, who treat arthritis patients, about half reported prescribing placebos at least two to three times a month and most said they did not explicitly tell patients they were getting a placebo.

The idea may be to trigger the "placebo effect" -- a genuine improvement in health driven by psychological expectations of a benefit and not due to the physiological effect of a given treatment -- in cases in which normal treatment might not be warranted, the researchers said.

More than 60 percent of the doctors who answered the survey published in the British Medical Journal said that prescribing a placebo is ethically permissible.

But such actions run afoul of standards set by the American Medical Association, which asserts it is unethical to use placebo therapy on patients without clearly telling them.

"Nobody's really asked American doctors in a systematic way what they they think about placebos," said researcher Dr. Jon Tilburt of the Mayo Clinic in Rochester, Minnesota, who worked at the National Institutes of Health when the survey was done.

"There was probably a time in medicine when (doctors) were using these more routinely in perhaps a more paternalistic era. I think there remains this general impulse among physicians to want to help and to promote the healing that comes from psychological expectations," Tilburt said in a telephone interview.

Doctors who prescribed placebos only rarely provided the sugar pills that most people think of as a placebo. More often they said they prescribed relatively harmless substances such as vitamins and over-the-counter pain relievers.

But 13 percent of doctors who reported prescribing a placebo said they gave patients a sedative, and an equal percentage said they prescribed an antibiotic. Tilburt said those have particular ethical concerns -- sedatives due to side effects and antibiotics because their overuse has fueled the rise of germs that defy antibiotic treatment.

The placebo has an important place in medical research. To test how well a given drug works, one group of patients in a clinical study may get the drug while another group gets an inert placebo such as a sugar pill to see if the drug provides comparative benefits.

But studies also have shown that giving a patient a placebo sometimes triggers true health improvements inspired by a patient's expectations that a treatment may help them.

The AMA, the largest U.S. doctors' group, said doctors may use placebos in treatment only if the patient is informed and agrees to it.

"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," an AMA ethics panel said in 2006.

"A placebo must not be given merely to mollify a difficult patient, because doing so serves the convenience of the physician more than it promotes the patient's welfare."

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