Placebos are important for medical research. In order to determine if a certain pharmaceutical is effective, researchers compare medical outcomes between one group given the drug and another given a placebo.
But should physicians give placebos to patients outside of clinical trials? The Economist magazine reports (“Great Expectations“) on the phenomenon that many physicians are giving placebos as treatment to patients. A study in the British Medical Journal by Jon Tilburt of the Mayo Clinic finds that 57% of practicing internists prescribed placebos on a regular basis. Few docs actually prescribe sugar pills, but 40% prescribed painkillers or vitamins as placebos. This may seem odd since Asbjorn Hrobjartsson and Peter Gotzsche (NEJM 2001) concluded that “outside the setting of clinical trials, there is no justification for the use of placebos”.
Why would doctors prescribe these placebos? One reason is to get rid of nagging patients. Many patients want a doctor to “do something.” If the physician is not sure what the patient’s actual illness is or they believe that the patient is imagining their illness, a placebo appease the patients desire for treatment. The second reason is that placebos may actually work.
A study “…co-authored by Dr Benedetti and published in Nature, made the striking observation that telling a patient a painkiller is being injected into him, when the injection is actually a saline solution, is as potent as covertly giving him 6mg to 8mg of morphine. This is slightly below the standard post-operative dose of 10mg to 12mg, but the covert dose had to be increased to the full 12mg to surpass the effect of the placebo.”
Should doctors continue to “deceive” patients by using painkillers or sedatives as placebos even if this treatment is effective?
- Jon C Tilburt, Ezekiel J Emanuel, Ted J Kaptchuk, Farr A Curlin, Franklin G Miller. “Prescribing ‘placebo treatments’: results of national survey of US internists and rheumatologists” BMJ 2008;337:a1938.
- Asbjorn Hrobjartsson and Peter C. Gotzsche (2001) “Is the Placebo Powerless?— An Analysis of Clinical Trials Comparing Placebo with No Treatment” NEJM, Volume 344:1594-1602.