Need for greater recognition of the use of placebos

Jan 4 2008

In the first study examining American physicians' use of placebos in clinical practice in the 21st Century, 45 percent of Chicago internists report they have used a placebo at some time during their clinical practice researchers report in the January issue of Journal of General Internal Medicine.

This study indicates a need for greater recognition of the use of placebos and unproven therapies and discussion about its implications," say the study authors, Rachel Sherman, a fourth year medical student at the University of Chicago's Pritzker School of Medicine, and John Hickner, MD, MSc, professor of family medicine, at the University of Chicago and University of Chicago Medical Center.

The authors sent questionnaires inquiring about placebo use to 466 internists at the University of Chicago, Northwestern University, and University of Illinois – Chicago. Fifty percent (231) of the physicians responded.

"Placebos have been used in medicine since ancient times, and remain both clinically relevant and philosophically interesting. In addition to their recognized use as controls in clinical trials, this study suggests that placebos themselves are viewed as therapeutic tools in medical practice," says Sherman.

Of the respondents who reported using placebos in clinical practice, 34 percent introduced the placebos to the patient as "a substance that may help and will not hurt." Nineteen percent said, "it is medication," and nine percent said, "it is medicine with no specific effect." Only four percent of the physicians explicitly said, "it is a placebo." In addition, 33 percent of the physicians reported they gave other information to patients, including, "this may help you but I am not sure how it works."

Only 12 percent of respondents said that placebo use should be categorically prohibited. The authors write that in the broader ethics literature, the routine use of placebos is controversial. Some commentators on informed consent and non-deceptive therapeutics caution against the use of placebos in medical practice. Others propose that the placebo effect can be harnessed in various therapeutic contexts that do not pose ethical dilemmas.

In addition, the authors say a growing number of physicians believe in mind-body connection; which means what a person thinks can impact the health and well-being of the body. Rather than using placebos to differentiate between patients who were faking their symptoms and those with genuine symptoms, as the majority of physicians did according to research several decades ago, 96 percent of physicians in this study believed placebos can have therapeutic benefits for patients.

The physicians most commonly defined a placebo as an intervention not expected to have an effect through a known or specific physiologic mechanism. Researchers then asked physicians about the possible benefits of other treatment and factors that may influence health according to this definition of a placebo.

Physicians responded to questions about whether there might be psychological or physiological benefits to meditation, yoga, or relaxation techniques; biofeedback; prayer or spirituality; a good social support system; having good doctor-patient rapport, and interior design of the healthcare environment. In most cases, the majority of physicians believed in both psychological and physiological benefits.