Are Placebos A Betrayal?




Drugs and Clinical Trials CategoryIn recent years, there’s been a resurgence of interest in placebos. Not the kind that are used to minimize bias in clinical trials, but the kind that doctors knowingly give to patients.

In a recent survey of more than 200 doctors practicing in academic medical centers, 45% reported that they had given placebos to patients in the course of providing clinical care. Nearly all the physicians surveyed agreed with the statement that “placebos have therapeutic effects,” and the condition for which they believed placebos offered the most psychological and physiological benefit was pain.

PlaceboThey endorsed a variety of suggested definitions for placebo substances: half agreed with the statement that placebos are interventions “that are not expected to have an effect through a known physiologic mechanism.” The primary reasons physicians used placebos were to calm patients (18% of the time) and as supplemental treatment (also 18% of the time). One of the particularly noteworthy things about this study is that 92% of the doctors believed that the mechanism of action of the placebo was psychological. They weren’t giving the placebos to anxious patients simply to shut them up; they were invoking a mechanism of healing — the mind-body connection — that they believed in, even though they couldn’t specifically identify how it operated.

This is a sea change from “old school” thinking about how placebos fit into clinical practice. In a 1979 study, a majority of academic physicians reported believing that the use of placebos helped expose patients who were “faking” their symptoms. In contrast, 80% of the doctors in the more recent survey disagreed with the notion that placebos can be used to identify symptoms that have a psychogenic origin.

All good news so far, but there’s more. Only 4% of the physicians told the patient that the substance they were receiving was a placebo. Most used vague statements like, “This may help and won’t hurt” or “It’s medicine with no specific effect.” Just over 10% of the doctors in the survey believed that the use of placebos should be categorically prohibited on ethical grounds.

I try to imagine how my internist, who I respect immensely, would respond. Would he use a ruse to invoke the healing power of my mind? He’s seen me through a number of minor crises over the last 15 years, and I can’t imagine a circumstance under which this wouldn’t feel like a betrayal. Is it just me? Are there circumstances under which you’d be glad to have your doctor deceive you if it made you feel better?

References

Sherman, R., Hickner, J. (2008). Academic Physicians Use Placebos in Clinical Practice and Believe in the Mind–Body Connection. Journal of General Internal Medicine, 23(1), 7-10. DOI: 10.1007/s11606-007-0332-z

Goodwin, J.S., Goodwin, J.M., Vogel, A.V. (1979). Knowledge and use of placebos by house officers and nurses. Ann Intern Med, 91(1), 106-110.

Jennifer Green, MS

Jennifer Green, MS, is a freelance health care writer. A former nurse and college professor, she now writes about health care for clients around the world. She's particularly interested in research into the mind-body connection.
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