About half the US physicians polled in a recent survey regularly prescribe placebos and most believe the practice is ethical, according to a report in the British Medical Journal.
The placebo effect refers to perceived clinical improvement caused by an inert substance such as a sugar pill or salt water, or one that has no impact on the condition for which it is prescribed. Since the 1960s, many clinicians and ethicists have frowned on placebo therapy because it involves deception and thus disregards principles of informed consent and patient autonomy. Others disagree, noting that placebos can be the most effective treatment for certain conditions, and they can be administered without deception.
In the BMJ study, scientists surveyed 600 internists and 600 rheumatologists they had randomly selected from the American Medical Association master files. 46-58% (depending upon how the question was worded) reported using placebos regularly. The most common placebos were over-the-counter analgesics (41%) and vitamins (38%). Thirteen percent used antibiotics and sedatives as placebos.
Physicians typically told patients the placebos were potentially beneficial interventions, but not for the patients’ particular condition. In only 5% of cases did physicians explicitly describe the treatment as a placebo.
Pizaazz has no problem with physicians who prescribe benign treatments that foster a positive expectation for clinical improvement. But antibiotics and sedatives are not benign, vitamins present opportunities for overdose and OTC analgesics can cause side-effects, sometimes severe. Physicians prescribing the latter two as placebos would be wise not to forget.