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Prescribing "placebo treatments": Results of national survey of US internists and rheumatologists – Source: BMJ, Oct 23, 2008

  [ 17 votes ]   [ 8 Comments ]
By Jon C Tilburt, et al. • • October 23, 2008

Prescribing Placebo Treatments[Note: Respondents were asked - assuming a clinical trial had indicated fibromyalgia patients receiving a sugar pill did better than those receiving no treatment - "to rate the likelihood of their personally recommending this treatment [sugar pills] to non-diabetic patients with Fibromyalgia…” The full text of this important article is available free at the BMJ website.]

Objective: To describe the attitudes and behaviors regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.

Design: Cross sectional mailed survey.

Setting: Physicians’ clinical practices.

Participants: 1,200 practicing internists and rheumatologists in the United States.

Main outcome measures: Investigators measured physicians’ self reported behaviors and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a "placebo treatment," their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.

Results: 679 physicians (57%) responded to the survey.

• About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased).

• Most physicians (399, 62%) believed the practice to be ethically permissible.

• Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments,

• While large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year.

• A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period.

• Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%);

• Only rarely do they explicitly describe them as placebos (18, 5%).

Conclusions: Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists.

Vitamins and over the counter analgesics are the most commonly used treatments.

Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.

Source: BMJ, Oct 23;337:a1938. doi:10.1136/bmj.a1938, by Tilburt JC, Emanuel EJ, Kaptchuk TJ, Curlin FA, Miller FG. Department of Bioethics, National Institutes of Health, Bethesda, Maryland; Osher Institute, Harvard Medical School, Boston, Massachusetts; Section of Internal Medicine and the McClean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA. [E-mail: J Tilburt]

[Note: See also "Half of Doctors Routinely Prescribe Placebos," by Gardiner Harris, Oct 23, 2008.]

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Article Comments Post a Comment

do no harm
Posted by: outofstep
Oct 26, 2008
This practice is unethical and should be illegal. It's disgraceful that a physician would give a placebo to a Fibromyalgia patient when there is FDA approved medication available specifically for that illness. If the only treatment that a dr. can come up with is a placebo, then they should refer the patient to another dr. who actually knows how to effectively treat the illness.
Reply Reply

This is a very sad thing to do how are fibro people suposed to believe in there doctor.
Posted by: KitCat40
Oct 28, 2008
Doctors that do not believe in Fibro or CF should not treat us. Patient could be getting the help they need by being refferd to other doctors that actually care about them and know what they are doing. Doctors like I have finnaly come across after years of suffering, and jumping from one none Fibro believing doctor to another. I finally found a doctor who took me seriously, and my whole life has turned around. I am getting the treatment I deserved in the beginning. I lost a lot from not getting the treatment I needed in the beginning of my search for wellness. I lost time with my husband and children. I was bed ridden and had to move out of my house because I could not longer take care of my family. Now that I have found a doctor that truly cares and is getting me the treatment I needed and deserved in the first place. I am getting to know my husband again, I am spending time with my children, and I am not bed-ridden anymore. Fibro is real and now they are finding proof in x-rays of patients brains. It is not in our minds. It is in our brain and our spinal cord. It is a nerve thing. It hurts and it is real! We don't have to suffer anymore if we believe in ourselves and don't have doctors taking advantage of us because they are clueless as what to do next. I will tell them what to do!!! Do some research the information about this illness is finally out there!!!! 0r, give us a refferal to a doctor that specialises in Fibromyalgia and Chronic Fatigue.
Reply Reply

The article is insulting and misleading
Posted by: TKerr
Oct 29, 2008
Why choose fibromyalgia for the study? It implies that fibromyalgia is not real and can be controlled with placebo. Over the counter analgesics, vitamins and antibiotics are not placebo treatments. They may not be totally effective but they can be helpful. In fact, since many fibromyalgics test positive for lyme and co-infections, antibiotics may be an effective treatment. More nonsense from the allopathic medical community.
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my opinion
Posted by: sundog
Oct 29, 2008
I have lost everything several times over. Not because of the illness but because of the attitude to medical professionals to me and their refusal to treat me as anything but a contemptible drug seeker. I have faced decades of it. Until I became an illegal drug user just to get relief and try to have a life I guess it some doctors like to gamble. By giving a patient a placebo they are gambling the patient doesn't find out. They are gambling that the patient is suggestible. If the patient is not suggestible the doctor then becomes the CAUSE of the suffering as much as the disease and even adds to the suffering They are gambling they will not face a law suit for causing pain and suffering. And the big one, they are gambling that on the day the patient finds out he/she is not suffering mood swings and rage from the illness. I will leave that one hanging.
Reply Reply

This is horrible.
Posted by: akandmk
Oct 29, 2008
These doctors should be sued for this. It sounds as though these idiot doctors were trying once again to prove that this is all in our head. And in the mean time those people who were recieving the placebos were suffering because they weren't really getting the medicines that they needed for pain and what not. God when will these stupid people finally get it? We are not faking and this isn't in our heads!
Reply Reply

NOT acceptable !
Posted by: Geddabear
Oct 29, 2008
This is just unbelievable.I feel very sorry for those people who have been treated with placebos this way. I would like to see any of my doctors try this one on me. Luckily I have 30 years nursing experience behind me and make sure doctors know it. This behaviour is in my opinion a major cop out. They should be ashamed, G
Reply Reply

This explains a lot. How discouraging.
Posted by: jenunsa
Nov 1, 2008
Well, this sure offers an explanation of how the rhuemies that I've gone to were a waste of time and completely useless. Going to a naturopath now. Also, confused about why antibiotics and OTC pain killers are considered placebos....? Those are actual medications. This article sounds misleading.
Reply Reply

When will they learn that they are playing with lives?
Posted by: gemm1291
Nov 5, 2008
I have been ill for 10 years and at points in the fight I have just wanted to lay down and give in......and knowing that some (in this study 679 out of 1200) doctors STILL think it is in our heads really very sad. Then to try and trick?? us into thinking that they care and giving us placebos.....I just hope they can live with themselves when someone (thinking they are being treated) gives up for good!!!!! Maybe that is what it will take to WAKE UP everyone to this VERY REAL illness. How many have just given up, HOW MANY???????
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