Prescribing “placebo treatments”: Results of national survey of US internists and rheumatologists – Source: BMJ, Oct 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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