About Half of U.S. Physicians Surveyed Say They Routinely Prescribe Placebos, Study Finds

Between 46% and 58% of U.S. physicians regularly prescribe placebos to their patients, but only 5% of those physicians inform patients about the placebos, according to a survey published on Friday in BMJ, the Chicago Tribune reports. For the survey, researchers at NIH distributed questionnaires to 1,200 internists and rheumatologists nationwide (Graham, Chicago Tribune, 10/23). The Department of Bioethics and the National Center for Complementary and Alternative Medicine at NIH funded the study (Cheng, AP/Los Angeles Times, 10/24).

Among the 679 physicians who responded to the survey, about half said that they prescribed placebos to patients two to three times monthly, and more than 60% said that they consider the practice ethical (Reuters/Boston Globe, 10/24). Almost 70% of respondents said they described placebos to patients as "a potentially beneficial medicine not typically used for your condition," the survey found. Forty-one percent of respondents said that they used pain medications as placebos, 38% said that they used vitamins, 13% said that they used antibiotics, 13% said that they used sedatives, 3% said that they used saline injections and 2% said that they used sugar pills, according to the survey (AP/Los Angeles Times, 10/24).

Comments
Lead study author Jon Tilburt, who worked at NIH during the survey and currently works at the Mayo Clinic, said, "Nobody's really asked American doctors in a systematic way what they think about placebos," adding, "There was probably a time in medicine when (doctors) were using these more routinely in perhaps a more paternalistic era. I think there remains this general impulse among physicians to want to help and to promote the healing that comes from psychological expectations" (Reuters/Boston Globe, 10/24).

Ezekiel Emanuel, a study co-author and chair of the NIH bioethics department, said that, although physicians should not prescribe sedatives and antibiotics as placebos because those medications have risks, the use of other placebos is understandable. "Everyone comes out happy: the doctor is happy, the patient is happy," he said, adding, "But ethical challenges remain."

Franklin Miller, a study co-author and director of the research ethics program in the NIH bioethics department, raised concerns about the results of the survey. He said, "This is the doctor-patient relationship, and our expectations about being truthful about what's going on and about getting informed consent should give us pause about deception."

According to American Medical Association policy, in a "clinical setting, the use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient" (Harris, New York Times, 10/24).

An abstract of the survey is available online.

Broadcast Coverage
NBC's "Nightly News" on Thursday reported on the survey. The segment included comments from Emanuel (Bazell, "Nightly News," NBC, 10/23).

NPR's "Morning Edition" on Friday reported on the survey. The segment included comments from Emanuel; Howard Brody, an expert on placebos at the University of Texas Medical Branch; and Robert Sade, a surgeon from South Carolina and former chair of the AMA Council on Ethical and Judicial Affairs (Knox, "Morning Edition," NPR, 10/24).