A medical student and a professor of family medicine at the University of Chicago recently found that almost half of the physicians who responded to a survey say they've prescribed a placebo. I find that alarming. Does my provider believe in the power of placebo? Has she prescribed one for me?
The study by Rachel Sherman and John Hickner is published in the January issue of the Journal of General Internal Medicine (Academic physicians use placebos in clinical practice and believe in the mind-body connection. J Gen Intern Med. 23). That issue is not yet available online, but several news articles report the details.
The researchers surveyed physicians at 466 Chicago-area academic medical centers. Of the 231 who responded, 45% said they'd prescribed a placebo; 12% said they never would. Respondents chose from among definitions of "placebo," with "an intervention not expected to have an effect through a known or specific physiologic mechanism" as the definition most commonly selected.
Here's how the physicians presented the sham treatment to their patients:
- 34% told the patient the placebo was "a substance that may help and will not hurt"
- 19% said "it is medication"
- 4% said "it is a placebo"
The first two sound slippery (akin to "depends on what the definition of ‘is' is"), and the last sounds like it relies on a trusting patient with a limited vocabulary.
Prescribing placebos, of course, raises ethical concerns, primarily the issue of informed consent. Presumably, a placebo wouldn't work if the patient knew that there was no reason it should work. But doesn't prescribing a placebo also imply that the provider is withholding information about the patient's condition? Does the provider think the patient is faking his symptoms? Is the provider throwing up her hands because she believes there are no effective treatments left to try?
That's my reaction as a patient. The study addressed physician behavior. What about nurse practitioners? Would you ever prescribe a placebo?