A study just published in the British Medical Journal (full disclosure: I haven’t read it, only seen wire service reports of it, but I have absolute confidence it is true — or, more accurately, I’d say it accords 100% with my prior beliefs so I’d have no reason to question it), says that US doctors routinely prescribe drugs purely for their placebo effect, believing they have no other substantive efficacy:
Almost half of the rheumatologists and internists surveyed said they prescribed pills whose benefits derive from “positive patient expectations” two to three times a month, Jon Tilburt from the National Institutes of Health in the U.S. said in a study published today in the British Medical Journal.
Tilburt and colleagues from the NIH and scientists from Harvard Medical School and the University of Chicago surveyed 1,200 internal medicine physicians and rheumatologists, doctors who commonly treat patients with chronic conditions that are difficult to manage.
Of the 57 percent of physicians who responded to the confidential survey, 61 percent said they believe it is ethically acceptable or even obligatory to recommend or prescribe placebo treatments.
Forty-one percent of the doctors prescribed over-the-counter painkillers and 38 percent prescribed vitamins. Thirteen percent used antibiotics and sedatives.
Only 2 percent of the doctors used actual sugar pills and 3 percent used salt water-based treatments. (Chantal Britt, Bloomberg)
There are some ethical tangles here regarding deliberate deception. I’ll leave that to the bioethicists. What has always interested me about placebos is that in study after study they work. It’s not just beneficial effects, either. Placebo drugs have been shown to have a higher rate of headache, nausea and dizziness. If they had absolutely no effect at all then it wouldn’t be necessary to have placebo controlled drug trials. We could just give the drug and compare it to no treatment at all.
In my father’s time (60 years ago) a large injection with a big syringe of red vitamin B12 was a common placebo treatment. Vitamin B12 is a real vitamin, good for you if you don’t have enough of it. Beyond that it is just a syringe full of red liquid. And indeed the BMJ authors observe that doctors engaged in this practice still prefer “active placebo treatments” rather than inert agents. One reason is that you can’t write a prescription for a sugar pill and there is no official and marketed placebo agent.
One explanation may be that placebos work best when both the patient and the doctor believe they work (even if for different reasons). I suspect that an awful lot of things we doctors do for patients is really placebo medicine. It’s just both doctor and patient (falsely) believe they are effective. But writing prescriptions for things that have biological activity like antibiotics or sedatives is problematic if there is no expectation they will have any benefit for what ails the patient. And let’s face it. Lots of doctors write prescriptions to please the patient, or more accurately, to keep the patient’s business.
Some people are probably helped. But an awful lot more aren’t. The chief beneficiaries are the drug and insurance companies.