Kaiser Daily Health Policy Report

Friday, January 04, 2008
http://www.kaisernetwork.org/daily_r...fm?DR_ID=49664

Prescription Drugs

Many Physicians Prescribe Placebos to Patients, Study Finds

About 45% of physicians at three U.S. medical schools in the Chicago area have prescribed placebos to patients, and 96% believe that patients can benefit from placebos, according to a study published on Thursday in the Journal of General Internal Medicine, Bloomberg/Arizona Daily Star reports (Bloomberg/Arizona Daily Star, 1/4). For the study, Rachel Sherman, a medical student at the University of Chicago, and John Hickner, a professor of family medicine at the university, sent a survey to 466 physicians at the University of Chicago, Northwestern University and University of Illinois-Chicago and received 231 responses (Steenhuysen, Reuters/Boston Globe, 1/4).

According to the survey, physicians said that placebos can help calm patients, supplement other medications, control pain, satisfy unnecessary requests for treatments and address complaints from patients. Only 12% of respondents said that physicians should never prescribe placebos to patients, the survey found (Ritter, Chicago Sun-Times, 1/4).

The use of placebos raises ethical concerns because many physicians do not inform patients that their prescriptions likely would not have any physical effects, study authors said. About 34% of respondents who have prescribed placebos described them as substances that "may help and will not hurt," compared with 19% who described them as medications and 4% who described them as placebos, the survey found (Bloomberg/Arizona Daily Star, 1/4).

In addition, about 48% of respondents said that they prescribe medications to patients without any evidence of likely effectiveness, according to the survey (Chicago Sun-Times, 1/4).

Comments
Sherman said, "It's not about what's inside the pill, it's about using the pill as a symbol of healing," adding, "The division between mind and body is no longer being seen as distinct, and doctors believe that how patients think and feel can influence health" (Bloomberg/Arizona Daily Star, 1/4). She added, "We may underestimate the body's natural healing potential," adding, "This shows that doctors may think that, too" (Reuters/Boston Globe, 1/4).

The American Medical Association recommends that physicians prescribe placebos only with the informed consent of patients and not "merely to mollify a difficult patient" (Chicago Sun-Times, 1/4).

Placebo Prescribing By Internists

06 Jan 2008
http://www.medicalnewstoday.com/articles/93044.php

In the first study examining American physicians' use of placebos in clinical practice in the 21st Century, 45 percent of Chicago internists report they have used a placebo at some time during their clinical practice researchers report in the January issue of Journal of General Internal Medicine.

This study indicates a need for greater recognition of the use of placebos and unproven therapies and discussion about its implications," say the study authors, Rachel Sherman, a fourth year medical student at the University of Chicago's Pritzker School of Medicine, and John Hickner, MD, MSc, professor of family medicine, at the University of Chicago and University of Chicago Medical Center.

The authors sent questionnaires inquiring about placebo use to 466 internists at the University of Chicago, Northwestern University, and University of Illinois - Chicago. Fifty percent (231) of the physicians responded.

"Placebos have been used in medicine since ancient times, and remain both clinically relevant and philosophically interesting. In addition to their recognized use as controls in clinical trials, this study suggests that placebos themselves are viewed as therapeutic tools in medical practice," says Sherman.

Of the respondents who reported using placebos in clinical practice, 34 percent introduced the placebos to the patient as "a substance that may help and will not hurt." Nineteen percent said, "it is medication," and nine percent said, "it is medicine with no specific effect." Only four percent of the physicians explicitly said, "it is a placebo." In addition, 33 percent of the physicians reported they gave other information to patients, including, "this may help you but I am not sure how it works."

Only 12 percent of respondents said that placebo use should be categorically prohibited. The authors write that in the broader ethics literature, the routine use of placebos is controversial. Some commentators on informed consent and non-deceptive therapeutics caution against the use of placebos in medical practice. Others propose that the placebo effect can be harnessed in various therapeutic contexts that do not pose ethical dilemmas.

In addition, the authors say a growing number of physicians believe in mind-body connection; which means what a person thinks can impact the health and well-being of the body. Rather than using placebos to differentiate between patients who were faking their symptoms and those with genuine symptoms, as the majority of physicians did according to research several decades ago, 96 percent of physicians in this study believed placebos can have therapeutic benefits for patients.

The physicians most commonly defined a placebo as an intervention not expected to have an effect through a known or specific physiologic mechanism. Researchers then asked physicians about the possible benefits of other treatment and factors that may influence health according to this definition of a placebo.

Physicians responded to questions about whether there might be psychological or physiological benefits to meditation, yoga, or relaxation techniques; biofeedback; prayer or spirituality; a good social support system; having good doctor-patient rapport, and interior design of the healthcare environment. In most cases, the majority of physicians believed in both psychological and physiological benefits.

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Article adapted by Medical News Today from original press release.
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Source: Scot Roskelley
University of Chicago Medical Center