About half of the American doctors responding to a nationwide survey say they regularly prescribe placebos to patients, according to a new study published in the British Medical Journal. Surveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.

Researchers from the U.S. National Institutes of Health conducted a nationwide survey which they received responses on from 679 doctors in the U.S. They were chosen randomly from a national list of doctors. The participants were addressed a series of questions, including: 1. If a clinical trial showed a sugar pill was better than no treatment for fibromyalgia, would you recommend sugar pills to fibromyalgia patients? 2. Do you ever actually recommend treatments primarily to enhance a patient's expectations? 3. In the last year, did you recommend a placebo treatment to a patient?

In response to these three questions included as part of the larger survey, about half reported recommending placebos regularly. Half of the doctors reported using placebos several times a month. Nearly 70 percent of those who did so described the treatment to their patients as “a potentially beneficial medicine not typically used for your condition but might benefit you.” Just 5% of the doctors actually revealed to the patients that the drugs were a placebo. 41% of doctors used painkillers, 38% used vitamins and 13% used either antibiotics or sedatives.

“It's a disturbing finding,” said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. “There is an element of deception here which is contrary to the principle of informed consent.”
The study’s authors said they believed the participants were representative of internists and rheumatologists across the U.S.

Placebos are inactive treatments or formulations; however a patient may experience either a positive or negative clinical effect while taking one. Controlled clinical trials have shown that placebos may have powerful effects. As an example, some 30 percent to 40 percent of depressed patients who are given placebos get better. Placebos have proved effective against hypertension, some heart ailments, gastric ulcers and other stomach complaints.
Originally, a placebo was a substance that a well-meaning doctor would give to a patient, telling him that it was a powerful drug when it was nothing more than a sugar pill. Any therapeutic effect of this substance is thought to be based on the power of suggestion.

The American Medical Association recommends doctors only use treatments to which patients have given their informed consent. The association clearly says that 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.

The U.S. research was paid for by the National Center for Complementary and Alternative Medicine and the Department of Bioethics at the National Institutes of Health.
“Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed U.S. internists and rheumatologists,” the study’s authors concluded.