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Placebo Effect: New Survey Gives Life to Ethical Debate
Rita Rubin, USA TODAY
December 11, 2008
A nationwide survey this year suggested that as many as half of U.S. doctors prescribe a fake treatment — or placebo — at least once a month. Adam Kolber suspects that his dermatologist is one.
Kolber visited the doctor because after his bug bites had faded, the itching didn’t. The dermatologist proffered a small bottle of lotion and said it ought to provide relief. He didn’t explain why, Kolber recalls.
Sure enough, the itching stopped after he applied the lotion, and Kolber, a law professor who has written about placebos, suspects that the doctor’s assurance of relief, not any ingredient in the lotion, is what scratched his itch.
“Something like itching has a very strong psychological component,” Kolber says.
Doctors have known about the placebo effect, a product of the interaction between mind and body, for decades. They’ve seen patients’ discomfort diminish after taking a sugar pill or getting an injection of saltwater. Placebos work only as long as patients don’t know they’re fake, research suggests. But is it ethical for doctors to deceive patients by not telling them?
The American Medical Association says no, but the survey found that one in 20 doctors who prescribed placebos explicitly described them as such to patients. The survey, which was published in the journal BMJ in October, has helped fuel debate about whether their potential to make patients feel better outweighs doctors’ responsibility to be truthful.
In addition, the survey found that most doctors who prescribed placebos, no longer able to obtain innocuous sugar pills, actually were using real drugs not proven effective in treating patients’ complaints. These “impure placebos,” such as antibiotics and sedatives, could be doing more harm than good.
“Until 1960, a physician in any hospital in the United States could order a placebo,” says Harvard scientist Ted Kaptchuk, who has long studied the placebo effect and co-wrote the report about the doctor survey. Doctors even could specify what color sugar pill they wanted, he says.
“It was routine care until really the end of the ’60s,” when the civil rights revolution led to an increased emphasis on patient autonomy and informed consent. Increasingly, effective treatments became available, which reduced doctors’ reliance on placebos.
Today, the only sugar pill on the market is cherry-flavored Obecalp (spell it backward), which is aimed at children. (Some critics wonder whether parents who dispense Obecalp might be contributing to a whole new generation of pill-poppers.)
For clinical trials only, drug companies make placebos that look identical to their products, so neither the researchers nor the participants know who’s getting a placebo and who’s getting the real thing.
Studies have shown repeatedly that placebos are effective in treating health complaints with a strong psychological component, such as pain, depression, constipation and erectile dysfunction.
“The more vague the complaint, the more room for the mind to affect perception,” Kaptchuk says. Placebos can’t cure cancer — “the mind has power, but it’s not a superpower”— but given the right setting and the right complaint, they might work as well as proven drugs, he says.
