The use of placebos in medical practice

The ethics of prescribing placebos in medical practice is highly debated. Some practitioners argue that the use of placebos is sometimes justified because it will do no harm and may do some good. With the publication of studies by Hróbjartsson and Götzsche and others, the proposition that placebos may do some good is under fire. A placebo, from the Latin for I will please, is a medical treatment (operation, therapy, chemical solution, pill, etc.

A study of Danish general practitioners found that 48% had prescribed a placebo at least 10 times in the past year. The most frequently prescribed placebos were antibiotics for viral infections. and vitamins for fatigue. Specialists and hospital-based physicians reported much lower rates of placebo use. (Hrobjartsson 2003) A 2004 study in the British Medical Journal of physicians in Israel found that 60% used placebos in their medical practice, most commonly to "fend off" requests for unjustified medications or to calm a patient. Of the physicians who reported using placebos, only 15% told their patients they were receiving placebos or non-specific medications. (Nitzan 2004) An accompanying editorial stated, An antibiotic is a drug that kills or slows the growth of bacteria. Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845.

"The placebo effect, thought of as the result of the inert pill, can be better understood as an effect of the relationship between doctor and patient. Adding the doctor's caring to medical care affects the patient's experience of treatment, reduces pain, and may affect outcome. This survey makes it clear that doctors continue to use placebos, and most think they help."

The editorial suggested there were problems with Hróbjartsson and Götzsche's methods and argued that their results show that placebos can't cure everything, but don't prove that the placebo effect cures nothing. The editorial concluded, "We cannot afford to dispense with any treatment that works, even if we are not certain how it does." (Spiegel 2004)

The editorial prompted responses on both sides of the issue. [1]

Critics of the practice responded that it is unethical to prescribe treatments that don't work, and that telling a patient that a placebo is a real medication is deceptive and harms the doctor-patient relationship in the long run. Critics also argued that using placebos can delay the proper diagnosis and treatment of serious medical conditions. Defenders of the use of placebos suggested that placebos do not work in clinical trials because the subjects know they might be getting a placebo, but do work in medical practice where the patient believes she is getting an active drug. Other writers pointed to the empirical data showing that placebos can have measurable biological effects, especially in pain relief (see above), or argued that the use of a placebo to "please the patient" fosters real healing as part of a caring doctor-patient relationship. (Barfod 2005, Di Blasi 2005)

About 25% of physicians in both the Danish and Israeli studies used placebos as a diagnostic tool to determine if a patient's symptoms were real, or if the patient was malingering. Both the critics and defenders of the medical use of placebos agreed that this was unethical. The BMJ editorial said, "That a patient gets pain relief from a placebo does not imply that the pain is not real or organic in origin. the use of the placebo for 'diagnosis' of whether or not pain is real is misguided." In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. Empirical is an adjective often used in conjunction with science, both the natural and social sciences, which means an observation or experiment based upon experience that is capable of being verified or disproved. Malingering is a psychological term that refers to an individual faking the symptoms of mental or physical disorders. The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845.

The placebo effect is an active area of research and discussion and it is possible that a clear consensus regarding the use of placebos in medical practice will emerge in the future.

There is general agreement that placebo control groups are an important tool for controlling for several types of possible bias. including the placebo effect, in double blind clinical trials. From Latin ex - + - periri (akin to periculum attempt). A bias is a prejudice in a general or specific sense, usually in the sense for having a preference to one particular point of view or ideological perspective. The Double blind method is an important part of the scientific method, used to prevent research outcomes from being influenced by the placebo effect or observer bias. In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study.