Prescribing "placebo treatments": results of national survey of US internists and rheumatologists

doi:10.1136/bmj.a1938

Published 23 October 2008, doi:10.1136/bmj.a1938
Cite this as: BMJ 2008;337:a1938

Research

Prescribing "placebo treatments": results of national survey of US internists and rheumatologists

Jon C Tilburt, staff scientist¹, Ezekiel J Emanuel, director¹, Ted J Kaptchuk, associate director², Farr A Curlin, assistant professor of medicine³, Franklin G Miller, director, research ethics programme¹

¹ Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA , ² Osher Institute, Harvard Medical School, 401 Park Dr, Boston, MA 02215, ³ Section of Internal Medicine and the McClean Center for Clinical Medical Ethics, University of Chicago, 5841 S Maryland Ave, MC 2007 Chicago, IL 60637

Correspondence to: J Tilburt tilburt.jon{at}mayo.edu

Objective To describe the attitudes and behaviours regardingplacebo treatments, defined as a treatment whose benefits derivefrom positive patient expectations and not from the physiologicalmechanism of the treatment itself.

Design Cross sectional mailed survey.

Setting Physicians’ clinical practices.

Participants 1200 practising internists and rheumatologistsin the United States.

Main outcome measures Investigators measured physicians’self reported behaviours and attitudes concerning the use ofplacebo treatments, including measures of whether they woulduse or had recommended a "placebo treatment," their ethicaljudgments about the practice, what they recommended as placebotreatments, and how they typically communicate with patientsabout the practice.

Results 679 physicians (57%) responded to the survey. Abouthalf of the surveyed internists and rheumatologists reportedprescribing placebo treatments on a regular basis (46-58%, dependingon how the question was phrased). Most physicians (399, 62%)believed the practice to be ethically permissible. Few reportedusing saline (18, 3%) or sugar pills (12, 2%) as placebo treatments,while large proportions reported using over the counter analgesics(267, 41%) and vitamins (243, 38%) as placebo treatments withinthe past year. A small but notable proportion of physiciansreported using antibiotics (86, 13%) and sedatives (86, 13%)as placebo treatments during the same period. Furthermore, physicianswho use placebo treatments most commonly describe them to patientsas a potentially beneficial medicine or treatment not typicallyused for their condition (241, 68%); only rarely do they explicitlydescribe them as placebos (18, 5%).

Conclusions Prescribing placebo treatments seems to be commonand is viewed as ethically permissible among the surveyed USinternists and rheumatologists. Vitamins and over the counteranalgesics are the most commonly used treatments. Physiciansmight not be fully transparent with their patients about theuse of placebos and might have mixed motivations for recommendingsuch treatments.

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