- 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
- 1Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA
- 2Osher Institute, Harvard Medical School, 401 Park Dr, Boston, MA 02215
- 3Section 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
- Accepted 19 August 2008
Objective To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.
Design Cross sectional mailed survey.
Setting Physicians’ clinical practices.
Participants 1200 practising internists and rheumatologists in the United States.
Main outcome measures Investigators measured physicians’ self reported behaviours and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a “placebo treatment,” their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.
Results 679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using 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 within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).
Conclusions Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.
Development and implementation of the survey was performed by the Center for Survey Research, University of Massachusetts, Boston, MA. Statistical support was provided by Summit Consulting, LLC, Washington, DC.
Contributors: JCT devised the study items, analysed the data, and is guarantor. EJE assisted in devising survey items, gave critical feedback on design, and extensively revised the manuscript. TJK helped to draft the introduction and interpret data. FAC gave critical feedback on all aspects of design, analysis, and manuscript preparation. FGM drafted the introduction with TJK and was responsible for critical revisions of the discussion.
Funding: This work was supported by National Center for Complementary and Alternative Medicine (NCCAM) and the Department of Bioethics, National Institutes of Health, Bethesda, MD. NCCAM was not involved in data collection, analysis, or writing of the manuscript.
Competing interests: None declared.
Ethical approval: This study was approved by the University of Massachusetts Boston Institutional Review Board and the Offices of Human Subjects Research at the National Institutes of Health. Returned questionnaires were considered to indicate informed consent.
Provenance and peer review: Not commissioned; externally peer reviewed.
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