Intended for healthcare professionals


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

BMJ 2008; 337 doi: (Published 23 October 2008) Cite this as: BMJ 2008;337:a1938

Placebos: trick or treat

Psychoanalysis teaches us that there are two kinds of thinking: primary process
and secondary process. Primary process is magical thinking characteristic of
children. Secondary process is rational thinking characteristic of adults. Since
we never really outgrow our childhood, we never fully give up our primary
process thinking. Ironically, education sometimes promotes primary process
thinking, rather than secondary process thinking. This happens in medical
education, in which medical students are taught that the use of placebos
promotes a sense of “healing” in the patient, and moreover, promotes a sense
of “success” in the physician. Sadly, a sugar pill is being used to “treat” both
patient and physician. Since health care is ostensibly based on science and
secondary process thinking, it’s time to dispense with placebos and to stop
dispensing them to patients.

Competing interests:
None declared

Competing interests: No competing interests

24 October 2008
Hugh Mann
Eagle Rock, MO 65641 USA