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US doctors regularly prescribe real drugs as placebo treatments

Many rheumatologists and general internal medicine physicians in the US say they regularly prescribe “placebo treatments", but rarely admit they are doing so to their patients, according to a study on today.

The use of placebo treatments in clinical practice has been widely criticised because it is claimed that the practice by its very nature is deceptive and violates patients' autonomy. But advocates of placebo treatments argue that they could offer effective treatment for many chronic conditions without necessarily deceiving patients.

Dr Jon Tilburt and his colleagues from the National Institutes of Health, as well as collaborators at Harvard and the University of Chicago, examined the attitudes and behaviours to placebo treatments in a national sample of general internal medicine physicians and rheumatologists in the US.

The researchers sent a confidential survey to 1,200 randomly selected practising general internal medicine physicians and rheumatologists (a group of doctors who commonly treat patients with debilitating chronic conditions that are notoriously difficult to manage medically).

The most commonly used placebo treatments prescribed in the past year were over-the-counter painkillers (41%) or vitamins (38%). Some of the physicians reported using antibiotics (13%) and sedatives (13%) as placebos, only 3% reported using sugar pills.    

Interestingly, among those who prescribed placebo treatments, most doctors (68%) said they typically describe the placebo treatments to their patients as “a potentially beneficial medicine or treatment not typically used for their condition”. Only rarely did they admit to explicitly describing them to patients as “placebos”.

The authors say that while the use of placebos has been controversial, the physicians in the study did not believe they were behaving unethically by either using placebos or not being upfront with their patients about doing so.