For Many Doctors, Placebos Are an Answer

Tuesday, October 28, 2008

You've heard of the placebo effect: the benefit that comes from believing that a drug or procedure will do you good. What you may not have heard is that many doctors prescribe supplements and drugs without telling patients there's no evidence that they are effective.

That's the finding of a confidential nationwide survey of internists and rheumatologists published last week in BMJ Online First.

Almost half of the 1,200 physicians randomly selected for the survey did not respond to it. Of the 679 who did send back the mailed questionnaire, half said they regularly prescribed placebo treatments.

That does not mean many doctors are handing out sugar pills (though a small percentage do), says National Institutes of Health staff scientist Jon C. Tilburt, the lead researcher. More often, a physician may advise a chronically ill patient who has run out of treatment options to try a certain vitamin or to take a Tylenol at bedtime. "The doctor may be thinking, 'I don't think the biochemistry is going to do anything with their illness,' " Tilburt says. But he or she prescribes the drug anyway in the hope that it will be psychologically beneficial.

Sixty-two percent of the physicians surveyed said they believed the practice to be ethical.

The researchers point out that promoting positive expectations by prescribing vitamins or over-the-counter painkillers is not necessarily cause for alarm; on the other hand, prescribing antibiotics and sedatives, as 13 percent of the doctors said they do, when there is no clear medical indication could have less than beneficial effects on patients and public health.

-- Frances Stead Sellers

© 2008 The Washington Post Company