Placebos commonly prescribed, survey says

The "placebo effect" is one of the more fascinating phenomena blurring the mind-body divide: If you think a pill will help you, it will.

A survey of American internists and rheumatologists reveals that about half of the doctors who responded think it is ethically permissible to use this kind of magical thinking to help patients, according to an article in the British Medical Journal whose authors include Ted J. Kaptchuk of Harvard Medical School. The survey was developed and implemented by the Center for Survey Research at the University of Massachusetts-Boston.

A little more than half of the 679 doctors said they regularly prescribed drugs just for their positive psychological effects, not their physiological properties. The list of treatments using this definition included over-the-counter painkillers and vitamins and, to a lesser degree, antibiotics and sedatives.

Few said they used the classic sugar or salt pill placebos commonplace until about 1960, after which better drugs and stricter insistence on informed consent relegated them to the sidelines.

Only 5 percent of the doctors, who were polled in a mailed survey last year, told their patients they were getting placebos. Instead, the doctors told them they were prescribing potentially beneficial medications not typically used for their conditions.

Most said they thought this practice was ethically permissible, the authors write, suggesting that the doctors may have felt the need to offer their patients something in the absence of other effective treatments. Internists and rheumatologists were chosen for the survey because they commonly treat patients with difficult, debilitating chronic conditions.

The survey did not ask the doctors about their motivations, the authors say.

"Whether, or under what circumstances, recommending or prescribing placebo treatments is appropriate remains a topic for ethical and policy debates," they write.

The study was funded by the National Center for Complementary and Alternative Medicine and the Department of Bioethics in the National Institutes of Health.