Are You Getting Placebos from Your Doctor?

The New York Times (NYT) reports that according to a national survey, the majority of doctors routinely prescribes placebos to patients, depending on how the question is presented. (Read the article here) Are you being lied to? Apparently, that would depend on your definition of "placebo".

Generally, a placebo would be defined as an inert substance (one that has no effect on the patient), such as a sugar pill. If your doctor was giving you these, it would be easy enough to tell, as usually sugar pills are just referred to by the fancier name "dextrose". Any doctor recommending these would have to let you know that they are unlikely to have a physical effect, to stay on the 100% ethical side. This kind of treatment would come up for conditions that can have psychosomatic origins, such as fatigue or certain pains. The idea is that the patient may get relief just from feeling like they are doing something to get better, but the medical community has an ongoing debate about the efficacy of a placebo when subjects are forewarned that it's not real medicine.

Two ethical arguments create gray areas around the use of "placebos" in medical practice. One is that some doctors surveyed said they prescribed vitamins, headache pills, antibiotics, and even sedatives to patients with conditions not immediately treated by those methods. Though only 5% of doctors described these as "placebos", they admit their intention was to treat the patient's psyche, not the illness. When a doctor tells you that what they are prescribing you is "not commonly used to treat your condition", they may be using a drug "off label" (in which case it likely will have effect), but if the prescription is for something like strong vitamins, you may be getting the placebo treatment. It's unlikely that you would suffer harm from this practice, but as a patient you have the right (and responsibility) to understand your treatment. If you believe you're not getting real treatment, do some research on your prescription and ask educated questions at your follow-up.

The counterbalancing ethical issue is that in some cases, placebos are almost as effective as "real" medications. Consider antidepressants: placebos help 30-40% of patients, almost as many as the real thing. Given the health risks associated with anti-depressants, it's not hard to understand why a doctor might try to treat milder cases with safer methods.

As with any matter of ethics, there is no black-and-white, right-or-wrong rule. For the most part, our health lies in our physician's hands and we must allow ourselves to trust them, but we are still responsible for staying educated about our treatment. Ask questions (politely), and do your research (with humility). Doctors are not as deceitful as the NYT would have you believe. The original study, published by the British Medical Journal (and available at bmj.com), doesn't imply that the majority of doctors "routinely" prescribes placebos. Rather, it seems that the majority prescribes these gray-area placebos (such as vitamins) 3-4 times a month, when it appears the best course of action (be it because there is no better alternative, a difficult patient, etc). When you consider that the average doctor will see hundreds of patients a month, using "placebos" 3-4 times hardly seems "routine".

While the BMJ survey should make us aware that our prescriptions aren't always intended to directly treat our conditions, there seems to be little reason to become overly worried that our doctors are giving us placebos. Firstly, their use appears limited. Secondly, you'll know if you're being given vitamins or sugar pills instead of anti-depressants. Lastly, you can ask questions and you may learn that what the NYT calls "placebos" may really be the best option for you at the time.