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Thursday, April 12, 2012

Should Doctors Prescribe Placebos?

By Roy Benaroch, MD

Pill

There was a recent post on one of the WebMD boards about a child suffering from abdominal pains. From the details provided, it was pretty clear that there wasn’t anything seriously wrong with the child, but these belly aches were causing a lot of worry and missed school, and the child wasn’t feeling good at all. Then someone suggested a product that was obviously a placebo. And it worked! The child felt better! So what’s wrong with that?

A placebo can be any medical intervention—a pill, a “brain scan”, any sort of treatment at all—that doesn’t have any biologic effect. We commonly describe them as “sugar pills” or “sham treatment.” In giving the placebo, there’s always an element of dishonestly. The person receiving the placebo has to believe it will work.

And they do, indeed, work. As illustrated in this brief video, placebos can very powerfully reduce symptoms. Studies have confirmed that placebos can drastically and consistently reduce pain, anxiety, and blood pressure; they can even improve diabetes control, help treat ear and sinus infections, improve school performance, and improve the confidence and performance of public speakers. Ever hear the story of the magic ballet slippers? A young ballerina performs brilliantly when she thinks her shoes are enchanted. That’s a great example of how placebos can really work.

But doctors aren’t supposed to prescribe placebos. Doing so is considered deceitful, and we’re supposed to be honest with patients about the risks and benefits or treatment decisions. Of course, if we’re entirely honest about a placebo, it won’t work.

Here’s a secret, though: doctors do indeed prescribe placebos, every day. Whether knowingly or not, doctors suggest and prescribe things to patients that have been proven to be essentially placebos—that is, to work only as well as a sugar pill. That antibiotic for bronchitis? Placebo. Often physical therapy, or antacid medicines, or pain medicine, or medicine to help you sleep—for almost all of these, the “effect” is only a little bit better than a placebo, though they’re all more effective than doing nothing. In other words, most of the effectiveness of many medical treatments is your own mind deciding that you feel better, encouraging you to act more healthy.

True placebos are, mostly, harmless. By their very nature, they have no biologic effect and can’t harm your body. The harm they can do is in developing habits and expectations—people used to “medicines” to treat problems, whether they’re “real” or “placebos”, are far more likely to keep returning to the doctor and health food store for remedies. It can add up to a lot of money. At other times, placebos are chosen rather than a potentially more-effective therapy, which can delay or prevent a cure. Plus, many of the doctor’s placebos, though ineffective, are still genuine medicines that have genuine side effects. For this last reason, homeopathic and alternative-medicine placebos are at least somewhat less harmful than the doctor’s medicine placebos.

So, should doctors prescribe placebos or not? Certainly not, if there is a genuinely effective and safe medicine that will help. Certainly not, if the placebo itself is a medicine that can cause harm. But what about a truly harmless placebo for a condition that otherwise doesn’t have an easy or effective treatment? What if the placebo can really help alleviate pain and suffering? These are good questions, and ones that thoughtful doctors and patients ought to be asking themselves.

Have you ever taken a placebo? Would you be upset if you found out your doctor had prescribed one? Share your thoughts in the comments below.

Photo: iStockphoto

Posted by: Roy Benaroch, MD, FAAP at 9:39 am

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