Ethics

Placebo Deception of Children

By Adam Kolber

Today's New York Times has an article about a company that is marketing placebos, intended to be deceptively administered to children:

With the help of her husband, Dennis, she founded a placebo company, and, without a hint of irony, named it Efficacy Brands. Its chewable, cherry-flavored dextrose tablets, Obecalp, for placebo spelled backward, goes on sale on June 1 at the Efficacy Brands Web site. Bottles of 50 tablets will sell for $5.95. The Buettners have plans for a liquid version, too.

Because they contain no active drug, the pills will not be sold as a drug under Food and Drug Administration rules. They will be marketed as dietary supplements, meaning they can be sold at groceries, drugstores and discount stores without a prescription.

?This is designed to have the texture and taste of actual medicine so it will trick kids into thinking that they?re taking something,? Ms. Buettner said. ?Then their brain takes over, and they say, ?Oh, I feel better.? ?

I don't know whether this is a good use of placebos or not.  The pills likely will make some kids feel better.  They may also increase their need for medical interventions, even when kids might be better off developing some tolerance for life's minor aches and pains.  The same is true, of course, for drugs like aspirin.  Clearly, there are costs and benefits of placebo deception.  I do believe that the issue can be studied scientifically and that we would be better off doing so than merely speculating about the effects of deceptive placebo administration.

In 2006, the American Medical Association amended its code of ethics to categorically prohibit doctors from deceptively administering placebos.  Thus, if a doctor were to give "Obecalp" to a patient, he or she would be violating the profession's code of ethics and would face increased risk of a malpractice lawsuit and of disciplinary sanctions.  Moreover, the doctor is likely violating the code simply by recommending to parents of their pediatric patients that they occasionally use Obecalp.  Doctors may even be violating the code of ethics when using Obecalp on their own child.  The AMA prohibition only applies to "substances" administered in order to obtain placebo effects, so you can still do the "kiss it and make it better" routine with kids.  But the difference between Obecalp and the "kiss it and make it better" routine is arguably not so big.

Do you think that placebo deception is rare? Not so much.  Here's what I wrote in an earlier blog post:

While many people are aware that placebos are openly used in double-blind medical experiments, far fewer know that doctors sometimes surreptitiously give patients placebos in hospitals and medical offices.  Doctors may use pure placebos, like sugar pills and saline injections, as well as so-called impure placebos, conventional medications used in situations just to generate a placebo effect (e.g., antibiotics to treat viral infections or multivitamins to treat conditions that do not involve vitamin deficiencies).  So if a doctor prescribes an antidepressant just to generate a placebo effect, then the doctor has prescribed an impure placebo.

A recent survey of faculty physicians at Chicago-area medical schools found that almost half had used a placebo of one form or another in clinical practice and almost all believed that placebos can be therapeutic.  Only 12% believed that placebos should be categorically prohibited. 

Again, I don't know if the AMA's prohibition is so bad in the specific context of children and Obecalp.  But, I do believe that the AMA's categorical prohibition of placebo deception is overinclusive, insensitive to patient preferences, and likely to have unforeseen consequences.  There are times when placebos can be used appropriately--even if deceptively.  I discuss the issue in more detail in this article, recently published in the Yale Law & Policy Review.

Full post as published by Neuroethics and Law on May 27, 2008 (boomark / email).