Ethics

Rates of Clinical Placebo Administration in the US

By Adam Kolber

A study that was just published in BMJ reveals that doctors (specifically, internists and rheumatologists) in the United States prescribe placebos at a surprisingly high rate.  In brief, within the preceding year, roughly 3% of the doctors who responded reported using pure placebos like sugar pills while roughly 40% reported using placebos like over-the-counter analgesics or vitamins (sometimes called impure placebos or active placebos when they are prescribed solely in order to generate a placebo effect).

As I see it, physicians often use active placebos instead of pure placebos because their easier to obtain, and they make it harder for patients to detect the deception.  Ironically, however, using active placebos for such purposes may actually be worse for patients, as active placebos carry more risks of side effects than pure placebos.  (Yes, pure placebos can have side effects, too, sometimes called nocebo effects.)

In this article, I provide a limited defense of clinical placebo deception.  Though I wrote it without the benefit of this recent study (and another recent study by Sherman and Hickner), it was nevertheless clear to me that active placebos are prescribed quite frequently.  In the article, I take issue with a recent AMA policy that categorically prohibits doctors from administering placebos deceptively.  Apparently, based on the implications of their answers to the study discussed here, doctors are not very keen on the AMA provision either.

The New York Times reports on the BMJ study here.

Full post as published by Neuroethics and Law on October 24, 2008 (boomark / email).