Perception, deception, and placebo power

Ever heard of obecalp? It's used to treat many conditions, from the flu to fibromyalgia. Although no one knows for sure how it works, more than half of doctors in a recent survey said they regularly give it to patients. So what is this mystery treatment? Spell it backwards and you may recognize its usual name: placebo.

Placebos are substances given to patients that don't have any specific effect on their illness. Doctors occasionally call placebos "obecalp" as a code name. Placebos can be inert substances, such as sugar pills or saline injections, or active treatments, such as vitamins, painkillers, or other medications.

Doctors may prescribe them if regular treatments haven't worked or if a patient has a condition that lacks good medical options. The hope is that patients will feel better if they take something. Any improvement is believed to come from the patient's expectation that the placebo will help them (this is known as the placebo effect).

Before 1960, placebo treatments were routinely used. However, with the development of better medications and a focus on patient consent, the use of placebos has fallen out of favor. Critics say treating patients with placebos raises ethical concerns. In the words of the American Medical Association (PDF download): "the use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient."

So it's surprising to learn that many doctors still routinely give placebos to patients, usually without their knowledge. Researchers sent 1,200 surveys to general internal medicine doctors and rheumatologists. Of the 679 doctors who responded, 6 in 10 said they thought placebo use was ethically acceptable and around half said they give placebos to patients.

Most doctors reported using "active" placebos, including over-the-counter painkillers (41 percent), antibiotics (13 percent) and sedatives (13 percent). This is troubling, say researchers, since misuse of some medications can be harmful, and overuse of antibiotics can lead to drug-resistant bacteria.

Among doctors using placebos, almost 70 percent told patients the treatment was a potentially beneficial medicine not typically used for their condition. Only 5 percent explicitly said it was a placebo.

What you need to know. The AMA recommends doctors follow this approach: Explain to patients that you would like to try different treatments, including a placebo, to better understand their medical condition. If the patient agrees to this, the physician isn't obliged to say which treatment is the placebo or when it is being given.

As a patient, I'm not sure how I'd feel if my doctor suggested using a placebo. But I think I'd rather know a placebo might be used than to have my doctor try one without my consent. How about you? You can share your thoughts below.

—Sophie Ramsey, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Read what Dr. Marvin Lipman, one of our Health Experts, says about placebo power.

Comments

[k. shannon]

First,I think it's unethical to prescribe a placebo-particullarly if the cost does not reflect that one is receiving the ork proverbial "sugar pill".If a doc wants to see if a placebo will work, the doc should 1.Dispense the placebo through his office-he shouldn't need a pharmacist lisc.to dispense an inert substance, and 2.the placebo drug ,should come with anactive drug to treat the symptoms with instructions to try one for a certain period and then the other to see if one seems to be more efficacious to the patient.

I would also like to know how a doctor even writes a prescription for a placebo-does he/she write Disp:20 placebo tabs;Take 1 tab q.6hrs-I'm pretty sure even my 80 yr old mother would understand that. So-how do docs get away with this deception. I look forward to your response.

[Medical]

I disagree that you should make people "pay" a normal prescription price for a drug that is only a placebo. Where does the profit go from that placebo? Of course what about placebos vs homeopathy?

Should homeopathy be available as a placebo? Absolutely – it's possibly the safest, most ethical and most effective placebo there is. Where money is truly wasted is in trying to find evidence that homeopathy works.

If you think that what passes for homeopathy today can be properly assessed by modern science, it should only take a visit to a homeopathic pharmacy to change your mind. Even though they may have crazy names like "F sharp minor", "Gog and Magog, Oaks at Glastonbury", "Flapjack" and "Crop Circle".

Also stored somewhere at that "pharmacy" was a homeopathic remedy made from the blood of an HIV positive man. There were remedies made from more conventional substances too, plants that any herbalist might use. But where do you draw the line when trying to assess this field? Whatever you do, I wish you luck.

The same is true for the legions of people who say homeopathy works for them. During my research I came across perfectly sane people whose initial skepticism had been blown away after their reluctant use of homeopathic treatments was followed by dramatic improvements in their symptoms. But anecdote, however impassioned, is not scientific evidence – there are always too many unknowns behind each success story.

[Melissa Snyte]

This does not apply to placebos or flu or fever reducers. I have seen that the best option for the consumers is to conduct their own research on credible and reputable health sites.
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Melissa

[elisabeth]

I'm fine with my doctors using whatever might help -- including placebos, though I suspect that if I was told it was a placebo it might not have as much (any?) effect, whereas if I am told "this might help" it might -- I think I am pretty suggestible. I want a good outcome, no matter how it occurs, and since the activity of some "real" medications is also only dimly understood, I don't see a major ethical problem with placebo use. If doctors replace unneeded-but-demanded antibiotics with something else, for instance, that's a good thing in my view.