Nearly half of physicians have
used placebos in their clinical practice and a vast
majority believe it has tangible affects. That's the
finding of a University of Chicago study in the January
2008 issue of the Journal of General Internal Medicine,
which is sure to shock patients but leave many MDs unmoved.
UPLIFTING
INJECTIONS
Only about 3% of the docs in the study admitted to prescribing
prepared placebo or sugar pills (which are sometimes
termed 'Obecalp' — placebo spelled backwards).
Physicians are far more likely to opt for a legitimate
treatment in subtherapeutic doses, says Dr Philip Hébert,
chair of Sunnybrook's Research Ethics Board and a GP
in Toronto. "That happens all the time. I've done that.
I doubt there's any physician practising who hasn't."
Another common treatment is to
inject vitamin B12 into the many patients who come in
complaining of fatigue, he says. "It's a nice red colour
and has an impressive effect. Alternately we may give
them a little bit of thyroid extract, a homeopathic
dose. Patients often come back for another."
But what is a placebo? Of the 231
physicians who participated in the university's study,
51% defined it as a treatment which isn't expected to
have known physiological effects and 37% said it may
have possible 'unspecific' effects. Only 28% labelled
it as an inert or innocuous substance.
WISH
FULFILLMENT
Physicians aren't just prescribing placebos to get hypochondriacs
off their backs. Doctors frequently rely on placebos
because patients believe they'll get better under a
physicians care, says Dr Hébert. "Sometimes we
trade on this faith in medicine, especially when the
patient has a self-limiting disease, like a cold," he
says.
At other times physicians use placebos
when the patient's illness is hard to pinpoint and not
easily explained. "While you're trying to figure out
what's really going on you might prescribe something
that will have a limited effect," he reports. "We're
happy that patients improve, but sometimes aren't sure
why they do."
Meanwhile, a vast body of knowledge
has accumulated in support of the placebo effect. Brain-scan
research reveals that endorphins in the brain are triggered
when a patient believes they're being cured. However,
the placebo effect appears to have its limits. A 2002
New England Journal of Medicine article concluded
there is little evidence to suggest placebos have powerful
clinical effects beyond a small number of patients.
A
LAST RESORT
Physicians need to consider the degree of deception
they're practising when giving treatments that may have
some side affects, says Dr Jeff Blackmer, director of
ethics for the CMA and Ottawa spinal-cord-injury specialist.
Dr Blackmer says the ethics surrounding
placebos are a grey area. "Giving B12 is not completely
innocuous," he says. "Occasionally you'll see effects
from giving it, like an infection from the needle."
The way around this is for doctors to disclose what
the treatment is for and its possible side effects —
all the information you need to get informed consent,
he says.
When Dr Hébert prescribes
a placebo he tells patients about the side effects and
that they're going to start out with a really low dose
to see how they do. "I'm against deception, but there
are these more subtle interactions between the doctor
and patient that I would not want to deny medicine access
to."
The current study suggests that
since around 23% of doctors surveyed reported using
placebos routinely (interestingly, 80% said they thought
their colleagues used placebos routinely), the numbers
warrant further studies into physicians' belief in the
mind-body phenomenon.
|
