By Julie Burger

A recent survey of American physicians found that nearly half routinely prescribe placebo treatments—treatments that do not have a physiological mechanism of working but might make the patient feel better because of the patient’s belief the treatment will work.  The most commonly reported prescribed “placebos” were pain relievers, vitamins, antibiotics and sedatives. 

Though they are being described as “placebos,” these are hardly the sugar pills envisioned by most people when placebos are mentioned.  Given recent concerns of superbugs and drug resistant bacteria, prescribing antibiotics when the patient doesn’t actually have an infection seems, at the least, counterproductive.  Antibiotics also kill beneficial bacterial naturally found in the body which can trigger other health problems.  Pain killers might mask symptoms, leading the patient to fail to recognize a problem.  The over prescription of sedatives seems even more dangerous.  All medications have side effects and some people prefer to minimize their exposure to these potentially harmful substances.  Prescribing medication knowing that it isn’t necessary but hoping that the patient’s expectations will help their condition takes away the patient’s right a choice about ingesting medication.

The so-called placebo effect doesn’t even actually work in 2 out of 3 patients, and some research demonstrates it might not exist at all.  The physician has no way of knowing if a particular person will respond.  Should medication really be prescribed when there is at least a 67% chance it won’t work?

Prescribing medication unnecessarily also has other harms.  The AMA cautions that using a placebo may “undermine trust” and “compromise the patient-physician relationship.”  (The organization does suggest ways to reconcile informed consent with the use of placebos.)  It also warns that prescribing a placebo just to get rid of a difficult patient is not ethically acceptable.  Prescribing a placebo for the convenience of the physician does indeed seem to violate the physician mandate to first, do no harm. It may be time to reevaluate the definition and the clinical use of placebos.