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Prescribing Antibiotics for Placebo Effect

Would you go to a doctor who prescribes antibiotics, sedatives, and other medicines off-label as placebos?

There’s a good chance that you already do.

About half of U.S. internists and rheumatologists in a national survey said that they had prescribed placebo treatments to their patients in the previous year—18 percent had done so as often as once a week. Most of the placebos were real drugs prescribed on the chance that they might help if a patient believed that they would, not because of evidence that the medications actually worked for the patient’s condition.

Of the 679 doctors, 13 percent said that they prescribed antibiotics and sedatives as placebos. The most common placebo treatments were over-the-counter painkillers (recommended by 41 percent of the doctors) and vitamins (30 percent).

The doctors had different ways of describing a placebo treatment to their patients. The majority told patients it was “a medicine not typically used for your condition but might benefit you.” Just nine percent used the word “placebo.”

Only in America, right? Prescribing placebos is symptomatic of what’s wrong with American medicine—its wastefulness, its pill-popping culture, its lack of accountability. But it turns out that we’re not alone. Surveys of doctors in Denmark, Israel, the United Kingdom, Sweden, and New Zealand report similar results.

The saddest finding in the latest survey is that most of the doctors had no ethical problem prescribing placebos. Fifty-nine percent said it was permissible, 31 percent said it was permissible in rare circumstances, and 3 percent said it was obligatory.

Apparently, it didn’t matter that their patients couldn’t give informed consent to the treatments. The potential harms were also off the radar. Antibiotics, sedatives, and OTC painkillers can have adverse effects on health. Used as placebos, they can have adverse effects on the health care system.

On the other hand, the placebo effect is real and may benefit some patients. For this reason, bioethicists and the medical profession itself are divided over the ethics of prescribing placebos, as discussed in the New York Times and National Public Radio coverage of the survey.

What do you think? Share you reactions to these findings.

Susan Gilbert is Staff Writer at The Hastings Center.

Published on: October 24, 2008
Published in: Health and Health Care

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