According to a new study in the BMJ, between 46-58% of 679 surveyed US internists and rheumatologists regularly prescribe placebo treatments. Indeed, a large majority of the respondents - 62% - said they think the practice is ethically permissible. Interestingly, though, only a minority of the surveyed physicians prescribe inert substances (like sugar pills), preferring painkillers and vitamins.
While medical ethicists disapprove, arguing prescribing placebos undermines trust and violates the principle of informed consent, I'm not so sure it's a bad thing. If we view medicine as a technology for healing (a perspective persuasively advanced by David Wootton in Bad Medicine), then disallowing anything that works seems odd. Indeed, given how powerful the placebo effect is - often significantly outperforming pharmacological or surgical interventions - not occasionally prescribing placebos seems perverse. Patients, it seems to me, care about getting better, not about how they get better. If so, I agree with Ben Goldacre: prescribing placebos is permissible.
(See also: Goldacre's two-part radio program on the placebo effect and the NYT's piece on the BMJ study).
Medical ethicists who disapprove of placebos have not truly thought about the problem. A general medical doctor is not a psychiatrist and does not have the time or the knowledge to treat hypochondriasis. Most hypochondriacs deny their disease and refuse to see a psychiatrist, so attempting to refer the patient will fail. By prescribing a placebo, the doctor provides a benefit (the patient feels better) without adding a risk from prescribing a medicine with side effects. But, now that I think of it, perhaps hypochondriacs should be referred to medical ethicists.
ReplyDeleteI agree with you but I'd emphasize that I think it's not only permissible to prescribe placebos to hypochondriacs. Whenever placebos work (most usually, but not always, on psychogenic ailments) then it should at least be on option to prescribe them.
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