Placebo Prescriptions: Recent Research and Ethical Implications

Placebo Pills
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Has your doctor ever prescribed "Obecalp" or "Cebocap" to calm your headache, reduce your stomach upset, or relieve your pain? Obecalp and Cebocap are actually placebos—fake drugs. Obecalp is simply the word placebo spelled backward. Cebocap is a name of a pill made from lactose, which is sugar.

Doctors Do Prescribe Placebos

University of Chicago researchers issued the results of a study showing that 45 percent of the internists surveyed (all Chicago area family doctors) had prescribed placebos for their patients. Of the doctors who prescribed placebos, 34 percent told the patients that the prescription wouldn't hurt and could possibly even help; 19 percent simply said it was medication; 9 percent said it was medication with "no specific effects"; and just 4 percent told their patients they were prescribing a placebo.

Surveys consistently seem to show that some doctors use placebos in their clinical practices in an effort to help patients. One recent survey on physicians' ethical dilemmas reported that 34 percent of those surveyed said it's acceptable to prescribe a placebo to a patient who doesn't need treatment but is insisting on it anyway.

Types of Placebos

There are two types of placebos:

  • Pure or inactive placebos, such as sugar pills or saline injections
  • Impure or active placebos, such as prescribing an antibiotic for a viral infection or a vitamin even though the patient doesn't need it

Placebos Can Work

Here's the real surprise: Sometimes, often enough to be counted, placebos work to help the patient. Despite the fact that there is no real medicine being ingested, patients feel better. Their pain or other symptoms go away. Even in carefully controlled clinical trials where placebos have been used as the control in the experiment, some patients improve simply because they think they are getting the real medicine.

That effect – the placebo effect – is now front and center in discussions of the mind-body connection. Western medicine (as opposed to Eastern, usually more alternative medicine) is beginning to embrace this mind-body connection as having real therapeutic value.

Placebos May Become a Legitimate Treatment in the Future

One Harvard medicine professor, Ted Kaptchuk, has been engaged in cutting-edge research on placebos with some pretty amazing results: Giving people open-label placebos, sugar pills that the patients know are sugar pills, has been helping alleviate the symptoms of patients with chronic health problems such as irritable bowel syndrome (IBS) and lower back pain.

In this case, the symptom relief has nothing to do with a mind-over-matter situation or even patient expectations, as most of these patients have seen multiple doctors with little success. Rather, Kaptchuk believes that neurotransmitters are activated in the patients' brains by interacting with a caring doctor and receiving the prescription and this helps alleviate physical symptoms. More studies need to be done for greater lengths of time, but the potential looks promising for people who suffer from chronic pain, fatigue, and malaise.

Potential Ethical Pitfalls of Placebos

The use of placebos as a way to treat patients without their knowledge is fraught with ethical questions and implications, including:

  • The potential for a patient's health not to improve since the placebo isn't a real medication.
  • The decision on whether or not to tell the patient the medicine is fake.
  • The possibility that the doctor is simply defaulting to thinking the patient's problems are all in her head.
  • The potential for a malpractice suit if someone is harmed or dies because they were misdiagnosed or undiagnosed and prescribed a placebo.

What Patients Think About Placebos

One study on a group of patients set out to find what their beliefs were about physicians prescribing placebos. The study concluded that there were two basic beliefs among the group: One group had a negative view of physicians prescribing placebos if there are implications that the doctor was deceptive and/or if they believe the placebo doesn't work. They felt the deception could potentially be alleviated if the doctor informed the patient that the medication being prescribed was a placebo. The other group of patients had a positive view of prescribing placebos as long as they had the potential to work, even if this involved physician deception. Clearly, more research is needed in order to figure out the best way to best use the positive effects of placebos in clinical practice.

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