AMA: It's not OK to use placebos deceptively

Doctors also should tell patients when laws require reporting of confidential data, and pharmacists should notify physicians when they refuse a prescription, delegates say.

By Kevin B. O'Reilly, AMNews staff. Dec. 4, 2006.

Las Vegas -- Physicians may use placebos only if patients agree, and doctors should never resort to placebos for their own convenience or to mollify a difficult patient, says a new ethical policy the AMA House of Delegates adopted at its November Interim Meeting.

The new measure defines a placebo as "a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated" and says that deceptive use of placebos in a clinical setting "may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient."

It is not only patients' trust that is undermined, but their care could be delayed or their condition misdiagnosed if physicians rely on deceptive placebo use, said Robert M. Sade, MD, chair of the AMA's Council on Ethical and Judicial Affairs.

According to the adopted council report, there is evidence suggesting that patients can benefit from a placebo even when they are aware it is being used. The report says physicians could explain to patients that a better understanding of their condition can be achieved by evaluating different medications, one of which could be a placebo. The council report also says doctors may use placebos, with patients' consent, in single-patient controlled studies known as N-of-1 trials.

The policy was first proposed at the June Annual Meeting but referred after several physicians testified about successes with undisclosed placebo use. At the November Interim Meeting, Michael E. Greene, MD, a Macon, Ga., family physician, talked about a doctor he knew who would deal with elderly, comfort-seeking patients by using three inert, different-colored pills of supposedly varying strengths.