Doctors use placebos but don't tell patients

Physicians are taking advantage of the placebo effect in clinical care, but the AMA warns that deceptive use could undermine patient trust.

By Kevin B. O'Reilly, AMNews staff. Jan. 28, 2008.

Nearly half of physicians use placebos in clinical care, and only 4% tell their patients the truth about it, according to a survey of Chicago academic physicians that was published this month in the Journal of General Internal Medicine.

Only 8% of the 231 physicians surveyed used placebos more than 10 times during the last year, but experts were alarmed by doctors' self-reported, less-than-straightforward conversations with patients about placebos.

The study is troubling because deceptive use of placebos is "inconsistent with what we now understand as the rights of patients to decide on treatment in a knowledgeable way and the duties of physicians to disclose to patients the treatments that they are providing," said Paul S. Appelbaum, MD, director of the division of psychiatry, law and ethics in the psychiatry department of Columbia University College of Surgeons.

Dr. Appelbaum was one of several experts who reviewed the American Medical Association Council on Ethical and Judicial Affairs' 2006 report on placebo use in clinical practice. In November 2006, the AMA House of Delegates adopted the report, which said, "Use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient."

The AMA's ethical policy said doctors should ask for patients' permission to use placebos but vary the timing of when they are given so the placebo effect is not undermined. The new survey was conducted before the AMA adopted its current policy.