A survey of doctors practising in Chicago, USA, found that forty five per cent of them recommended placebos to patients in clinical practice and believed in the mind-body connection.

The study is published in the January issue of the Journal of General Internal Medicine and is the work of Rachel Sherman, a 4th year medical student at the University of Chicago’s Pritzker School of Medicine, and Dr John Hickner, a professor of family medicine, at the University of Chicago and University of Chicago Medical Center.

The placebo is often investigated in clinical trial research, but there is little evidence of its effectiveness and use in day to day health care practice.

The researchers wanted to find out how doctors used placebos and what knowledge, attitudes and beliefs about placebos influenced their practice.

Sherman and Hickner invited doctors from internal medicine departments in 3 medical schools in the Chicago area to complete an anonymous web based survey of 16 questions.

The results showed that:

50 per cent of the 466 invited participants responded (231 out of 466).

45 per cent of respondents reported using a placebo in clinical practice.

Of these, 34 per cent introduced the placebo to the patient as “a substance that may help and will not hurt”, 19 per cent said “it is medication”, and 9 per cent said “it is medicine with no specific effect”.

Only 4 per cent of those who used placebo told the patient “it is a placebo”.

The most common reasons for using a placebo were to calm the patient and to supplement another treatment.

There was much disagreement on the definition of placebo and how it works.

96 per cent of respondents believed placebos have therapeutic effects.

40 per cent of respondents said placebos can have physiological benefits for certain health problems.

12 per cent of respondents said placebos should be categorically prohibited in routine medical care.

48 per cent of respondents reported giving at least one type of placebo-like treatment where there was no clinical evidence to support it.

The most common definition chosen by respondents was that a placebo was “an intervention not expected to have an effect through a known or specific physiologic mechanism”.

The respondents were also asked if they thought there might be psychological or physiological benefits to yoga, meditation, relaxation, biofeedback, prayer, social support, doctor-patient rapport, and the interior design of the healthcare facility. In most cases the majority of respondents reported they believed there were both psychological and physiological benefits.

Sherman and Hickner concluded that:

“Nearly half of the respondents use placebos in clinical practice and most believe in the mind-body connection.”

They cautioned that the study was limited by the fact it was based on retrospective self-reported behavior, and the results were subject to recall bias and may not be representative of all American doctors.

Sherman said:

“Placebos have been used in medicine since ancient times, and remain both clinically relevant and philosophically interesting. In addition to their recognized use as controls in clinical trials, this study suggests that placebos themselves are viewed as therapeutic tools in medical practice.”

In their paper, the authors mentioned literature that suggests the routine use of placebos is controversial. Some writes on informed consent and non-deceptive therapies urge medical professionals to be cautious about using placebos, while others say it is possible to use them in some cases without causing ethical problems.

Sherman and Hickner suggested there is a growing body of medical professionals who believe in the mind body connection, where how and what a person thinks can impact their health and body state.

Decades ago, they wrote, doctors used to give placebos to patients who were faking symptoms, but today, as their survey showed, it appears that the vast majority of doctors believed placebos can have a therapeutic effect.

Sherman and Hickner said their study pointed to a need for greater recognition in the medical profession about the use of placebos and unproven therapies. The implications of such practice should be discussed, they urged.

“Academic Physicians Use Placebos in Clinical Practice and Believe in the Mind-Body Connection.”

Rachel Sherman and John Hickner.

Journal of General Internal Medicine, Volume 23, Number 1, January, 2008

DOI: 10.1007/s11606-007-0332-z

Click here for Abstract.

Sources: University of Chicago Medical Centre press release, journal abstract.

Written by: Catharine Paddock