The National Institutes of Health recently published an interesting study in the "BMJ," where they approached 1,200 internists and rheumatologists about what they called "placebo treatments," where patient expectations rather than an expected physiological response was the rationale for the treatment. Only 679 physicians responded, which limited the conclusions, along with the design of the study itself, as this type of survey is a weak form of science. Nevertheless, the results were disturbing - about half of the responding doctors indicated they prescribed these kind of treatments on a regular basis, and more than 60 perecent believed there was no ethical problem in doing so. It has long been known that cures and responses to treatment can be affected by a patient's mental attitude and expectation, and that healing itself involves suggestion as well as chemical intervention.
But I find these results deeply disturbing for the following reasons_
1) Most of those surveyed were not using sugar pills or harmless salt water, they were using medicines with potential side effects. These included over-the-counter analgesics (41percent), vitamins (38 percent), sedatives (13 percent), and antibiotics (13 percent).
2) More than 90 percent of upper respiratory infections are viral, yet physicians are knowingly prescribing antibiotics to meet patient expectation.
3) Patients are fueled to ask for pills because of advertising, the Internet and a culture of instant gratification.
4) Physicians are motivated to provide a quick fix rather than a more elaborate explanation which could eliminate the need or urge for the treatment. A study published in the "Annals of Family Medicine" published in 2005 concluded that physicians only spend 55 percent of their time in face-to-face patient care. In this environment of 5 to 10 minute office visits, it is often easier for doctors to provide a quick placebo treatment rather than a more elaborate diagnosis and explanation.
5) This is a survey of doctors, but it is highly doubtful to me that patients would be satisfied with this approach. I suspect that a similar survey of patients would reveal that less than 10 percent of patients believe that it is okay for placebo treatments to be given for deceptive reasons, with false expectations. I suspect that most patients would like an interaction with their doctor to be completely honest and based on full disclosure.
Do my readers agree?
Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of "False Alarm: the Truth About the Epidemic of Fear" and "Bird Flu: Everything You Need to Know About the Next Pandemic". Read more at www.doctorsiegel.com