According to an Associated Press story, the German Medical Association, is recommending that doctors should consider prescribing placebos to some of their patients without their knowledge. This, of course, has stirred up much controversy and debate.
The so-called “placebo effect” in randomized controlled trials is well-known and, indeed, well-documented. In the minds of many, it is seen as evidence of a connection between mind and body, in spite of a lack of understanding of the various mechanisms that the body/mind might use. Personally, I don’t have a problem with that hypothesis and would agree that the pervasiveness of the placebo effect in clinical research could be used to support a view that what goes on in our brains can have an effect on our health and well-being.
There is a valid rationale for using placebos in clinical trials, but even this has been controversial on the basis that, although those patients would still receive treatment per the current standard of care, a control group is purposefully denied a potentially beneficial new medication. This is seen as necessary, however, in order to help establish the efficacy of a new and innovative medicine (for more on this controversy, read this article from the New York Times). Canada conducted a thorough review of many of these issues under the National Placebo Initiative, which issued its report in 2004.
But, should we be recommending that patients be mislead by taking placebos outside of a controlled trial without telling them? There are some key points to consider.
First of all, is it scientific? While the placebo effect has been observed generally throughout clinical trials in a number of disease areas and against many drug therapies, is there enough research in which the placebo itself (which may just be a pill made of sugar, flour or other non-medicinal substance) has been the subject? After all, we put medicines through rigorous studies to prove their efficacy. Shouldn’t we want to apply a similar standard to a prescribed placebo?
The second question is whether it is ethical for a physician to lie to their patient about having prescribed them something that is essentially pixie dust? How would patients feel about this? What would this mean for the patient-doctor relationship, a relationship that works best when built on a foundation of mutual trust and open communication?
While this German study is the latest volley in the debate, this has been a controversial question for some time. Indeed, the American Medical Association had already advised against prescribing placebos without a patient’s informed consent (as do the British authorities), but does not deny the possibility of their role in therapy. In spite of this, a University of Chicago study reported that nearly half of the Chicago-area doctors they examined admitted to regularly prescribed placebos, including a significant minority that owned up to having “lied” to patients about it.
Clearly, this is a debate that is far from over.
This post was originally written by Jason Grier, who is no longer working at Hill+Knowlton.