Posted by John Ager on 25 March 2013.
A recent AP article I read discussed the use of placebo by British physicians in a clinical setting. (It is an important an indispensable tool in the research setting.) It noted that 75% prescribe a treatment, like low dose drugs or vitamins, they know won’t work at least once a week. The sample was fairly broad, encompassing 71 percent of all physicians registered in the U.K. The British Medical Association, however, deems such conduct unethical.
I take issue with the suggestion that physicians know “it won’t work” because there is a vast array of medical literature that says exactly the opposite. I think what the author intended to communicate was that the physicians did not believe that the treatment would have a measurable physiological affect on the patient. The psychological effect is another story.
The medical community has known for a long time that the “placebo effect” is actually very powerful, especially for pain reduction. Although the brain is an amazingly complicated organ about which we know very little, one thing we do know is that when patients are told a sugar pill, for example, will reduce pain, the brain in some individuals will tell them they have less pain after they take it. Although the nature and extent of a patient’s physiological response to the brain’s psychological stimuli is also something that is not well understood, current research suggests there truly is little if any physiological effect. I think over time, however, we will learn that the brain alone can profoundly affect healing and physiology in ways we can’t yet imagine and that placebo can be an important part of that.
So what’s all the hubbub? Well, I checked to see if the American Medical Association takes a similar position to that of the Brits. The AMA position statement on the issue is here. https://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8083.page It’s basically he same. The problem seems to be one of patient trust. Additionally, physicians are required to obtain informed consent from patients before proceeding with any type of treatment. This means discussing the relative risks and benefits. Unfortunately, for placebo to work, the patient can’t be aware that the prescribed remedy is in fact placebo. Therefore, the physician can’t obtain informed consent.
Despite the ethical admonition, studies suggest that physicians in the U.S., U.K. and worldwide frequently use placebo when they believe that it is the best option and will be beneficial for a patient. Isn’t that what medicine is all about? While patient trust is very important, the fact is placebos work and may be an excellent or only treatment option in many situations. The medical communities’ governing bodies need to explore ways to remove the stigma of placebo use and develop protocols for its ethical use in the clinical setting. In the meantime, I doubt I’ll ever pursue a medical negligence claim based on placebo when no better option was available.