TORONTO ó We may be in the era of evidence-based medicine, but a new study suggests doctors are still falling back on a habit of yore ó prescribing placebos. And they may be doing it with surprising frequency.
The study, based on a survey of U.S. doctors, found that between 46 per cent and 58 per cent of responding physicians prescribed treatments they knew werenít medically likely to improve the health of their patients. And 62 per cent saw no ethical dilemmas in doing so.
One of the study co-authors, Dr. Ezekiel Emanuel, admitted he hadnít expected the high rate of placebo use.
"The notion that 50 per cent of American doctors do this two to three or more times a month I think is very, very surprising," said Emanuel, chair of the department of bioethics at the U.S. National Centers for Health in Bethesda, Md.
"Thatís a high number."
The survey didnít poll Canadian doctors. And Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, said to his knowledge there are no data on whether or how often Canadian physicians prescribe placebos.
But Schafer said he suspects that when it comes to use of placebos, Canadian doctors donít differ much from their U.S. counterparts.
"I think this is deeply unethical. Expensive, dangerous, deceptive and wrong. Itís bad medicine," he said from Winnipeg.
The study, published today in the British Medical Journal, is based on survey responses from 679 doctors who specialize in internal medicine or rheumatology. Those specialties were selected because these doctors routinely see patients with debilitating and hard to manage chronic conditions, the authors said.
Most of the doctors who reported prescribing placebos didnít resort to the sugar pills or saline solutions that doctors in bygone eras might have kept close at hand for patients with conditions for which no real therapy existed. Instead, they acknowledged prescribing over-the-counter pain medications (41 per cent), vitamins (38 per cent), sedatives (13 per cent) and antibiotics (13 per cent).
It is a well-known phenomenon that giving people something ó even something as innocuous as sugar pills ó will produce beneficial results in some of them. Itís thought that the mere notion of being treated, even with a sham therapy, produces an expectation of healing that has a beneficial psychological effect.