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Researchers are calling for appraisal of the clinical use of placebos and debate about the ethics of using them, after finding that patients are given placebos more commonly than supposed.
Three out of every five hospital or community doctors and hospital head nurses responding to a questionnaire on past use admitted to prescribing placebos, almost two thirds once a month or more for a range of conditions. More than two thirds of them had misled patients, passing off the placebo as medication, and 94% found placebos generally or occasionally effective. Worryingly, more than a quarter saw placebos as a diagnostic tool to separate organic from psychogenic pain. Only 5% (4/79) thought using placebos should be banned, the rest said it depended on circumstances. In 38–43% of cases placebos had been used to satisfy patients’ “unjustified” demand for treatment, calm patients down, and treat pain. Three quarters of the respondents thought that placebos work solely through psychological mechanisms.
Thirty one doctors and 31 head nurses in two hospitals and 27 family doctors in community clinics in the Jerusalem area took part. The questionnaire covered experience of and attitude to using placebos like saline, paracetamol or vitamin C tablets, sugar or artificial sweetener pills, or prepared placebo tablets.
Using placebos in clinical practice is not approved. Indeed, the previous report on the practice some 25 years ago estimated that use was low—about once a year per doctor. However, anecdotal evidence and first hand observation had suggested to the researchers that the practice continues.