A new British study out in the journal PLOS ONE is stirring up a lot of debate, as it gives some estimates on the number of doctors who are giving patients placebo to treat their various conditions. It finds that a resounding 97% of the 783 doctors surveyed admitted to giving patients some sort of placebo in their practice. But it would be misleading to say that doctors are giving patients sugar pills or saline injections at the drop of a hat – there are different kinds of placebos, and, as the survey found, doctors have different feelings about when each should be used. Not surprisingly, so does the public. “Pure” placebos are indeed sugar pills or saline injections with no therapeutic value (aside from that stemming from the psychological effects – more on this later). This "pure" variety was used by about 12% of the general practitioners at some time in their careers. Among these doctors, there were various motivations, including the wish to generate psychological treatment effects, to calm patients, to appease patients’ wish for a treatment, and to treat “non-specific complaints.” Half the doctors only told their patients something vaguely promising, like “this therapy has helped many other patients.” About 25% told their patients that the treatment “promoted self-healing,” and less than 10% revealed that the treatment was actually placebo. “Impure” placebos, on the other hand, are therapies for which there is no strong evidence that they work for a given problem – for instance, the use of antibiotics to treat a virus, off-label uses of medications, or probiotics for diarrhea. Impure placebos also include lab tests or physical exams that are given simply in order to reassure patients. This type of placebo was much more common, with 97% of doctors reporting their use at least once across their career, and 77% reporting “frequent” use, i.e., at least once per week. The topic of placebo has been a hot one since there is often an impression that deception is involved (and, funnily, placebos probably work better when there is). But some argue that dishonesty doesn’t have to play a role: 'This is not about doctors deceiving patients,” says study author Jeremy Howick, of the University of Oxford, “The study shows that placebo use is widespread in the UK, and doctors clearly believe that placebos can help patients.” In terms of ethics, the study found that about 66% of the doctors felt that pure placebos are acceptable under certain circumstances, although the majority felt that they were unacceptable when they involved deception or threatened doctor-patient trust. The other 33% of doctors felt pure placebos were always unacceptable. Of the impure variety, however, there was much more acceptance, with 84% of doctors believing that they were OK in some circumstances. There is something to be said for the placebo effect, and for some conditions, it appears to work whether a patient believes it will or not. It is very likely that placebos should play a certain role in medicine, but deciding what it is will continue to be the problem. As Clare Gerada, chairwoman of the Royal College of GPs, told the BBC, "Lots of doctors use [placebos] and they can help people. If you think about it, a kiss on the cheek when you fall over is a placebo." The placebo effect has been particularly promising in pain-related conditions, possibly because it may increase body’s natural capacity to reduce pain. “The placebo effect works by releasing our body's own natural painkillers into our nervous system,” said study author George Lewith, of the University of Southampton. “In my opinion the stigma attached to placebo use is irrational, and further investigation is needed to develop ethical, cost-effective placebos.” The authors point out that there are lingering ethical issues, particularly if doctors do not make the patient aware of what they are receiving. “This raises unresolved ethical issues about how GPs approach informed consent in relation to their prescriptions of placebos,” they say. The other unaddressed issue is the possible negative effects of placebo, known as “nocebo,” which is especially a concern with impure placebos like antibiotics. Sorting the issue out won’t happen overnight, and will probably involve a lot more research in the lab, and debate outside of it. The authors conclude, “The time has come…to investigate ways to rationalize placebo use. The long term viability of placebo use in clinical practice depends on whether placebo benefits outweigh harms, their cost, and whether patients and practitioners deem their use to be ethically acceptable.” Source
Lots of doctors use [placebos] and they can help people. If you think about it, a kiss on the cheek when you fall over is a placebo." totally disagree ,, falling over is a condition may require actual treatment ,, placebo is given to patients physically and mentally intact
