Internists describe positive use of placebos
Placebos have been a part of medicine since ancient times, and remain both clinically relevant and philosophically interesting, according to a University of Chicago medical student whose research has shown that 45% of Chicago-area internists use placebos in their practice.
"This study indicates a need for greater recognition of the use of placebos and unproven therapies and discussion about its implications," says study author Rachel Sherman, a fourth-year medical student at the University of Chicago's Pritzker School of Medicine. Sherman and her co-author gathered information on placebo use from 231 physicians, who described whether they used placebos in their practice, and why.
"This study suggests that placebos themselves are viewed as therapeutic tools in medical practice," says Sherman.
Of the respondents who reported using placebos in clinical practice:
- 34% introduced the placebos to the patient as "a substance that may help and will not hurt;"
- 19% said, "it is medication;"
- 9% told patients, "it is medicine with no specific effect;"
- 4% of the physicians explicitly said, "it is a placebo."
The authors write that in the broader ethics literature, the routine use of placebos is controversial. Some commentators on informed consent and non-deceptive therapeutics caution against the use of placebos in medical practice. Others propose that the placebo effect can be harnessed in various therapeutic contexts that do not pose ethical dilemmas.
In addition, the authors say a growing number of physicians believe in mind-body connection; which means what a person thinks can impact the health and well-being of the body. Rather than using placebos to differentiate between patients who were faking their symptoms and those with genuine symptoms, as the majority of physicians did according to research several decades ago, 96% of physicians in this study believed placebos can have therapeutic benefits for patients. (Sherman R, Hickner J. Academic physicians use placebos in clinical practice and believe in the mind–body connection. J Gen Internal Med 2008;23:7-10.)
FDA mulls broader off-label promotions
The U.S. Food and Drug Administration (FDA) is considering permitting drug and device makers to more broadly use published scientific and medical journal articles about unapproved, or off-label, uses when promoting their FDA-approved products to physicians.
While physicians are free to prescribe drugs and devices for off-label uses, manufacturers are banned from promoting their products for indications not approved by the FDA.
However, the agency, in a new draft guidance document issued in February, proposed that firms under certain circumstances may distribute journal articles and other publications about the off-label uses of approved products. The new guidelines would give drug and device makers a broader use of journal articles in marketing efforts than has been allowed in past years. The proposed new guidelines are being opposed by some consumer advocates and members of Congress.
Placebos have been a part of medicine since ancient times, and remain both clinically relevant and philosophically interesting, according to a University of Chicago medical student whose research has shown that 45% of Chicago-area internists use placebos in their practice.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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