I was wondering if it happens sometimes that doctors actually prescribe placebos outside medical studies. Homoeopathy comes to my mind, but besides that… is it acceptable to give sugar pills to a patient who is convinced that he needs meds but actually does not?
I believe part of a double blind study typically has a doctor do such a thing, but the Dr does not know if the Rx is the placebo or not.
I think the OP is asking about regular visits to the doctor…not double blind studies by research organisations.
As a child, I received a placebo, according to stories from my parents. I developed a weird habit of rolling my eyes, like a tic. There was no physical reason for it, and the family doctor prescribed a very foul-tasting liquid that I had to take a spoonful of whenever I did the weird behavior. Apparently, it worked.
They told me it was medicine, of course, but many years later they told me it was just a placebo. This was 50 years ago, though
Interesting question. In my experience the doctor and pharmacist go out of their way to tell you the specifics of what it is you are taking, so I’m not sure a “black box” drug where they just tell you “just take this stuff, yeah, not gonna tell you what’s in it”, or an outright lie (e.g. “uh huh, these are narcotics, yeah”) would go over well with ambulance-chasing attorneys who advertise for medical malpractice clients on TV.
How would the doctor notify the pharmacist to dispense a placebo without the patient finding out? If the medical establishment came up with a few “code word” drug names that really meant “placebo”, eventually someone would find out and post the name all over teh internets and patients curious about the side effects of “Bompoline” would discover its placeboness with a quick search. If doctors start rotating in new names, first of all you’re going to have a high communications overhead, and second that wouldn’t work well because patients are going to get suspicious if they get an Rx for something whose only Google hits are from the last week and a half.
Yes.
I saw once on E.R (the old tv show) a doctor telling the nurse to give the patient some obecalp, which is placebo written backwards.
About the foul tasting substance, I think that the taste could be related to the eye-rolling stoppage, as you would associate the taste with the eye rolling. It would also work with electric shocks, loud noises or something like that… I think.
It really isn’t ethical to tell the patient something has a therapeutic value when it really doesn’t. I believe the doctor’s workaround is to tell the patient to take aspirin or some over the counter cold medicine and see if it doesn’t clear up in a couple of days.
Also, patients who know how to do a medical literature search or even know how to use the Physician’s Desk Reference or other books (probably a minority, but my parents had a PDR at home when I was a kid and I was taught to use it at least cursorily, at least to understand that X drug was an antibiotic, Y drug was a painkiller, etc.) are likely going to discover the ruse quickly, and some of them are going to spread the word and start chatting or even posting online, then the game is up. I could imagine doctors trying to publish false research articles in medical journals to add an air of legitimacy (“A new study by Robinson (2013) in the New England Journal of Medicine indicates that obecalp is effective for depression, meningitis, and blunt force trauma.”), but that opens up additional ethical issues. All you need is a neophyte researcher from another country who is not “in” on the joke and they waste half a million dollars in grant money on obecalp research and get laughed out of their PhD defense.
The following is purely speculation on my part (IANAD): There are a lot of medications marketed as therapeutic (and looking up which on the web will confirm to be bona fide pharmaceutical products) but prescribing which may, in the doctor’s mind, amount to prescribing placebo: e.g. herbal OTC remedies, homeopathic preparations, perhaps minerals or vitamins in harmless dosages.
Amoxicillin for most earaches and “sinus infections.”
I’ve been wondering this as well. I don’t think they actually give sugar pills, but I wouldn’t be surprised if they prescribe a drug with minor side-effects that isn’t meant to treat this condition. Particularly with things like depression and insomnia.
Certainly a lot of crap prescriptions are handed out without much real belief on the part of the physician they’ll make a real difference…
Off the top of my head, the closest thing I can think of to a common genuine placebo is a relatively common (I suspect) practice of given a B12 injection to the vaguely fatigued. May be a little more common with practioners who’ve been around a while, and maybe to their patients who have also been around a while.
As noted, in the modern world it would be difficult to prescribe an overt placebo. However, there are probably lots of things that provide the equivalent. Where you get into all sorts of ethical issues are where real money is involved - claims against public subsidised drug schemes, medical insurance claims etc, plus obviously the patients own money. Crossing the divide into natropathy, homoeopathy and the like does give otherwise legitimate doctors the freedom to prescribe placebos. But only to a certain subset of the populace. It would not be a good idea to try that on me.
I remember talking to my father about this decades ago, and he noted that (especially when many prescriptions were actually recipes for the pharmacist to make up, and not simply dole out boxes of pills) a prescription for a bitter, thick, coloured liquid was trivially made from a selection of innocuous components, mostly prescribed with important sounding Latin names. So a patient would cheerfully get the prescription made up, and it would be accepted as a bona-fide active drug for the condition. Perfect. Some doctors had their own “tonics” that they prescribed. Not to be outdone, pharmacists marketed their own as well.
The B12 injections and the like were a great money spinner for private doctors in the UK. Wealthy patients of a certain age could be signed up for regular injections for the rest of their life, and provide a nice base income with little to no effort. The manner in which the UK health system works made this very attractive.
I went for a medical check-up earlier this year, and on the doctor’s desk was a small cardboard box (possibly containing a glass bottle of liquid or pills) with the word “PLACEBO” written clearly on it. In fact “Placebo” was by far the largest writing on the packaging.
It really caught my eye as I was intrigued as to what it might be used for. Possibly it is for administering to children with the full knowledge and consent of their parents?
Ran across this photo today on Reddit - for a little girl who had trouble getting to sleep.
I think it qualifies as a placebo and it is easy to imagine how the Rx was worded.
This is pretty common, according to friends & relatives in the medical (& pharmacy) professions.
Many of the ‘common cold or flu’ type complaints are caused by viruses, so antibiotics will have no effect on them – they are just placebos. But patients expect their doctor to prescribe something, and are dissatidfied if they don’t. So many doctors prescribe antibiotics, knowing that they won’t have any real medical efficacy.
But that upsets the insurance company, which has to pay for the needless prescription. (And, occasionally, upsets a medical review board.) So the doctor is stuck between a patient who demands a medicine and a payer who objects to it.
And doctors themself are becoming concerned about over-prescription of antibiotics leading to an increase in resistant infections, so they are trying to cut down on this. Some doctors have mentioned to me that they try to prescribe the older antibiotics in such cases, rather than current ones like Amoxicillin – because the older ones are usually cheaper (no longer patent-restricted) and have already triggered as much antibiotic-resistance as expected. So the doctors are saving the most effective current ones for ‘real’ infections that need them.
Steven Novella, an MD who does the Skeptic’s Guide to the Universe podcast, has addressed this question a few times. He always says that prescribing a placebo amounts to lying to the patient, and therefore it would be completely unethical. It doesn’t matter if the doctor has good reason to believe that a placebo would help the patient, it’s still lying. If I found out that my doctor had knowingly prescribed a placebo, I’d report him to the medical board.
I’m not a lawyer, but I’d go to law school and sit the bar for this one. One of the common effects of untreated depression is suicide. A doctor that treated it with placebos would lose their license, at a minimum.
My dear offspring have been receiving placebo for years now. We actually call it placebo and they ask for placebo. It is used to help them fall asleep when either “just can’t fall asleep or stop their mind from thinking too many thoughts”- it has never failed 
Placebo started as 1/8 of a tums tablet and is up to 1/2 of one. Being tweens now it is only a matter of time before they get it, but we almost couldn’t stop laughing a couple of years ago when NPR was talking about a medical study and talked about the placebo control group and my kids got very excited.
I have a Ph.D. in Chemistry so I’d like to think that I qualify as a “doctor prescribing placebo”!
*Also with regard to the lying aspect and my eventual discovery as a fraud, I have never once lied about the medical benefits or symptoms addressed by Placebo.
Not sure, but when I was a kid I used a Ventolin inhaler for mild asthma. When the doc or nurse was demonstrating to me how to use it, they took one from a package marked “placebo”. I presume this was so that I could practice the technique without overdosing myself on the actual medicine. Could it have been one of those?