Are doctors in the US allowed to prescribe placebo medications without informing their patients (which would, of course, defeat the purpose)? I only ask because one of my friends insists that his doctor is giving him a placebo in lieu of his normal medication. I didn’t think that it would be allowed.
Short answer : No. Outside of research, the use of placebos is considered unethical.
Longer answer : Sort of. Sometimes a relatively benign medication ( aspirin, multi-vitamin) will be prescribed to a patient that wants something for a set of non-specific symptoms that don’t have any objective findings. I am NOT a doctor so hopefully one will be along to give a better answer.
If your friend is concerned that he has been given a placebo, all he has to do is read the label on the bottle. Whatever is listed WILL be what’s in the bottle.
He did and said that it showed the generic name of whatever medication he had been taking. I assumed that for a placebo to “work”, the patient would need to believe that the bottle contained the actual medication. So maybe there was some placebo code between the doctor and pharmacist, or something.
No placebo code. The pills are whatever is listed.
I was prescribed a drug by one doctor (Cyanocobalamin) and later told by another doctor that it is a placebo. I don’t think me meant to say that I was intentionally prescribed a placebo, but that he considered its therapeutic value to be negligible and if I thought it helped me (I didn’t), it would be a placebo effect.
My dad knew some older doctors(I’m sure they’re all dead now)who would prescribe “Old People Pills” essentially as a placebo. Older patients who were hypochondriacs, they would give something dirt cheap, and mostly useless, but harmless* because they would not be happy until they were given something.
*or were thought to be in the old days, I think I remember tetracycline mentioned, but I heard the story 30+ years ago so my I’m not promising accurate recollection.
The name on the generic bottle is usually the name of the actual drug being prescribed. The name on the doctor’s prescription is the brand name of the same drug sold by a specific pharm, generally the one who developed it but no longer controls the patent. Highly regulated but not foolproof.
More commonly, people will go to the doctor wanting an antibiotic for what turns out not to be a bacterial infection, and the doctor knows them well enough to know that the patient has to be given something or they’ll pitch a fit. They will then give them something to treat the symptoms, and that usually placates them.
Some older pharmacists have told me stories about seeing Cebocap or even a capsule (because people tend to think that capsules work better than tablets) called Obecalp. :o 
They were usually used as “sleep aids”, often in nursing homes.
Why does your friend think he is being given a placebo?
Is it something his doctor said, or is it because the medication is not working as expected?
It’s not allowed, and any doctor or pharmacist who prescribes meds which turn out to be sugar pills would likely lose their license and probably face a malpractice lawsuit.
However, it is very likely that your friend’s specific medication simply doesn’t work for him, or has lost its effectiveness over time. This happens all the time. He should tell his doctor that the medication’s no longer working.
Previous threads:
I believe that he had some symptoms associated with BPH, but his doctor may have mentioned that it was “all in his head”. When they switched from a brand name to a generic, he felt it wasn’t working, which prompted the question.
Cyanocobalamin is B-12. Your body doesn’t require much of it, but it’s difficult to absorb orally. Would seem to be a good placebo, since it is an actual drug/supplement/et al. Taking it wouldn’t do you any harm, and it’s good enough to pacify a need for SOMEthing for your condition.
Your friend can use an online pill identification guide. If he claims that the doc and pharmacist are in cahoots and he’s been given fake pills done up to look like real ones, you’ll know that it’s not a placebo but an anti-psychotic.
Placebos can still work even when knowingly taken.
In addition to the placebo effect, there’s also the nocebo effect, where someone can experience negative effects based only on their beliefs. Your friend might be experiencing a reduced effectiveness of his medication simply because he believes that he is taking a placebo.
Your friend was probably given a generic equivalent. There have been claims (that I believe) that indicate some generics may not be as effective as their name brand counterparts, even though the active ingredient is the same.
(and I know some physicians who insist on name brands for some specific medications in certain circumstances)
mmm
There are several drugs where a patient has often been stabilized on the brand, or even a certain generic manufacturer, and that is what the patient should have. Other patients may do this because they have an allergy or other intolerance to a dye or other excipient ingredient in a formulation (and gluten is often used as a tablet binder).
The ones for which this is most commonly done are Coumadin (warfarin), Dilantin (phenytoin), and Synthroid (levothyroxine).
With the drug prices the way they are (even generic), I don’t see how prescribing a placebo would even work without the patient knowing it. Can you imagine the lawsuits that would arise from this? Yes, prescribe me a $430/month medicine and fill the script with look-a-like sugar pills. Can you imagine the blowback from trying that?
It’s not a placebo in and of itself, but it’s possible you didn’t need it. If you don’t absorb enough B12 naturally, megadoses orally can be used for supplementation. You will absorb around 1-3% of it.
In fact, this is now recommended over the shots due to ease of use.