Doctors in Australia commonly give their patients a placebo treatment intended mainly to ease their minds, according to a new study out Monday. But it’s not just an Australian practice—other research has found the same is true of doctors across the world.
The new study, published in The Australian Journal of General Practice, surveyed more than 130 primary care physicians (in many parts of the world, they’re known as general practitioners). The doctors were asked if they had ever prescribed an inert placebo—something that couldn’t have any physical effect, like a literal sugar pill—or an active placebo, a treatment that could affect the body but not do anything specifically for their patient’s problem, like an antibiotic for a cold virus.
The survey found that 39 per cent of doctors said they had prescribed an inert placebo at least once in their careers, most often things like saline nasal sprays and skin creams. A whopping three-quarters of doctors also reported that they had given out an active placebo once in their careers, while 40 per cent said they did so routinely, at least once a month. Of these active placebos, antibiotics (42 per cent), vitamin and mineral supplements (17 per cent), and therapies considered alternative medicine like homeopathy (10 per cent) were the most commonly prescribed.
The results aren’t altogether surprising, though, given how commonly doctors elsewhere prescribe placebos.
“We already know that doctors and GPs use placebos regularly overseas,” said study author Ben Colagiur, an associate professor of psychology at the University of Sydney, in a statement released by the university.
A 2008 study of internists (doctors who only see adults) and rheumatologists in the U.S. found, for instance, that around half regularly prescribed placebos. Another 2012 study of German doctors found that 88 per cent had used placebos with their patients at least once, most often active placebos. And a 2013 study in the UK found that 97 per cent of doctors there had prescribed active placebos at least once in their careers. Overall, depending on where and the type of placebo asked about, rates of placebo prescribing range from 17 to 80 per cent of doctors.
As the authors of this latest study point out, there’s a perfectly reasonable place for placebos in medicine. Often, health complaints like colds and stomachaches are self-limiting and don’t go away any faster regardless of what treatment you use. But placebos can make us feel better during that period of suffering. That’s why scientists need to test any new treatment against a comparable placebo, to ensure it’s having an added effect.
Part of the problem, of course, is that people generally don’t take a placebo believing it to be one—it’s the expectation it will work that strengthens the placebo effect. And lying to your patients isn’t exactly endorsed in the Hippocratic Oath. In the current study, some 80 per cent of doctors agreed that a placebo should be prescribed only if patients are told up front that it probably won’t do anything specific to treat their problem. You might think this would render the placebo useless, but there’s growing evidence that even people who know they are taking a placebo end up feeling better than those who take nothing, at least for certain health conditions.
Another concerning pattern of placebo use, the authors noted, is the rampant overprescription of antibiotics for viral infections. Any amount of antibiotic use raises the risk of creating strains of bacteria resistant not only to that antibiotic but others related to it, so we have to carefully manage our stockpile. Hospitals and organisations have tried to educate doctors and patients about antibiotic overuse in recent years, with some success in driving down rates of unneeded prescriptions.
In the U.S., organisations like the American Medical Association have their own guidelines on when doctors can prescribe a placebo, which note that doctors must be upfront about their use and “avoid giving a placebo merely to mollify a difficult patient.” But no such guidelines exist in Australia, according to the authors. And they add that there’s still a lot of work that needs to be done in figuring out how to get the most out of the placebo effect in a harmless and honest way.