Should Doctors Use More Placebos?

Leigh Page

Disclosures

December 31, 2014

In This Article

The Power of Belief

The placebo phenomenon, disparaged for almost a century, has been making a comeback—in part owing to findings that it can be a useful factor in helping physicians improve their clinical outcomes.

Placebos, of course, are inert pills, saline solutions, or sham procedures that aren't supposed to have any effect at all. But a whole array of studies in the past 20 years have shown that they actually have a significant effect, simply because patients want them to.

Many physicians use placebos or placebo treatments in their practice, but rather than use an inert pill, they often use vitamins, antibiotics, sedatives, or some other active ingredient. These pills are frequently given to patients who demand a pill when there is no appropriate treatment available or necessary. In a Medscape Ethics survey in 2012, 36% of physicians said it was acceptable to prescribe a placebo treatment to a patient who doesn't require treatment but is adamant about receiving it.

However, experts who study placebos are more interested in applying the placebo effect than in using placebos. They think the placebo effect can be harnessed in the use of actual treatments—an area that promises a much wider impact than placebos alone.

One factor identified in the placebo effect is the physician's demeanor. When doctors are warm and encouraging and are engaged with patients, studies show, patients' outcomes improve.

The placebo effect shows that "doctors have a great deal of power over clinical outcomes through everything they say and do," said Ted Kaptchuk, a leading researcher of the placebo effect. "Every word and every silence communicates to the patient."

Kaptchuk, who does not have a medical degree or a PhD, started as an acupuncturist and is now a professor at Harvard Medical School. He devotes himself full-time to scientific studies of the placebo effect as director of the Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston.

"There is an art of medicine that has to do with how the physician delivers the therapy," Kaptchuk explained. "It's just as important as the therapy itself."

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