Jon C Tilburt, staff scientis, 1 Ezekiel J Emanuel, director,1 Ted J Kaptchuk, associate director,2 Farr A Curlin, assistant professor of medicine,3 Franklin G Miller, director, research ethics programme1.
1Department of Bioethics, National
Institutes of Health, Bethesda, MD
2Osher Institute, Harvard Medical
School, 401 Park Dr, Boston, MA
3Section of Internal Medicine and
the McClean Center for Clinical
Medical Ethics, University of
Chicago, 5841 S Maryland Ave,
MC 2007 Chicago, IL 60637
Correspondence to: J Tilburt
Cite this as: BMJ 2008;337
To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment
whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.
Cross sectional mailed survey.
Physicians’ clinical practices.
1200 practising internists and rheumatologists in the United States.
Main outcome measures
Investigators measured physicians’ self reported behaviours and attitudes
concerning the use of placebo treatments, including measures of whether they would use orhadrecommended a “placebo treatment,” their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about
679 physicians (57%) responded to the survey.
About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo
treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).
Prescribing placebo treatments seems to be commonand is viewed as ethically permissibleamong the surveyedUS internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.