Clinical use of placebos: Still the physician's prerogative?

Hastings Center Report

Volumn 42, Issue 3, 2012, Pages 29-37

  Barnhill, Anne ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

PLACEBO;

ARTICLE; CLINICAL PRACTICE; DOCTOR PATIENT RELATION; ETHICS; HUMAN; MEDICAL ETHICS; MEDICAL SOCIETY; PATIENT; PERSONAL AUTONOMY; PHYSICIAN; PSYCHOLOGICAL ASPECT; PSYCHOPHYSIOLOGY; TRUST; UNITED STATES;

AMERICAN MEDICAL ASSOCIATION; ETHICS, MEDICAL; HUMANS; PATIENTS; PERSONAL AUTONOMY; PHYSICIAN'S PRACTICE PATTERNS; PHYSICIAN-PATIENT RELATIONS; PHYSICIANS; PLACEBOS; PSYCHOPHYSIOLOGY; TRUST; UNITED STATES;

EID: 84862743810     PISSN: 00930334     EISSN: 1552146X     Source Type: Journal    
DOI: 10.1002/hast.33     Document Type: Article

References (27)

1. J.C. Tilburt et al., "Prescribing 'Placebo Treatments': Results of National Survey of US Internists and Rheumatologists," British Medical Journal 337 (2008): 1-5, at http://www.bmj.com/content/337/bmj.a1938.short, DOI: 10.1136/bmj.a1938.
2. O. O'Neill, "Paternalism and Partial Autonomy," Journal of Medical Ethics 10 (1984): 173-78; P. Lichtenberg et al., "The Ethics of Placebo in Clinical Practice," Journal of Medical Ethics 30 (2004): 551-54; A. Kolber, "A Limited Defense of Clinical Placebo Deception," Yale Law and Policy Review 26 (2007-2008): 75-134; B. Foddy, "A Duty to Deceive: Placebos in Clinical Practice," American Journal of Bioethics 9, no. 12 (2009): 4-12.
3. S. Bok, "Ethical Issues in Use of Placebo in Medical Practice and Clinical Trials," in The Science of the Placebo, ed. H.A. Guess et al. (London: BMJ Books, 2002), 53-74; A. Braillon, "Placebo Is Far from Benign: It Is Disease-Mongering," American Journal of Bioethics 9, no. 12 (2009): 36-38; H. Brody, "Medicine's Continuing Quest for an Excuse to Avoid Relationships with Patients," American Journal of Bioethics 9, no. 12 (2009): 13-15; K.R. Shah and S.D. Goold, "The Primacy of Autonomy, Honesty and Disclosure-Council on Ethical and Judicial Affairs' Placebo Opinions," American Journal of Bioethics 9, no. 12 (2009): 15-17.
4. Nathan A. Bostick, Robert Sade, Mark A. Levine, and Dudley M. Stewart, Jr., "Placebo Use in Clinical Practice: Report of the American Medical Association Council on Ethical and Judicial Affairs," CEJA Report 2-I-06, Journal of Clinical Ethics 19, no. 1 (2008): 58-69.
5. American Medical Association, Code of Ethics Opinion 8.083, "Placebo Use in Clinical Practice," 2006, at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8083.shtml.
6. I. Kleinman, P. Brown, and L. Librach, "Placebo Pain Medication: Ethical and Practical Considerations," Archives of Family Medicine 3 (1994): 453-57.
7. A. Hróbjartsson and P.C. Gøtzsche, "Is the Placebo Powerless?" New England Journal of Medicine 344 (2001): 1594-1602; A. Hróbjartsson and P.C. Gøtzsche, "Placebo Interventions for All Clinical Conditions," Cochrane Database of Systematic Reviews (2010): doc. no. CD003974; L. Vase, J.L. Riley, 3rd, and D.D. Price, "A Comparison of Placebo Effects in Clinical Analgesic Trials Versus Studies of Placebo Analgesia," Pain 99 (2002): 443-52; D. Spiegel, H. Kraemer, and R.W. Carlson, "Is the Placebo Powerless?" New England Journal of Medicine 345 (2001): 1276; F. Benedetti, Placebo Effects: Understanding the Mechanisms in Health and Disease (New York: Oxford University Press, 2008); F.G. Miller and L. Colloca, "The Legitimacy of Placebo Treatments in Clinical Practice: Evidence and Ethics," American Journal of Bioethics 9, no. 12 (2009): 39-47.
8. J.C. Fournier et al., "Antidepressant Drug Effects and Depression Severity: A Patient Level Meta-Analysis," Journal of the American Medical Association 303 (2010): 47-53.
9. K. Linde et al., "Acupuncture for Patients with Migraine: A Randomized Controlled Trial," Journal of the American Medical Association 293 (2005): 2118-25; D. Melchart et al., "Acupuncture in Patients with Tension-Type Headache: Randomised Controlled Trial, British Medical Journal 331 (2005): 376-82; B. Brinkhaus et al., "Acupuncture in Patients with Chronic Low Back Pain: A Randomized Controlled Trial," Archives of Internal Medicine 166 (2006): 450-57; M. Haake et al., "German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel Group Trial with 3 Groups," Archives of Internal Medicine 167 (2007): 1892-98; Miller and Colloca, "The Legitimacy of Placebo Treatments in Clinical Practice: Evidence and Ethics"; M.E. Suarez-Almazor et al., "A Randomized Controlled Trial of Acupuncture for Osteoarthritis of the Knee: Effects of Patient-Provider Communication," Arthritis Care and Research 62, no. 9 (2010): 1229-36.
10. Miller and Colloca, "The Legitimacy of Placebo Treatments in Clinical Practice: Evidence and Ethics."
11. Lichtenberg et al., "The Ethics of Placebo in Clinical Practice."
12. American Medical Association Code of Ethics, Opinion 3.0, "Nonscientific Practitioners," 1996, at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion301.shtml.
13. In "The Legitimacy of Placebo Treatments in Clinical Practice," Miller and Colloca review studies of the effect of acupuncture and sham acupuncture (insertion of needles into the skin, but at different points than traditional acupuncture prescribes) on four kinds of pain. Another study compared the effect of acupuncture and a different kind of sham acupuncture (using toothpicks to prick the skin, rather than inserting needles); D.C. Cherkin et al., "A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain," Archives of Internal Medicine 169 (2009): 858-66, DOI: 10.1001/archinternmed.2009.65. All five studies show that acupuncture and sham acupuncture are equally effective at relieving pain and are more effective than either no treatment or usual treatment (physical therapy and pain medication as needed). In "A Randomized Controlled Trial of Acupuncture for Osteoarthritis of the Knee," Suarez-Almazor et al. also found that acupuncture worked as well as sham acupuncture in relieving pain from knee osteoarthritis.
14. V.S. Sierpina and M.A. Frenkel, "Acupuncture: A Clinical Review," South Medical Journal 98, no. 3 (2005): 330-37.
15. For example, Opinion 8.082, "Withholding Information from Patients," at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8082.page; accessed March 29, 2012.
16. Bostick, Sade, Levine, and Stewart, "Placebo Use in Clinical Practice," CEJA Report 2-I-06.
17. G. Chen and M.H. Johnson, "Patients' Attitudes to the Use of Placebos: Results from a New Zealand Survey," New Zealand Medical Journal 122 (2009): 35-46, as discussed in Kolber, "A Limited Defense of Clinical Placebo Deception."
18. N. Lynöe et al., "The Attitudes of Patients and Physicians towards Placebo Treatment-a Comparative Study," Social Science and Medicine 36, no. 6 (1993): 767-74, as discussed in Kolber, "A Limited Defense of Clinical Placebo Deception."
19. M. Haake et al., "German Acupuncture Trials (GERAC) for Chronic Low Back Pain."
20. Tilburt et al., "Prescribing 'Placebo Treatments': Results of National Survey of US Internists and Rheumatologists."
21. J.C. Fournier et al., "Antidepressant Drug Effects and Depression Severity."
22. American Medical Association Code of Ethics, Opinion 8.08, "Informed Consent," 2006, at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion808.shtml.
23. J. Katz, The Silent World of Doctor and Patient (New York: The Free Press, 1984); G.S. Loeben and B.S. Wilfond, "What We Should Learn about Communication from the Placebo Effect," Ethics and Behavior 8, no. 1 (1998): 89-98; Bok, "Ethical Issues in Use of Placebo in Medical Practice and Clinical Trials"; Brody, "Medicine's Continuing Quest for an Excuse to Avoid Relationships with Patients."
24. Miller and Colloca, "The Legitimacy of Placebo Treatments in Clinical Practice"; Z. Di Blasi et al., "Influence of Context Effects on Health Outcomes: A Systematic Review," Lancet 357 (2001): 757-62; L. Colloca et al. "Overt Versus Covert Treatment for Pain, Anxiety, and Parkinson's Disease," Lancet Neurology 3 (2004): 679-84; F.G. Miller, L. Colloca, and T.J. Kaptchuk, "The Placebo Effect: Illness and Interpersonal Healing," Perspectives in Biology and Medicine 52, no. 4 (2009): 518-39.
25. Miller and Colloca, "The Legitimacy of Placebo Treatments in Clinical Practice"; T. Kaptchuk et al., "Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome," PLoS ONE 5, no. 12 (2010): e15591.
26. Pollo et al. found that patients who believed they might be taking a placebo rather than a powerful painkiller did not experience as much pain relief (as measured by requests for additional painkiller) as patients who believed they were taking powerful painkillers; A. Pollo et al., "Response Expectancies in Placebo Analgesia and their Clinical Relevance," Pain 93 (2001): 77-84 (described in Miller and Colloca). In a meta-analysis, Hróbjartsson and Gøtzsche found much variability among studies in the size of the placebo effect on various conditions and discovered larger placebo effects in drug trials that did not inform those patients receiving placebos that they might receive a placebo; Hróbjartsson and Gøtzsche, "Placebo Interventions for All Clinical Conditions." Foddy also identifies indirect evidence that disclosed placebos will be less effective than undisclosed evidence. There's ample evidence that patients benefit more when they expect more benefit; for example, patients benefit more when they receive larger pills than they do when they receive smaller pills. If patient expectations influence the therapeutic effect of treatments, then, Foddy reasons, we should expect disclosed placebos to be less effective than undisclosed placebos; Foddy, "A Duty to Deceive."
27. For example, if a patient has not been helped by an active treatment, or if the active treatment is unavailable because of cost or intolerable side effects, then a placebo treatment with proven efficacy could be the best available treatment, and the placebo will likely be most effective if the patient believes it is an active treatment; Foddy, "A Duty to Deceive"; Kolber, "A Limited Defense of Clinical Placebo Deception."