Survey finds many patients OK with placebos in primary care

A majority of patients favored allowing placebo treatments in medical care, especially when they were used honestly and transparently, a recent telephone survey found.

Researchers surveyed 853 Northern California patients, ages 18 to 75, who had been seen by a primary care clinician for a chronic health problem in the previous six months. Patients were asked some general questions about their beliefs on placebos and given specific scenarios in which a placebo might be used. Results were published online by BMJ on July 2.

Only 21.9% of the survey respondents said that it was never acceptable for physicians to recommend placebos, with 76.2% saying it was acceptable to prescribe a placebo that's expected to benefit and not harm the patient. However, only half of the respondents approved of prescribing a placebo of uncertain benefit.

Respondents had complicated views on honesty and placebos: Over 80% believed that placebos can only be effective if patients don't know they are taking a placebo. However, slightly less than half thought it was acceptable for a physician to call a placebo “real medicine.” When given a scenario in which a patient asked for antibiotics to treat a cold and was given a placebo instead, more than half the respondents thought finding out the medication was a placebo would negatively impact the patient's future relationship with the physician.

The respondents expressed willingness to try placebos in their own care. Given a scenario of moderate stomach pain with no clear cause, two-thirds of respondents would be willing to try a medication that their doctor said might help through a placebo effect, and in another scenario, over half would be willing to take a placebo for chronic abdominal pain that had been shown in studies “to produce relief through mind-body self-healing processes.”

The survey's results reveal a disconnect among clinical practice guidelines (which recommend against placebo use), physicians' practices and patient opinions, the study authors concluded. The survey participants were more highly educated than the overall U.S. population, and yet their conflicting answers about “open” placebos raise questions about how well they understand the concept of placebos. Based on the survey's findings, physicians may want to consider discussing placebos with their patients and tailoring treatment according to patients' preferences and beliefs on the subject, the authors concluded.