• Patients don’t always mind being in the dark…

    Counter-intuitive study in the BMJ. “Patients’ attitudes about the use of placebo treatments: telephone survey“:

    Objective To examine the attitudes of US patients about the use of placebo treatments in medical care.

    Design One time telephone surveys.

    Setting Northern California.

    Participants 853 members of Kaiser Permanente Northern California, aged 18-75, who had been seen by a primary care provider for a chronic health problem at least once in the prior six months.

    In medicine, we do things all the time that we don’t have any expectation will work. The placebo effect  is a well known phenomenon where the patient’s expectation that a treatment will work, actually makes it so. Doctors could capitalize on this by prescribing harmless things like vitamins or analgesics with the hope that patients will get an additional unexpected benefit. But it’s an ethically controversial area, and in the US this practice is generally frowned upon.

    There are times I wonder if that’s a good idea. Often, both doctors and patients want to do something to treat a problem. Doing nothing feels like giving up. This leads some physicians to perform procedures or give therapies of little to no value, but where the potential harms are real. I’ve often felt that if you were forced to do something that you believed had no benefit, you might as well make it also as harmless as possible. Like a sugar pill.

    This study asked patients if they would be ok with that. Would they object to being misled for their own benefit. I was surprised by the results.

    Only about a fifth of respondents said that placebo treatments were never ok. Many people were far more accepting. Is it acceptable for doctors to try placebo treatments for stomach pain when patients do not know doctors are recommending a placebo treatment? 71% said probably or definitely yes. Is it acceptable for doctors to give patients placebo treatment for cold symptoms if patients are told that they are getting medicine that is safe, has no side effects, and helps some people get better when they take it? Two thirds of people said yes.

    From the Discussion:

    The opinions of US patients have been missing from debates over the use of placebo treatments in clinical practice and deliberate efforts by physicians to enhance patient care by promoting placebo responses. Our data show that patients are open to the idea of placebo treatments. Most (50-84%) judged it acceptable for doctors to recommend placebo treatments under conditions that varied according to the doctor’s level of certainty about the benefits of the treatment, the purpose of the treatment (for example, to address a patient’s need to receive a treatment), and the transparency with which the treatment was described to patients.

    I don’t think we should take this data to mean we should all start prescribing placebos. But I do think it’s compelling, and really worth studying further.

    @aaronecarroll

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