Placebos receive little attention in the health policy space. I’m not sure if they are understudied by researchers, but it seems so. Are they underused or overused? How much do we pay for them? What are the benefits and harms? What are the ethical considerations?
The recent PLOS ONE paper by Jeremy Howick and colleagues is a good place to start.
Placebos may represent one of the more commonly used treatments in UK primary care in spite of (perhaps sometimes unjustified) ethical constraints. Twelve percent of respondents reported using pure placebos, and 97% reported using impure placebos at least once in their career. Many placebos were used frequently by over half the respondents, and most general practitioners felt there were circumstances in which impure and pure placebos were ethically acceptable. Half of the practitioners who use placebos informed their patients that this intervention has helped other patients without specifically telling them that they were prescribing a placebo. This raises unresolved ethical issues about how GPs approach informed consent in relation to their prescriptions of placebos. The analysis indicates potential gender differences in the frequency of placebo prescriptions. […]
The survey instrument was derived from previously published investigations and enables our data to be easily compared with other international studies. A 2009 systematic review of 22 surveys of placebo use in general practice in 12 countries found 17% to 80% of practitioners had used ‘pure’ placebos at least once in their career and between 54% and 57% had used impure placebos at least once in their career. The latest survey of placebo use was published after the systematic review and found 45% of German GPs had used pure placebos and 76% had used impure placebos in the last year. Hence the results of our UK survey are internationally consistent.
A “pure placebo” has no active ingredient, like sugar pills or saline injections. An “impure placebo” has an active ingredient appropriate for some conditions but used in circumstances for which their efficacy is unknown or known to be of little to know value, like antibiotics for viral infections.
What if comparative effectiveness or cost effectiveness analysis led to a reduction in use of impure placebos or an increase in the use of pure placebos?