Use of placebos common among physicians

The most well-known placebo is a sugar pill, but it can also be any inactive medication that could prompt physical relief of symptoms. Placebos also come in other forms, including nocebos, or negative placebos, which can result in physical discomfort or side effects from the inactive medication.

A survey of the use of placebos among Chicago physicians was published in the Journal of General Internal Medicine last month. Of the 230 physicians who responded, 45 percent reported they had used a placebo in clinical practice. The most common reasons for using placebos were to calm the patient and as supplemental treatment.

The guidelines on placebos for the American Pain Society, published in 2005, defined placebos as “a therapeutic effect thought to be nonspecific to the treatment.”

Maurice Warner, associate director of the UW Counseling Center, said all psychology research takes the placebo effect into account.

“For example, there was an acupuncture study where some research subjects were poked with a retractable needle, yet they said they felt the effects of the treatment,” she said.

Physician T. C. Graves first introduced the term “placebo” in an essay published in the medical journal The Lancet in 1920. Warner said placebos have been accepted within psychology for decades.

Greg Terman, an anesthesiology professor at the UW, said when he gives a pain medication to a patient expecting to feel relief, they may feel relief even before, or in addition, to the actual drug effect.

“These effects are neither unethical [n]or due to people’s being crazy,” he said. “There are a number of studies that placebo effects (at least in pain) are due to endorphin release and specific pain inhibitory systems within the brain and spinal cord.”

Terman said people may also develop a nocebo response after starting a treatment. 

“These are bad effects which we think are nonspecific,” he said.

He added that he believes the nocebo response is less common.

“That may be because hopefully fewer people take medications expecting to get bad effects,” he said. “On the other hand, if you take drugs for your cancer and they make you sick but you have to keep taking them, you may soon find yourself getting sick even before the meds have a chance to work, even before you take them.”

The term ‘nocebo response’ was coined in 1961 by Walter Kennedy to describe negative response to an inactive treatment due to the negative expectation of a patient.

Judith Turner, a psychiatry and behavioral sciences professor at the UW, cited an example published last year in the General Hospital Psychiatry journal.

“A man … came to the ER, saying that he had taken all the pills in a bottle of antidepressant medication and collapsed,” she said. “He was drowsy and lethargic, pale, had a very low blood pressure [and] rapid breathing. The patient expressed fear he would die from the overdose, and said [the] antidepressant medication [was] part of a clinical trial.”

The patient had actually been assigned to the placebo group and had taken a bottle of inert pills, Turner said.

“Within 15 minutes of being informed of this, the patient was fully alert, with normal blood pressure and heart rate,” she said.

[Reach reporter Chris Paredes at news@thedaily.washington.edu.]