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Experts debate giving placebos to patients

February 3, 2010 12:00:00 AM PST
Placebos are widely used in clinical trials and the power of the placebo effect is widely known, but would you know if your doctor gave you a sugar pill instead of real one? Some say the most effective medicine may be all in your head.When 5-year-old Eden Levin gets sick, his parents are quick to give him medicine.

"As a mom, I am for having my children feeling much better very quickly, so I do believe in medication," said Eden's mother Karine Etieve.

But it's not the kind other kids get. He gets juice, but his parents tell him it's medicine. Barack Levin chooses placebos to help his son get through illness.

"The placebo effect, for me, is to give the kids the feeling that they're taking medication when they're not really taking anything," Barack explained.

Many doctors don't agree with this tactic. Psychologist Tor Wager calls it a dangerous game of deception.

"It's not just mind over matter. It's dangerous for the relationship and for trust in medicine," explained Wager.

Parents aren't the only ones who believe in placebos. A study out of the National Institutes of Health reports half of doctors prescribe placebos.

The most common placebos prescribed are painkillers followed by vitamins, antibiotics and sedatives.

"Somehow, this thought process of anticipation actually does something in the brain that's similar to what happens when you get an active treatment," said Dr. Walter Brown, a clinical psychology professor at Brown University and Tufts University School of Medicine.

The NIH study reveals 62 percent of doctors find placebos ethically acceptable. Fifty percent report using placebos several times a month.

In children, one study shows that fake pills can help kids deal with attention deficit disorder. ADHD kids were asked to reduce their meds gradually and replace them with placebos.

"In ADHD in kids, you can reduce the dose of the real medicine, substitute placebo pills and get the same effect on ADHD," said Brown.

As for Barack Levin, he says that as long as the fake meds don't hurt, he'd rather give his children a sugar pill than a dose of something they don't need. However, if his child's problem does not go away within a few hours, he will give them medication or take them to a doctor.

When it comes to placebos, there is a difference between men and women.

The people most likely to respond to placebos tend to be those who are most optimistic, and that tends to be women.

In the future, doctors hope to harness how placebos work and stimulate the brain to enhance treatment, essentially hooking into the body's own natural production of pain relief.

More information about placebos


According to a new survey, nearly half of American doctors report regularly giving their patients placebo treatments. For the purpose of the survey, the definition of "placebo" went beyond sugar pills. These "treatments" typically included vitamins or harmless drugs such as pain relievers, antibiotics or saline injections, which were disguised as medical therapies. Researchers from the National Institutes of Health sent out surveys to 1,200 internists and rheumatologists. They received 679 responses. Of those who responded, 62 percent found placebo treatments ethically acceptable.

About half reported using the placebos several times a month. Of those who used placebos, 70 percent told patients the treatments were "a potentially beneficial medicine not typically used for your condition." Only 5 percent of doctors using placebos directly informed their patients of this fact. The survey found that, in some cases, placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also gave antibiotics to patients with viral bronchitis even though the virus is unreceptive to these drugs.

Do they work?:

In 1955, in the ground-breaking research paper "The Powerful Placebo," researcher H.K. Beecher concluded that one-third of all patients responded to a placebo. According to the Food and Drug Administration, other studies show up to 75 percent of patients respond to sugar pills. A recent small study published in the Journal of the American Medical Association found antidepressants may be just a little more effective than a sugar pill for most patients. Other research shows placebos can help patients with cancer, irritable bowel syndrome and multiple sclerosis.

Is it ethical?:

Many believe it is unethical for doctors not to disclose the use of placebo treatments to their patients. The American Medical Association's guidelines recommend that doctors only use placebos if the patient is informed and has consented. "In the clinical setting, the use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient," an AMA ethics panel said in 2006. Others argue disclosing this fact would counteract the potential effectiveness of the placebo treatment.

More information about placebo meds and kids

Placebo background:

According to the Merriam-Webster Dictionary, a placebo is usually a pharmacologically inert preparation prescribed more for the mental relief of the patient than for its actual effect on a disorder, something that is tending to soothe. The use of placebo pills is often compared to "mind over matter" healing. Placebo is an important phony treatment used to keep doctors and patients honest in clinical trials. It is used to prove if a drug works. Placebo pills are commonly used in birth control packs to ensure that you do not fall out of habit and keep an everyday pattern (Source: Associated Content). Recently, new studies show that nearly half of United States doctors surveyed have prescribed a placebo pill at some point. This high use of placebos has ignited ethical questions among many doctors. (Source: Reuters)

Placebos and ADHD:

Placebos are making their mark in the world of ADHD prescriptions. According to Science Daily, a study out of Chapel Hill showed a significant percentage of children with attention-deficit-hyperactivity disorder doing just as well when taking placebo to replace some of their daily medications. The study indicated that children can be treated with lower doses of medication with a placebo supplement.

Researchers have also found that there are four ways a placebo can have an effect on ADHD patients: Child expects change with direct use of a medication.

Positive change of caregiver's perception of children who think they are taking medication. Positive change in how caregivers behave towards children with ADHD who think they are on medication. Routine behavioral improvement when connected to administering a placebo pill. (Source: Psych Central)

Obecalp and efficacy brands:

Obecalp, "placebo" spelled backwards, is a chewable, cherry-flavored sugar pill marketed to parents to comfort children who are not feeling well. Obecalp is the first standardized, branded and pharmaceutical-grade placebo in the world. Obecalp is produced as a dietary supplement and is not FDA approved because it does contain any drugs. Obecalp is available online at http://www.inventedbyamommy.com.

For More Information, you can contact Walter A Brown of Brown University and Tufts University School of Medicine at Walter_brown@brown.edu.

You can also contact Dr. Tor Wager of Columbia University at Tor.Wager@Colorado.edu.