There is an interesting study this week in the BMJ. The study was a mailed survey to US internists and rheumatologists about their use of placebo treatments. The response rate wasn’t great (57%) but about half said they regularly prescribed placebo treatments. Most also said they thought it was ethically permissible.

Placebos do work and the placebo response is usually a clinically useful one. The question is how to use it practically without deceiving the patient. (I am not aware of any research that explores how the placebo effect varies according to what the patient is told about what the treatment contains; do let me know if you do know of any.)

Ethically, doctors should not deceive by lying or exaggerating what is being given. Some ethicists have postulated that by giving a placebo treatment and saying something like ‘we don’t really know how the treatment we are going to give you will work, but I believe it will, and it will not cause any side effects’ is okay. My  problem is that I am not quite sure this is a good enough explanation; I find the explicit omission uncomfortable.

However, the ‘placebo effect’ can be very usefully and ethically harnessed by way of ‘placebo-like’ effects,  the effect more generally of an ongoing relationship between patient and doctor. For example, continuous care from the same doctor, longer appointment times and empathy, all result in better outcomes for patients . The political direction that primary care has been sent in, though, hardly allows for the importance of these things to flourish.