German medical group recommends placebos

Globe and Mail Update

Consider this ethical dilemma: A doctor believes a fake pill might work better for your difficult symptoms – and have fewer side effects – than real medication. But it only works if she doesn’t tell you the truth. Should she do it?

In North America and Britain, medical associations have balked at the idea, saying that giving placebos without patient consent is unethical. (Even though previous studies suggest as many as half of the doctors in Britain, Denmark and the United States are doing so regularly. )

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But the German Medical Association is actually recommending that doctors in that country do it more often, after a major study found that placebos often work – especially for chronic pain and depression, which can be hard to treat and often involve medications with severe side effects. (Placebos are usually made up of ingredients such as sugar or flour, though they may also be vitamins or herbal supplements.)

The British Medical Association has taken a strong stand again prescribing placebos, arguing that it would erode trust between patients and physicians. But the German doctors says that although placebos should not be used for illnesses such as cancer or broken bones, they can be effective in cases where some of the symptoms are subjective. Even then, they shouldn’t be used when other effective treatment exists, said Dr. Peter Scriba, chair of the German Medical Association’s advisory board.

And although doctors don’t have to use the word “placebo,” they should tell patients they are getting an unusual treatment. “You could tell the patient you have something that has helped other patients with their condition, and you consider it possible this treatment might help,” Dr. Scriba was quoted as saying in a Canadian Press story. (The American Medication Association, on the other hand, emphasizes that doctors can’t give placebos to deal with a difficult patient, or out of convenience, and then not without the patient’s knowledge. In Canada, a medical working group on ethics has previously suggested that using placebos in trials where an effective treatment exists is unethical.)

Ted Kaptchuk, an associate professor of medicine at Harvard Medical School, has done research that suggests it may not always be necessary for the patient to be kept in the dark.

In a small-scale study published last December involving 80 patients with irritable bowel syndrome, half were given no treatment while the other half knowingly took daily “sugar pills” stored in bottles labelled “placebo.” The fake meds appeared to work roughly as well as some of the most powerful medication for IBS.

Another study published last fall found that sexual satisfaction among women improved after taking a placebo to increase their sex drive.

If a fake pill could make you better, would you be okay with your doctor not telling you about it?