Abstract
We aimed to investigate the use of placebos (e.g. saline injections) and non-specific treatments (e.g. vitamin supplements in individuals without a relevant deficiency) among physicians working in private practices in Germany, and how such use is associated with the belief in and the use of complementary and alternative treatments, and basic professional attitudes. A four-page questionnaire was sent to nationwide random samples of general practitioners (GP), internists and orthopaedists working in private practices. The response rate was 46% (935 of 2018). 24% of GPs, 44% of internists and 57% of orthopaedists had neither used pure placebos nor non-specific therapies in the previous 12 months. 11% percent of GPs, 12% of internists and 7% of orthopaedists had exclusively used pure placebos; 30%, 33% and 26%, respectively, had exclusively used non-specific therapies; 35%, 12% and 9% had used both. Age, sex and agreement to the statement that physicians should harness placebo effects were not significantly associated with any pattern of use. Exclusive use of pure placebos was associated with being a GP, being an internist, and having unorthodox professional views. In addition to these three factors, a lower use of CAM therapies and a wish for having more time was associated with the exclusive use of non-specific therapies. Among physicians using both pure placebo and non-specific therapies, heterodox views were also somewhat more pronounced. However, associations were particularly strong for being a GP (Odds ratio 11.6 (95%CI 6.41; 21.3)) and having orthodox views (Odds ratio 0.10 (95%CI 0.06; 0.18)) among this group. In conclusion, the use of placebos and non-specific treatments varies strongly between medical specialties and is associated with basic professional attitudes. The findings support the view that the use of placebos and, in particular, of non-specific therapies is primarily a coping behaviour for difficult and uncertain situations.
Highlights
There is clear evidence that many physicians in primary and secondary care, to some extent, use treatments for patients or in situations even though they hold a personal view that these treatments only have non-specific or placebo effects
A recent survey among UK general practitioners (GP) found that 12% had used treatments that do not contain any active components such as saline injections or sugar pills at least once in their professional life. 97% had used treatments containing active or potentially active components that did not have a specific effect on the condition treated, such as antibiotics for viral infections or vitamin supplements in individuals without relevant deficiency [4]
In the survey presented in this paper we aimed to investigate the use of placebos and non-specific treatments among GPs, internists and orthopaedists working in private practice in Germany
Summary
There is clear evidence that many physicians in primary and secondary care, to some extent, use treatments for patients or in situations even though they hold a personal view that these treatments only have non-specific or placebo effects. This evidence mainly comes from two quite different lines of research. 97% had used treatments containing active or potentially active components that did not have a specific effect on the condition treated, such as antibiotics for viral infections or vitamin supplements in individuals without relevant deficiency (called ‘impure’ placebos or non-specific treatments) [4]. One major survey defined placebo treatment to participants as ‘‘a treatment whose benefits derive from positive patients expectations’’ [3]
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