Abstract
BackgroundSurveys of doctors suggest that they use placebos and placebo effects clinically to help patients. However, patients' views are not well-understood. We aimed to identify when and why placebo-prescribing in primary care might be acceptable and unacceptable to patients.MethodsA purposive diverse sample of 58 English-speaking adults (18 men; aged 19–80 years) participated in 11 focus groups. Vignettes describing doctors prescribing placebos in primary care were used to initiate discussions. Data were analyzed inductively.ResultsParticipants discussed diverse harms and benefits of placebo-prescribing for individual patients, carers, healthcare providers, and society. Two perspectives on placebo-prescribing were identified. First, the “consequentialist” perspective focused on the potential for beneficial outcomes of placebo-prescribing. Here, some participants thought placebos are beneficial and should be used clinically; they often invoked the power of the mind or mind-body interactions. Others saw placebos as ineffective and therefore a waste of time and money. Second, the “respecting autonomy” perspective emphasized the harms caused by the deceptive processes thought necessary for placebo-prescribing. Here, participants judged placebo-prescribing unacceptable because placebo-prescribers deceive patients, thus a doctor who prescribes placebos cannot be trusted and patients' autonomy is compromised. They also saw placebo-responders as gullible, which deterred them from trying placebos themselves. Overall, the word “placebo” was often thought to imply “ineffective”; some participants suggested alternative carefully chosen language that could enable doctors to prescribe placebos without directly lying to patients.ConclusionsNegative views of placebos derive from beliefs that placebos do not work and/or that they require deception by the doctor. Positive views are pragmatic in that if placebos work then any associated processes (e.g. mechanisms, deception) are deemed unimportant. Public education about placebos and their effects is warranted and research to identify optimal ways of harnessing placebo effects in clinical practice is needed.
Highlights
Placebo effects can be broadly defined as changes in a person’s health status that result from the meaning and hope the person attributes to a procedure or event in a health care setting.[1,2]
Participants discussed more abstract ‘‘facts’’ about placebo effects, which were attributed to academic studies, radio and television programs; they discussed the role in illness and healing in general of psychological factors such as stress and thinking positively; and in some cases they turned to the focus group moderator to seek a more expert opinion on the veracity of placebo effects
Principal Findings Despite evidence indicating that placebos can be beneficial and lead to measurable physiological changes, there remains much professional uncertainty and contradictory views as to whether they should be used in the clinic
Summary
Placebo effects can be broadly defined as changes in a person’s health status that result from the meaning and hope the person attributes to a procedure or event in a health care setting.[1,2] These effects can be substantial[3,4,5,6] and are mediated by and involve measurable changes in neurological, immune, and endocrine systems.[7,8] In clinical research, placebo effects must be controlled for (using, for example, placebo pills or sham surgery) but are typically not thought inherently interesting.[9]. One approach is to enhance patients’ expectations and communicate empathically, for example when managing pain in primary care[12,13] or when delivering acupuncture.[14] This paper focuses on another, more controversial, approach to eliciting placebo effects: prescribing placebo-like substances such as sugar pills, ‘‘tonics’’ or low dose vitamins in primary care. Surveys of doctors suggest that they use placebos and placebo effects clinically to help patients. We aimed to identify when and why placebo-prescribing in primary care might be acceptable and unacceptable to patients
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