Spotlight on placebo

Doctors are actively prescribing placebos, a new Australian study has shown: and now, one stakeholder has urged patients not to always expect a medicine

Mainstream media have reported on a new study published in the Australian Journal of General Practice, in which GPs were surveyed about their use, beliefs and attitudes regarding placebos.

This study noted high international use of placebos by GPs, as well as the fact that usage in Australia is currently unknown.

A random sample of GPs from a national database were surveyed between February and April 2018; ultimately 136 GPs took part.

“Thirty-nine percent of GPs had used an inert placebo, and 77% had used an active placebo,” the researchers wrote.

“GPs primarily used placebos because they believed placebos could provide genuine benefit and viewed themselves as having a strong role in shaping patients’ expectations.

“Of concern, antibiotics were the most common type of active placebo prescribed.

“In total, 39% of respondents had used an inert placebo at some point in their careers,” the researchers wrote.

“Of the total sample, 14% reported prescribing inert placebos in general practice once a month or more.

“The GPs estimated that for every 100 patients treated, on average 4.82 – or one in 20 – are given an inert placebo. The majority (57%) of GPs who prescribe placebos reported doing so because they believe placebos can provide genuine benefit.

“Respondents also reported prescribing inert placebos because a patient expected or requested treatment (40%), where no good active treatment exists (34%) or as an adjunct to active treatment (25%).

“Fewer GPs reported prescribing placebos to treat symptoms believed to be psychosomatic (17%), medically unexplained (11%) or malingering (9%). The most commonly used inert placebo treatments were saline nasal spray (32%) and inert aqueous creams (23%).”

As for active placebos, 77% of GPs reported prescribing these during their careers, with 40% of respondents reporting active placebo use at least once per month.

“The GPs estimated that for every 100 patients treated, on average 8.33 – or one in 11 – are given an active placebo,” the researchers wrote.

“Active placebos were most commonly used to treat self-limiting viral infections (39%), sleep problems (21%) and pain-related conditions (21%).

“Antibiotics (for viral infections [42%]), vitamin or mineral supplements (17%) and complementary therapies (10%) were the most commonly prescribed active placebos.

“There was some overlap in the treatments that GPs described as inert and active placebos, with vitamin and mineral supplements frequently mentioned in both contexts.”

NPS MedicineWise has responded to the media reports by encouraging Australians to talk with their doctor about their medicines and their effects before starting treatment.

“People should not always expect a medicine when they visit their doctor,” it says.

“Antibiotics, for example, only work on bacteria, not other infections like viruses that cause colds and flu. Taking an antibiotic when it’s not needed will not make a significant difference to how you feel or how fast you recover.”

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