Perception, deception, and placebo power

Ever heard of obecalp? It's used to treat many conditions, from the flu to fibromyalgia. Although no one knows for sure how it works, more than half of doctors in a recent survey said they regularly give it to patients. So what is this mystery treatment? Spell it backwards and you may recognize its usual name: placebo.

Placebos are substances given to patients that don't have any specific effect on their illness. Doctors occasionally call placebos "obecalp" as a code name. Placebos can be inert substances, such as sugar pills or saline injections, or active treatments, such as vitamins, painkillers, or other medications.

Doctors may prescribe them if regular treatments haven't worked or if a patient has a condition that lacks good medical options. The hope is that patients will feel better if they take something. Any improvement is believed to come from the patient's expectation that the placebo will help them (this is known as the placebo effect).

Before 1960, placebo treatments were routinely used. However, with the development of better medications and a focus on patient consent, the use of placebos has fallen out of favor. Critics say treating patients with placebos raises ethical concerns. In the words of the American Medical Association (PDF download): "the use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient."

So it's surprising to learn that many doctors still routinely give placebos to patients, usually without their knowledge. Researchers sent 1,200 surveys to general internal medicine doctors and rheumatologists. Of the 679 doctors who responded, 6 in 10 said they thought placebo use was ethically acceptable and around half said they give placebos to patients.

Most doctors reported using "active" placebos, including over-the-counter painkillers (41 percent), antibiotics (13 percent) and sedatives (13 percent). This is troubling, say researchers, since misuse of some medications can be harmful, and overuse of antibiotics can lead to drug-resistant bacteria.

Among doctors using placebos, almost 70 percent told patients the treatment was a potentially beneficial medicine not typically used for their condition. Only 5 percent explicitly said it was a placebo.

What you need to know. The AMA recommends doctors follow this approach: Explain to patients that you would like to try different treatments, including a placebo, to better understand their medical condition. If the patient agrees to this, the physician isn't obliged to say which treatment is the placebo or when it is being given.

As a patient, I'm not sure how I'd feel if my doctor suggested using a placebo. But I think I'd rather know a placebo might be used than to have my doctor try one without my consent. How about you? You can share your thoughts below.

—Sophie Ramsey, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Read what Dr. Marvin Lipman, one of our Health Experts, says about placebo power.