Prescribing "placebo treatments": results of national survey of US internists and rheumatologists

Tilburt, Jon C.; Emanuel, Ezekiel J.; Kaptchuk, Ted J.; Curlin, Farr A.; Miller, Franklin G.

doi:10.1136/bmj.a1938

Cited by 240 publications

(243 citation statements)

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“…4,6 Patients' expectations can alter the course of illness, and surveys indicate that physicians often prescribe medications to promote placebo effects. [7][8][9] It is time to apply these findings to the ethics of shared decision-making (SDM), especially given SDM's inclusion in the Affordable Care Act of 2010. 10 The term SDM is often used inconsistently.…”

Section: Introductionmentioning

confidence: 99%

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

2012

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Recent research into the placebo effect has implications for the ethics of shared decision-making (SDM). The older biomedical model views SDM as affecting which therapy is chosen, but not the nature or likelihood of any health outcomes produced by the therapy. Research indicates, however, that both the content and manner in which information is shared with the patient, and the patient's experience of being involved in the decision, can directly alter therapeutic outcomes via placebo responses. An ethical tension is thereby created between SDM aimed strictly and solely at conveying accurate information, and "outcome engineering" in which SDM is adapted toward therapeutic goals. Several practical strategies mitigate this tension and promote respect for autonomous decision-making while still utilizing the therapeutic potential of SDM.

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Section: Introductionmentioning

confidence: 99%

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

2012

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“…About 75% (68/90) of the practitioners opined in favor of psychological mechanism for A survey of GPs reported 86% prevalence of use of placebo at least once within the past year, and 48% using placebo treatments more than 10 times in the past year. [4] Another study reported 60% prevalence, [2] a national survey of U.S. internists and rheumatologists showed 55% prevalence [3] while a study of U.S. academic physicians reported 45% prevalence. [5] Our study showed higher (89%) prevalence of placebo prescribing; and of these, 80% reported using it more than 10 times a year.…”

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confidence: 99%

“…These findings are similar to those of U.S. studies. [3,5] Only 9% reported use of saline and distilled water injections, showing a trend of preferential use of "impure" placebo over "pure" placebo. [1] Limitations of this study are its small sample size and possible under-reporting by the practitioners.…”

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confidence: 99%

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Use of placebo: Knowledge, attitude and practice among medical practitioners

Shah¹,

Panchal²,

Vyas³

et al. 2009

Indian J Med Sci

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“…Vitamin C was thought to be a reasonable placebo particularly for this study due to the fact that it has not been suggested to mediate food selection (Cangiano et al., 1992, 1998; Morris et al., 1987). Conventional placebo pills that have been used in other pharmacological research were sugar pills (dextrose), over the counter analgesics as well as vitamins (Tilburt, Emanuel, Kaptchuk, Curlin, & Miller, 2008). Since caloric intake was the main focus of this study, the placebo used did not have any active ingredients that could have contaminated the data, or intervened with the transmission of tryptophan to the brain such as fatty acids (insulin spikes Golomb et al., 2010), or contain traces of tryptophan (e.g., rice, oats) (Gerhardt & Gallo, 1998).…”

Section: Methodsmentioning

confidence: 99%

Preliminary fMRI findings concerning the influence of 5‐HTP on food selection

Ioannou

Williams

2016

Brain and Behavior

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ObjectiveThis functional magnetic resonance imaging study was designed to observe how physiological brain states can alter food preferences. A primary goal was to observe food‐sensitive regions and moreover examine whether 5‐HTP intake would activate areas which have been associated with appetite suppression, anorexia, satiety, and weight loss.Methods and ProcedureFourteen healthy male and female participants took part in the study, of which half of them received the supplement 5‐HTP and the rest vitamin C (control) on an empty stomach. During the scanning session, they passively observed food (high calories, proteins, carbohydrates) and nonfood movie stimuli.ResultsWithin the 5‐HTP group, a comparison of food and nonfood stimuli showed significant responses that included the limbic system, the basal ganglia, and the prefrontal, temporal, and parietal cortices. For the vitamin C group, activity was mainly located in temporal and occipital regions. Compared to the vitamin C group, the 5‐HTP group in response to food showed increased activation on the VMPFC, the DLPFC, limbic, and temporal regions. For the 5‐HTP group, activity in response to food high in protein content compared to food high in calories and carbohydrates was located in the limbic system and the right caudomedial OFC, whereas for the vitamin C group, activity was mainly located at the inferior parietal lobes, the anterior cingulate gyri, and the left ventrolateral OFC. Greater responses to carbohydrates and high calorie stimuli in the vitamin C group were located at the right temporal gyrus, the occipital gyrus, the right VLPFC, whereas for the 5‐HTP group, activity was observed at the left VMPFC, the parahippocampal gyrus bilaterally, the occipital lobe, and middle temporal gyri.DiscussionIn line with the hypotheses, 5‐HTP triggered cortical responses associated with healthy body weight as well as cerebral preferences for protein‐rich stimuli. The brain's activity is altered by macronutrients rich or deprived in the body. By reading the organisms physiological states and combining them with memory experiences, it constructs behavioral strategies steering an individual toward or in opposition to a particular food.

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Prescribing "placebo treatments": results of national survey of US internists and rheumatologists

Abstract: Objective To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.

Cited by 240 publications

References 19 publications

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

The Placebo Phenomenon: Implications for the Ethics of Shared Decision-Making

Use of placebo: Knowledge, attitude and practice among medical practitioners

Preliminary fMRI findings concerning the influence of 5‐HTP on food selection

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