Placebos in Clinical Practice: Comparing Attitudes, Beliefs, and Patterns of Use between Academic Psychiatrists and Nonpsychiatrists

• Published in: Canadian journal of psychiatry 2011-04, Vol.56 (4), p.198-208
• Main Authors: Raz, Amir, Campbell, Natasha, Guindi, Daniella, Holcroft, Christina, Déry, Catherine, Cukier, Olivia
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Clinical Medicine - methods; Clinical Medicine - standards; Complementary Therapies - ethics; Complementary Therapies - methods; Complementary Therapies - standards; Culture; Data Collection; Ethics, Medical; General Practitioners - ethics; General Practitioners - psychology; Health Services Research; Hospitals, University; Humans; Medical research; Physicians; Placebo Effect; Placebos - therapeutic use; Practice Patterns, Physicians' - ethics; Practice Patterns, Physicians' - standards; Psychiatric Department, Hospital; Psychiatry; Psychiatry - ethics; Psychiatry - methods; Psychiatry - standards; Science; Studies; Surveys and Questionnaires
• ISSN: 0706-7437; 1497-0015
• DOI: 10.1177/070674371105600403

Controversial and ethically tenuous, the use of placebos is central to medicine but even more pivotal to psychosocial therapies. Scholars, researchers, and practitioners largely disagree about the conceptualization of placebos. While different professionals often confound the meanings of placebo effects with placebo responses, physicians continue to prescribe placebos as part of clinical practice. Our study aims to review attitudes and beliefs concerning placebos outside of clinical research. Herein we compare patterns of placebo use reported by academic psychiatrists with those reported by physicians from different specialties across Canadian medical schools. Using a web-based tool, we circulated an online survey to all 17 Canadian medical schools, with a special emphasis on psychiatry departments therein and in university-affiliated teaching hospitals. A variation on earlier efforts, our 5-minute, 21-question survey was anonymous. Among the 606 respondents who completed our online survey, 257 were psychiatrists. Our analysis revealed that psychiatrists prescribed significantly more subtherapeutic doses of medication than physicians in other specialties, although about 20% of both psychiatrists and nonpsychiatrists prescribed placebos regularly as part of routine clinical practice. However, compared with 6% of nonpsychiatrists, only 2% of psychiatrists deemed placebos of no clinical benefit. In addition, more than 60% of psychiatrists either agreed or strongly agreed that placebos had therapeutic effects relative to fewer than 45% of other practitioners. Findings from this pan-Canadian survey suggest that, compared with other physicians, psychiatrists seem to better value the influence placebos wield on the mind and body and maintain more favourable beliefs and attitudes toward placebo phenomena.