The Burrill Report

A professor of psychiatry whose past work as a magician spurred an interest in deception and the power of belief finds doctors are conflicted over the use of placebos.

Amir Raz, a McGill psychiatry professor who recently led a survey of physicians and psychiatrists at Canadian medical schools, found that one in five respondents said they had administered a placebo. But the study published in the Canadian Journal of Psychiatry found an even higher proportion of psychiatrists (more than 35 percent) reported prescribing doses of medication below the minimum recommended therapeutic level to treat their patients.

The survey also found that more than 60 percent of the psychiatrists that responded to the survey believe that placebos can have therapeutic effects. That compared to less than 45 percent for other physicians.

Prescribing what Raz calls “pseudoplacebos”– treatments that are active in principle, but that are unlikely to be effective for the condition being treated, such as using vitamins to treat chronic insomnia–is more widespread than we may have thought according to the survey. Raz and his colleagues suggest that this may be because physicians have shown themselves to be more prepared to prescribe biochemically active materials even at lower doses than might be effective.

“While most physicians probably appreciate the clinical merits of placebos, limited guidelines and scientific knowledge, as well as ethical considerations, impede open discussion about the best way we may want re-introduce placebos into the medical milieu,” says Raz. He adds, “This survey provides a valuable starting point for further investigations into Canadian physicians' attitudes towards and use of placebos.”

Raz notes that placebo use is controversial. He says in 2006, the American Medical Association said physicians may use a placebo only if the patient is informed and agrees to its use. The AMA statement followed a meta-analysis of clinical trials, since much criticized, which suggested placebo effects are either minimal or nonexistent. In fact, re-analysis of the same data, he says, yielded findings of “a robust placebo effect” that resulted in “a flurry of rebuttals and debates.”

Within the field of psychiatry, there have been studies, he notes, that suggest antidepressants are no better than placebos at treating patients with mild to moderate depression.

In a video posted on YouTube in which Raz describes his research he says there’s a disconnect between what we know about placebos and the way the medical community acts.

“When you are able to help a person, I do not argue with the help,” he says. “If a placebo is doing is it, or a real genuine bioactive drug is doing it, that’s not an issue for me. For me the issue is helping people cope with their symptoms and with their diseases.”




May 13, 2011
http://www.burrillreport.com/article-placebo_hocus_pocus.html