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Poser's avatar

Can a physician be sued for prescribing a placebo?

Asked by Poser (7789 points ) November 23rd, 2010

I was discussing medical ethics questions with my girlfriend, who is well on her way to becoming a physician. She stumbled across this question posed to practicing PhD’s: “Would you ever prescribe a treatment that is a placebo, simply because the patient wanted treatment?” 24% of doctors said “Yes,” and 58% said “No.”

I saw three separate issues with this. First, you’d be lying to your patient. But the lying is, by definition, what gives a placebo its effectiveness. You wouldn’t be lying to cover up any inherent ethical flaws in yourself or your practice, but in order to treat the patient.

Second, prescribing a placebo in place of a much harsher chemical which may have unhealthy side effects is, medically speaking, much safer and in the better interest of the patient.

And third, much of the medical world today is driven by drug company profits. That is why the pharmaceutical companies are marketing directly to the patient, rather than just to the phsycian. The patient, of course, has little to no medical training or knowledge and may be prone to false hope and falling for the marketing ploys of the drug co’s. The doctor may not be able to convince the patient that the risks don’t necessarily outweigh the rewards and fear the patient going somewhere else to obtain the drug.

In discussing this, my girlfriend wondered aloud whether choosing to prescribe a placebo could feasibly get a physician into trouble. Assuming that the doctor didn’t withold treatment that could reasonably be expected to provide relief for a symptom, could a doctor be sued for this?

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19 Answers

iamthemob's avatar

Assuming that there were no health consequences, I feel like the only damages might be whatever the cost of the prescription was. There may be professional consequences, but I don’t know about legal.

I just see very few reasons to prescribe a placebo instead of just refusing additional treatment – I can only think of (1) an attempt to placate the patient so that they won’t pursue potentially harmful treatment through another doctor or by themselves, or (2) simply not wanting to lose the patient, and knowing that it won’t do any harm.

In all honesty, highly specialized professionals really sometimes have to pretend or manipulate in order to ensure that clients or patients won’t really “eff” things up.

faye's avatar

We used to give placebos in hospital back in 1974! I don’t think it’s legal in Canada now- patients rights. You just can’t lie to me.

Seaofclouds's avatar

This article (though a few years old) makes it sound like it’s not illegal for doctors to prescribe placebos.

Here is the American Medical Associations stance on it. So it sounds like they can do it, but they are suppose to tell their patients it is a placebo or that they are going to try a few different things and that one of them will be a placebo, but not necessarily say which one is the placebo.

With the number of people that use Google for medical advice these days, I’d imagine they would fine out really quickly anyway in most cases.

iamthemob's avatar

I wonder whether there would be fraud issues if there were any insurance/pharmacy third party fillers involved as well.

faye's avatar

You can’t give a prescription for a placebo- can’t charge for it! It would be fraud to me

Seaofclouds's avatar

@faye From what I was reading, there were prescription placebos at one time. According to this and this the FDA approved several placebos to go on the market several years ago. Now, I read somewhere that there was talk of banning placebos, but as of right now, I haven’t found anything that has said it has been done (other than satire about Bush telling the FDA to ban them). I looked up the medications mentioned in the first article though and it doesn’t really look like they exist at this time (so either they have been removed or they have just changed the names). From what I could find, it looks like Cebocap and Obeclap were the most recent ones out there. Cebocap required a prescription, but it looks like Obeclap was labeled as a supplement. I couldn’t really find anything that said it needed a prescription. The information about those was really limited as well, so it could be that they aren’t used anymore. I wouldn’t be surprised if there was something else being used though.

faye's avatar

I know I said to a doctor that we should give one patient a saline shot int her IV just to make her happy. She would have been, too, would have gone to sleep feeling we really helped her. He was young and looked at me like I was eating a kitten- the horror. So I don’t think it’s big up here. I know some of the older doctors were joking about the good old days once. I’ll look it up for us.

flutherother's avatar

I expect my doctor to tell me the truth and he expects me to listen. I have respect for the medical profession and would be very unlikely to ever sue.

Kayak8's avatar

Back in the day, placebo’s (sugar pills) were often given by the doctor (like a drug sample) rather than having the patient go to the pharmacy and pay for the script. This is the same era of medicine that gave us the ad that featured a rocking chair that appeared to be made of carved clay. The arms of the chair were a woman’s arms and featured a woman’s head and shoulders as the top of the chair back. The caption read: “Is she becoming a fixture in your office? Valium”

There is a long history of the predominantly male medical community coming up with solutions for “women’s issues” rather than taking us seriously. Placebos were the least of it.

john65pennington's avatar

What about the co-payment? if the physician does issue a placebo script, the co-payment should be at cut 50%, since a person is not receiving anything, except a sugar pill.

Your question reminds me of a ruling handed down by The U.S. Supreme Court, that the police can lie to an individual, in order to obtain the truth.

Somehow, this seems to fit the same, as the question you asked.

marinelife's avatar

Apparently not.

“In a study published this week in the Journal of General Internal Medicine, a student-and-professor team at the University of Chicago surveyed 466 faculty physicians at Chicago-area medical schools. Almost half of the 231 respondents — 45% — said they had prescribed placebos in regular clinical practice and, of those, just over half had prescribed them in the previous year. Among the reasons the doctors gave: to calm a patient down, to respond to demands for medication that the doctor felt was unnecessary, or simply to do something after all other clinical treatment options had failed.

For its part, the American Medical Association (AMA), the largest association of U.S. doctors and medical students, tells its members that ”[p]hysicians may use placebos for diagnosis or treatment only if the patient is informed of and agrees to its use.”

Time Magazine

wundayatta's avatar

It’s pretty clear you can’t prescribe it without telling the patient what it is. Having said that, I don’t think it matters. What matters is that you are a doctor and the patient is the patient. If the doctor gives the patient a pill and says “this is a sugar pill. It will help you.” The placebo could still work. I mean, that’s what homeopathic doctors do. Only they claim there are trace elements of something in it that can make you ill. Maybe so. It’s still a sugar pill, and a lot of people say homeopathic medicine works.

Also, they reinforce the mental effects with ritual effects. “Hold the pill under your tongue until it dissolves.” It’s all smoke and mirrors and yet, knowing it’s a placebo, patients allow themselves to be sold on it, anyway, and it still works!

faye's avatar

I’d like to know the IQ of someone told he is getting a sugar pill and is still happy about it. I got a bit bogged down and sleepy last night. Everything I looked at in Canada stuff had to do with placebo use during clinical trials.

wundayatta's avatar

@faye I’ve been told I’m smart, and I have often taken sugar pills, knowing they are sugar pills and found them to work. The power of the mind is an amazing thing. Sometimes, all it takes to will yourself into health is a little prompting. I guess it wouldn’t work with people who don’t believe their attitudes have anything to do with their health.

After hearing this, maybe people will now think my IQ is below 100. Whatever.

Seaofclouds's avatar

To add to what @wundayatta said, the placebos can act as a little something extra to help a person will something away. Some people can say “I don’t have a headache” and their headache will go away (yes I know people that can do it). For others, perhaps that can’t quite do that, they can say “this pill will help my headache go away” and it will work. When our mind expects something to happen in relation to taking the pill, it often compensates. We start feeling better because we expect to feel better. That really is the whole basis behind the placebo effect for the most part.

faye's avatar

I asked my pharmacist today if he had ever had anything to do with placebos and he said no. This is Canada. @wundayatta and@Seaofclouds I understand the power of the mind. @wundayatta how would you think a sugar pill would help you? Better a warm blanket.

wundayatta's avatar

@faye I’ve noticed there’s this doctor effect. I’m sick and I stay home, hoping to get better. Finally I decide I better go to the doctor. The doctor tells me it’s a virus and will get better soon. And two days later, I’m better.

It’s just the doctor’s suggestion, and it works. It works with homeopathic medicine, too. Doctors tell you you will get better, and they give you some solution that is so dilute you can’t even detect the active ingredient, and it works. Patients get better. Homeopaths harness the power of the mind, I believe.

iamthemob's avatar

@wundayatta – I feel like that “doctor effect” is only accurate if you stay at home for inconsistent amounts of time; i.e., if it generally takes you 3 or 4 days to get to the doctor, then there’s no measurable effect, but if you stay home 1 day some times, and a week others, then that shows some correlation.

mollysmithee's avatar

The doctor could be sued if the fact that the doctor failed to prescribe another drug that would have been effective resulted in direct harm to the patient. For example, if a doctor thought a patient was exaggerating an ailment which then turned out to be a serious condition and the delay in treatment caused the ailment to become much worse, a lawsuit could be easily taken out. It would likely be under “delay in treatment.” Here’s an article on that: http://www.medicalmalpracticenj.com/articles/the-problems-with-delays-in-treatment/
But just the prescribing of a placebo is not, I believe, illegal.

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