Deceit Questioned
Today, when 26-year-old Jennifer Kennedy (not her real name) from Rockville, Md., has a panic attack, she simply distracts herself with a book or crossword puzzle. But at their height, several years ago, the attacks scared her so much that she finally went to the emergency room. "I thought I was going to die from a heart attack," says Kennedy.
She didn't believe her doctor when he told her to "just relax" and she would feel okay, and he ended up prescribing pills.
He didn't tell her until two weeks later, after her panic attacks had subsided, that the pills were simply placebos with no active medical ingredient.
Those who oppose the use of placebo pills in medical practice say that such deceit can undermine the essential trust between patient and doctor. Gastroenterologist Michael Kirsch, M.D., has called doctors who prescribe placebos outside medical research "con artists." Kirsch asks in a 1998 editorial in Priorities, the magazine of the nonprofit American Council on Science and Health, "If using placebos therapeutically is ethical and reasonable, shouldn't we encourage judges to render extralegal activist rulings, winegrowers to bottle 'placebo' vintages, curators to display masterpiece look-alikes misleadingly, and journalists and newscasters to sanitize news?" He continues, "In such a world, all of us would be groping for truth in a hall of mirrors."
Benevolent Deception
But placebo researcher Michael Jospe disagrees with what he calls this "strict, grumpy approach that concludes that any doctor who uses placebos is acting unethically." Some circumstances, he says, justify this kind of benevolent deception--like when a patient insists on a medicine that is unnecessary and carries needless risks.
"You've got to be there on the oncology ward," Jospe says, "and see how suffering people get so demanding of drugs that might be extremely harmful to them. If you look at sugar pills in the broader context of a supportive doctor-patient relationship rather than just as ripping off the patient, you may come to a different conclusion" about the ethics of placebos.
It's not uncommon for a patient to feel betrayed initially upon hearing that they were given a placebo, Jospe says, but a sensitive doctor can explain to the patient, "No, that the placebo worked doesn't mean you're crazy. You were just in distress and thus more prone to reacting to anything with the potential to help."
Kennedy admits to feeling deceived when she first found out the pills her doctor prescribed were fake, but says she now appreciates the doctor's decision to prescribe the placebo. "At first, I felt stupid. But that day at the hospital, the doctor must have realized I wasn't going to accept 'you're fine, it's all in your mind.' The placebo helped me realize that I'm not unhealthy and I'm going to be okay. Now, I think it's really neat that something that didn't really affect me had such a big effect on my life."
Source:
The Healing Power of Placebos, by Tamar Nordenberg, FDA Consumer magazine January-February 2000