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A new survey has uncovered a little secret of American doctors. Many prescribe pills that don't have any specific effect on the illness of the patient, in other words placebos, harmless pills that the patient is supposed to think are real medicine. NPR's Richard Knox has more.

RICHARD KNOX: Placebos are common in medical research. One group of volunteers gets a test drug, the other group a look-alike sugar pill. Everybody is told upfront they could get one or the other. But the new survey is about placebos in everyday medical care without patients' knowledge. The idea is that the patient thinks the pill will help, it might. The survey results are in the current issue of the British Medical Journal. Of nearly 700 U.S. internal medicine doctors and arthritis specialists surveyed, half said they regularly prescribe placebos for conditions that haven't responded to treatment, like chronic pain or fatigue.

Most often it's a vitamin pill or over-the-counter painkiller, although some prescribe an antibiotic or a sedative, which could be harmful. Typically, doctors tell patients the placebo is potentially helpful, but not designed for your specific illness. Doctor Ezekiel Emanuel is head of ethics at the National Institutes of Health and a study author.

KNOX: Half of all American internists and rheumatologists using placebos was a real surprise to me. I was pretty astonished.

KNOX: Doctor Howard Brody was surprised too. He's an expert on placebos at the University of Texas in Galveston. He didn't have anything to do with the survey, but he says it shows how much doctors' attitudes have changed over the past few decades.

KNOX: For many, many, many years, the typical reaction of a physician was - well, real doctors don't prescribe placebos. A placebo is a fake medicine. So only a quack would prescribe a placebo.

KNOX: Since the 1960s, the dominant ethic among U.S. physicians has been patient autonomy. It means the patient's in charge. He's entitled to know everything about his care. But if many doctors are handing out placebos, that's at odds with this ethic, Emanuel says.

KNOX: On the one hand, if we have placebos and they work and they make people feel good, we're advancing promoting people's health and promoting their welfare. If it requires us to deceive them, we're undermining autonomy.

KNOX: The American Medical Association recognizes the dilemma. Two years ago, it adopted a policy that the use of a placebo without a patient's knowledge can undermine trust and even result in medical harm. Robert Sade, a South Carolina surgeon, was chair of the AMA's ethics council when the new policy was adopted.

KNOX: Physicians who use placebos are not being quote, "unethical," end quote, but they're skirting on the edges of ethical behavior.

KNOX: The AMA says if doctors want to use placebos, they should tell patients that one or more of the pills they're getting is not specifically designed for their illness, but some have found it helpful. Studies have shown that placebos sometimes do help people who expect them to work.

KNOX: The physician would tell the patient, I'm going to give you these two medications. I want you to take this red pill for a month and record your symptoms. And I want you to take the blue pill for a month and record your symptoms in a log.

KNOX: It's sort of a little experiment involving a single patient. Either or both pills could be placebos. But some say this is just a more elaborate kind of deception. Again, Ezekiel Emanuel, the NIH ethics chief.

KNOX: I think we're all just a little nervous about that as a common practice. So even though it might be on the right side of deception, we're not being fully frank with the patient.

KNOX: But Emanuel doesn't condemn all placebo use. After all, he says, it shows that American doctors understand that the mind plays a big role in healing, and that's not a bad thing. Richard Knox, NPR News.

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