{"id":5449,"date":"2013-03-28T07:55:04","date_gmt":"2013-03-28T11:55:04","guid":{"rendered":"http:\/\/theness.com\/neurologicablog\/?p=5449"},"modified":"2013-03-28T09:35:46","modified_gmt":"2013-03-28T13:35:46","slug":"do-97-of-uk-doctors-prescribe-placebos","status":"publish","type":"post","link":"https:\/\/theness.com\/neurologicablog\/do-97-of-uk-doctors-prescribe-placebos\/","title":{"rendered":"Do 97% of UK Doctors Prescribe Placebos?"},"content":{"rendered":"<p>A <a href=\"http:\/\/www.plosone.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pone.0058247\">recently published survey<\/a> at PLOS One of UK primary care doctors reports that 97% have prescribed an &#8220;impure placebo&#8221; at least once in their career. Most news reporting of this survey leave off the &#8220;impure&#8221; bit.<\/p>\n<p>Let&#8217;s take a closer look at what this means.<\/p>\n<p>The survey asked about &#8220;pure&#8221; placebos, which are inactive sugar pills or a similar inactive treatment, and &#8220;impure&#8221; placebos, which are effective medicines given in a way that might not have a clinical effect. The survey found that only 12% have ever prescribed a pure placebo, and only 1% do it on a regular basis. However, 97% have prescribed impure placebo ever, and 77% on a regular basis.<\/p>\n<p>The survey had a 48% response rate, which is not bad for a survey, but this is why surveys are not considered strictly scientific. The low response rate introduces the potential for systematic bias &#8211; perhaps people who choose to respond do so because of a \u00a0certain attitude or belief that biases their responses.<\/p>\n<p><!--more-->That aside, let&#8217;s look at what the authors consider &#8220;impure placebo.&#8221;<\/p>\n<ul>\n<li>Positive suggestions<\/li>\n<li>Nutritional supplements for conditions unlikely to benefit from this therapy (such as vitamin C for cancer)<\/li>\n<li>Probiotics for diarrhea<\/li>\n<li>Peppermint pills for pharyngitis<\/li>\n<li>Antibiotics for suspected viral infections<\/li>\n<li>Sub-clinical doses of otherwise effective therapies<\/li>\n<li>Off-label uses of potentially effective therapies<\/li>\n<li>Complementary and Alternative medicine (CAM) whose effectiveness is not evidence-based<\/li>\n<li>Conventional medicine whose effectiveness is not evidence-based<\/li>\n<li>Diagnostic practices based on the patient&#8217;s request or to calm the patient such as\n<ul>\n<li>Non-essential physical examinations<\/li>\n<li>Non-essential technical examinations of the patient (blood tests, X-rays)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>In other words &#8211; if a physician ever does something to enhance the therapeutic relationship with the patient, that&#8217;s an impure placebo. I would have to consider myself an &#8220;impure placebo&#8221; prescriber, then. Sometimes I will do a brief neurological exam on a follow up patient not because it is definitely needed (it&#8217;s unlikely to change my management) , but because patient&#8217;s expect it will be part of their office visit and it makes them feel as if they are getting the attention their condition requires.<\/p>\n<p>What about subclinical doses? This is a gray area &#8211; patients respond to medication differently (different metabolism and sensitivity), and a subclinical dose for one patient may have an effect on another. It&#8217;s common when using symptomatic treatment to start at a low dose and slowly increase the dose until the patient gets unwanted side effects or until they get a good response. What if they get a good response at a low dose, one that is &#8220;subclinical&#8221; on average, but may be having an effect on the patient? Is that an &#8220;impure placebo?&#8221;<\/p>\n<p>Nutritional supplements are another gray area. For example, I check B12 levels on most of my patients. Low B12 can affect nervous system function. If the level is low, I prescribe supplements to get them into the normal range. I am optimizing any parameters that might affect neurological function, even if I don&#8217;t think the low B12 is causing their current symptoms. If the patient gets a positive placebo effect from taking the B12 also, that&#8217;s great. Is that an impure placebo?<\/p>\n<p>Off-label use is also a tricky area. Many drugs have good evidence and a solid rationale for uses that are not FDA indicated. Drug companies usually don&#8217;t bother getting every possible indication for their drugs, because that is expensive. They count on off-label use &#8211; which can be entirely evidence-based and effective. Do the authors, however, consider all off-label use impure placebos?<\/p>\n<p>In short &#8211; there are many problems with interpreting this survey, and the 97% figure that is being widely quoted is highly problematic and misleading. This is a useful area of medical practice to explore, but it is very complex and would require much more nuance than provided in this survey.<\/p>\n<p>Note &#8211; Scott Gavura also <a href=\"http:\/\/www.sciencebasedmedicine.org\/index.php\/behold-the-spin-what-a-new-survey-of-of-placebo-prescribing-really-tells-us\/\">wrote about this article at Science-Based Medicine<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A recently published survey at PLOS One of UK primary care doctors reports that 97% have prescribed an &#8220;impure placebo&#8221; at least once in their career. Most news reporting of this survey leave off the &#8220;impure&#8221; bit. Let&#8217;s take a closer look at what this means. The survey asked about &#8220;pure&#8221; placebos, which are inactive [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[273],"class_list":["post-5449","post","type-post","status-publish","format-standard","hentry","category-alternative-medicine","tag-placebo"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 5.0.1.1 - aioseo.com -->\n\t<meta name=\"description\" content=\"A recently published survey at PLOS One of UK primary care doctors reports that 97% have prescribed an &quot;impure placebo&quot; at least once in their career. Most news reporting of this survey leave off the &quot;impure&quot; bit. Let&#039;s take a closer look at what this means. 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The survey asked about &quot;pure&quot; placebos, which are inactive"},"aioseo_meta_data":{"post_id":"5449","title":null,"description":null,"keywords":null,"keyphrases":null,"canonical_url":null,"og_title":null,"og_description":null,"og_object_type":"default","og_image_type":"default","og_image_url":null,"og_image_width":null,"og_image_height":null,"og_image_custom_url":null,"og_image_custom_fields":null,"og_video":null,"og_custom_url":null,"og_article_section":null,"og_article_tags":null,"twitter_use_og":false,"twitter_card":"default","twitter_image_type":"default","twitter_image_url":null,"twitter_image_custom_url":null,"twitter_image_custom_fields":null,"twitter_title":null,"twitter_description":null,"schema_type":"default","schema_type_options":null,"pillar_content":false,"robots_default":true,"robots_noindex":false,"robots_noarchive":false,"robots_nosnippet":false,"robots_nofollow":false,"robots_noimageindex":false,"robots_noodp":false,"robots_notranslate":false,"robots_max_snippet":null,"robots_max_videopreview":null,"robots_max_imagepreview":"large","priority":null,"frequency":null,"local_seo":null,"breadcrumb_settings":null,"created":"2022-01-20 04:15:23","updated":"2026-05-15 17:37:50","primary_term":null,"schema":{"blockGraphs":[],"customGraphs":[],"default":{"data":{"Article":[],"Course":[],"Dataset":[],"FAQPage":[],"Movie":[],"Person":[],"Product":[],"ProductReview":[],"Car":[],"Recipe":[],"Service":[],"SoftwareApplication":[],"WebPage":[]},"graphName":"BlogPosting","isEnabled":true},"graphs":[]},"limit_modified_date":false,"ai":null,"seo_analyzer_scan_date":null,"focus_keyword":null,"additional_keywords":null,"truseo_locale":null},"aioseo_breadcrumb":"<div class=\"aioseo-breadcrumbs\"><span class=\"aioseo-breadcrumb\">\n\t\t\t<a href=\"https:\/\/theness.com\/neurologicablog\" title=\"Home\">Home<\/a>\n\t\t<\/span><span class=\"aioseo-breadcrumb-separator\">&raquo;<\/span><span class=\"aioseo-breadcrumb\">\n\t\t\t<a href=\"https:\/\/theness.com\/neurologicablog\/category\/alternative-medicine\/\" title=\"Science and Medicine\">Science and Medicine<\/a>\n\t\t<\/span><span class=\"aioseo-breadcrumb-separator\">&raquo;<\/span><span class=\"aioseo-breadcrumb\">\n\t\t\tDo 97% of UK Doctors Prescribe Placebos?\n\t\t<\/span><\/div>","aioseo_breadcrumb_json":[{"label":"Home","link":"https:\/\/theness.com\/neurologicablog"},{"label":"Science and Medicine","link":"https:\/\/theness.com\/neurologicablog\/category\/alternative-medicine\/"},{"label":"Do 97% of UK Doctors Prescribe Placebos?","link":"https:\/\/theness.com\/neurologicablog\/do-97-of-uk-doctors-prescribe-placebos\/"}],"_links":{"self":[{"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/posts\/5449","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/comments?post=5449"}],"version-history":[{"count":0,"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/posts\/5449\/revisions"}],"wp:attachment":[{"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/media?parent=5449"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/categories?post=5449"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/theness.com\/neurologicablog\/wp-json\/wp\/v2\/tags?post=5449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}