Tilburt Jon C, Emanuel Ezekiel J, Kaptchuk Ted J, Curlin Farr A, Miller Franklin G
Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA.
BMJ. 2008 Oct 23;337:a1938. doi: 10.1136/bmj.a1938.
To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.
Cross sectional mailed survey.
Physicians' clinical practices.
1200 practising internists and rheumatologists in the United States.
Investigators measured physicians' self reported behaviours and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a "placebo treatment," their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.
679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).
Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.
描述关于安慰剂治疗的态度和行为，安慰剂治疗定义为其益处源于患者的积极期望而非治疗本身的生理机制的治疗方法。
横断面邮寄调查。
医生的临床实践。
美国1200名执业内科医生和风湿病学家。
研究者测量了医生关于使用安慰剂治疗的自我报告行为和态度，包括他们是否会使用或已推荐“安慰剂治疗”的测量、他们对这种做法的伦理判断、他们推荐作为安慰剂治疗的方法，以及他们通常如何就这种做法与患者沟通。
679名医生（57%）回复了调查。约一半接受调查的内科医生和风湿病学家报告经常开具安慰剂治疗（46%-58%，取决于问题的表述方式）。大多数医生（399名，62%）认为这种做法在伦理上是允许的。很少有人报告使用生理盐水（18名，3%）或糖丸（12名，2%）作为安慰剂治疗，而很大比例的人报告在过去一年中使用非处方镇痛药（267名，41%）和维生素（243名，38%）作为安慰剂治疗。一小部分但值得注意的医生报告在同一时期使用抗生素（86名，13%）和镇静剂（86名，13%）作为安慰剂治疗。此外，最常使用安慰剂治疗的医生通常会向患者描述为一种可能有益的药物或治疗方法，并非通常用于其病情的治疗方法（241名，68%）；他们很少明确将其描述为安慰剂（18名，5%）。
在美国接受调查的内科医生和风湿病学家中，开具安慰剂治疗似乎很常见，并且被认为在伦理上是允许的。维生素和非处方镇痛药是最常用的治疗方法。医生在向患者说明安慰剂的使用时可能并不完全透明，并且在推荐此类治疗时可能有多种动机。
