A 2012 survey in the UK found that 1% of GPs use pure placebos and 77% use impure placebos at least once a week. The placebo effect is undoubtedly real, but not yet fully understood. It is now thought that there are different types of placebo effects that involve different mechanisms. These include reactive conditioning based on previous experience, waiting and reward effects mediated by the dopaminergic system, and natural analgesia through the production of endorphins, the body`s own painkillers. Placebo effects can generally be defined as changes in a person`s health status that result from the importance and hope that the person attributes to a procedure or event in a health setting. [1], [2] These effects can be significant[3]–[6] and are mediated by and include measurable changes in the neurological, immune and endocrine systems. [7], [8] In clinical research, placebo effects should be controlled (e.g. B with placebo pills or sham surgery), but are generally not considered inherently interesting. [9] In clinical practice, placebo effects can have great relevance and potential to be used for the benefit of the patient [10], [11] and there are many ways doctors could try this. One approach is to increase patient expectations and communicate with empathy, for example in pain management in primary care[12], [13] or acupuncture. [14] This article focuses on another more controversial approach to induce placebo effects: prescribing placebo-like substances such as sugar pills, «tonics» or low-dose vitamins in primary care. In the context of a serious illness, some participants also used a speech of desperation to justify prescribing placebos: provided that the patient could benefit from them and that certain other conditions were met, they felt that it was «worthwhile» to try placebos as a last resort.

Additional conditions necessary for the acceptance of placebos included the lack of a proven effective treatment, placebo that does not harm, and the person who suffers or otherwise suffers. Is it true that doctors prescribe treatments that they do not think are biochemically effective? Pure placebos contain a flat lie. It is less obvious that impure placebos are called misleading. With an impure placebo, the patient knows what they are actually taking, but may not realize that the doctor does not expect the treatment to work. Public education on placebo effects is needed to correct misunderstandings. Further research is warranted to identify optimal ways to use placebo effects in clinical practice for patients with different perspectives. The effectiveness of a drug is measured by the extent to which it is better than a placebo. Not all the benefits of drugs come from the pharmaceutical compound itself. With many medications, part of the benefit depends on the patient`s beliefs. The authors point out that there are ongoing ethical problems, especially when doctors do not make the patient aware of what they are receiving. «This raises unresolved ethical questions about how primary care physicians treat informed consent regarding their placebo prescriptions,» they say. The other unresolved problem is the potential negative effects of placebo, known as «nocebo,» which is a particular problem with impure placebos like antibiotics.

Impure placebos can be vitamins, supplements, antibiotics for viral infections, subclinical doses of drugs, unproven complementary and alternative medications, or unnecessary blood tests to calm an anxious patient. «I don`t think doctors have anything other than the best interest of patients in mind when they give a placebo prescription,» Tilburt says. «They think about both the physical and psychological well-being of the patient. However, the placebo effect suggests that complete information and unvarnished honesty are not always in the patient`s best interest. Sometimes it can be beneficial for patients to have expectations that their doctors don`t share. Researchers at the University of Chicago published the results of a study that showed that 45 percent of internists surveyed (all primary care physicians in the Chicago area) had prescribed placebos to their patients. Of the health care providers who prescribed placebos, 34% told patients that the prescription wouldn`t hurt and might even help; 19 per cent simply said they were drugs; 9% said they were drugs «without specific effects»; and only 4% told their patients they would prescribe a placebo. When participants looked at both the process and outcomes of prescribing placebo, they tried to weigh the pros and cons that were interpreted broadly in terms of individual patient, family, patient-doctor relationship, and society as a whole. .