Orthopedic Surgeons Say ‘Open-Label’ Placebos Are Ethical, Yet Few Use Them
Most patients who recently underwent surgery said they would take an “open-label” placebo (pills that are honestly described to patients as inactive) if their doctor prescribed it, according to a recent survey.1 Researchers interviewed 11 patients who recently underwent hand or wrist surgery and took at least one opioid pill. Most patients were at least somewhat reluctant about using open-label placebos, but did believe it was ethical because of transparency. Also, many respondents indicated their opinion of their physician would not change if he or she prescribed an open-label placebo.
This was a tiny, preliminary study, and “it will be important to examine patient attitudes among a bigger sample, across patients with various conditions,” notes Michael H. Bernstein, PhD, study co-author and assistant professor at Brown University.
In another study, Bernstein and a different group of research colleagues found most orthopedic surgeons perceive open-label placebos as ethical and effective.2 However, those same surgeons would not consider using placebos in their own practice.
Bernstein and colleagues gave 687 participants the scenario of a surgeon using both open-label placebos and opioids to manage postoperative pain. About three-quarters of surgeons said open-label placebos were ethical in this case. About half (55%) said it “probably” or “definitely” would be an effective way to reduce narcotic use, and 48.8% thought it “probably” or “definitely” would be effective for pain relief.
Still, only 19.2% of respondents said they were personally willing to consider open-label placebos in their own practice. More than half (59.6%) were unwilling to do so, and the remaining surgeons were unsure. For Bernstein, the findings pose an interesting question: If a treatment will work, and is not deceiving patients — are physicians obligated to at least consider using it in their own practice? “That is something for medical ethicists to debate,” Bernstein says. “The field of open-label placebo does raise interesting ethical considerations.”
REFERENCES
- Bernstein MH, Fuchs N, Rosenfield M. Treating pain with open-label placebos: A qualitative study with post-surgical pain patients. J Pain 2021;22:1518-1529.
- Bernstein MH, Rosenfield M, Fuchs N, et al. How orthopedic surgeons view open label placebo pills: Ethical and effective, but opposed to personal use. J Psychosom Res 2021;151:110638.
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