Placebo use in the UK: a qualitative study exploring GPs' views on placebo effects in clinical practice.
Bishop FL., Howick J., Heneghan C., Stevens S., Hobbs FDR., Lewith G.
BACKGROUND: Surveys show GPs use placebos in clinical practice and reported prevalence rates vary widely. AIM: To explore GPs' perspectives on clinical uses of placebos. DESIGN AND SETTING: A web-based survey of 783 UK GPs' use of placebos in clinical practice. METHODS: Qualitative descriptive analysis of written responses ('comments') to three open-ended questions. RESULTS: Comments were classified into three categories: (i) defining placebos and their effects in general practice; (ii) ethical, societal and regulatory issues faced by doctors and (iii) reasons why a doctor might use placebos and placebo effects in clinical practice. GPs typically defined placebos as lacking something, be that adverse or beneficial effects, known mechanism of action and/or scientific evidence. Some GPs defined placebos positively as having potential to benefit patients, primarily through psychological mechanisms. GPs described a broad array of possible harms and benefits of placebo prescribing, reflecting fundamental bioethical principles, at the level of the individual, the doctor-patient relationship, the National Health Service and society. While some GPs were adamant that there was no place for placebos in clinical practice, others focused on the clinically beneficial effects of placebos in primary care. CONCLUSION: This study has elucidated specific costs, benefits and ethical barriers to placebo use as perceived by a large sample of UK GPs. Stand-alone qualitative work would provide a more in-depth understanding of GPs' views. Continuing education and professional guidance could help GPs update and contextualize their understanding of placebos and their clinical effects.