The October 23, 2008 New York Times article "Half of Doctors Routinely Prescribe Placebos" states that half of American physicians admit to prescribing placebos, from a study being published in the British Medical Journal. The article then goes on to state that prescribing placebos without a patient's knowledge is unethical. The listed examples of placebos include "headache pills, vitamins, antibiotics and sedatives." In actuality, from the study, 95% of the doctors cited the medications as "possibly effective," with only 5% considering them as true placebos—a medication administered knowingly of no benefit.

Is prescribing a medication to a patient with the understanding by the physician that there is not likely to be biological benefit unethical? I think not. I would go so far to say that it often reflects the art of medicine. I do not think the New York Times authors appreciate the complexity of the physician-patient relationship and the nature of healing.

I am not recommending the prescription of worthless drugs to patients, wasting their money and putting them at risk of side effects. Often the physician has an intuitive sense that the patient wants and expects some prescription in order to get better.

The first rule of medicine is "First, do no harm" (Hippocrates). So any medication of questionable biological benefit must run a very low likelihood of causing harm. That is why I do not use antibiotics as a placebo. I use harmless medications such as a mild decongestant or antihistamine to garner the positive placebo effect. The less expensive the better.

What is the positive placebo effect? We all know from therapeutic trials that placebos have about a 50% effectiveness in most conditions. The positive placebo effect happens when a physician suggests the medication is likely to make the condition get better. It carries an extra belief, like the headache starting to go away before the aspirin hits the stomach. The response is 70%-80%. Face it, many patients believe they need to take something to feel better. Best to give them something innocent and supportive of the sense that they will recover. Healing happens fast that way.

I want to balance my comments with a statement that I do not want to create a dependency of my patients to me or to whatever placebo I might give them. That is unethical. I strive to help patients become self-reliant, and I want to give them whatever reinforcement that they will readily recover from self-limited viral infections, with or without medication. Whatever placebo I recommend, I make sure they can get it without coming back to me.

There are lots of placebos out there on the market. Airborne is a striking example, and even though it has been exposed as a placebo, its sales continue to flourish. Patients want to take something like that, and it is certainly harmless; they feel empowered to both avoid and quickly be rid of viruses. I saw a physician using it on an airplane this week. I am reminded of one of my favorite childhood cartoons, that of Dumbo the flying elephant and the magic feather. There are many out there that want our magic feathers, and I do not think it is unethical to provide them. What do you think?