Placebos have no place in diabetes care   (October 25, 2008)

There were a flurry of news stories this week after publication of an journal article about the use of placebo therapy by physicians. I was thinking off-and-on about writing something on the subject of placebos and diabetes, but an editorial entitled "Healers and heels" in the Newark Star-Ledger today pushed me to the keyboard. Among other rather bitter comments, the editorialist opined "It would have been fine if you [a doctor prescribing placebos] said that you didn't know what to do and referred us to someone else."

I found that the full text of the article, Prescribing "placebo treatments": results of national survey of US internists and rheumatologists, is available at the British Medical Journal website. The authors mailed out a survey about complementary and alternative medicine to 1200 practicing internists and rheumatologists in the United States; about half (57%) responded. Among other items on the survey, the physicians were "asked to rate the likelihood of their personally recommending [placebo] treatment to non-diabetic patients with fibromyalgia; how often they recommend a therapy "primarily because you believe it will enhance the patient's expectation of getting better"; and whether recommending treatments in this manner was "obligatory," "permissible," "permissible in rare circumstances," or "never permissible." Respondents were then asked to indicate which of several treatments they had used within the past year primarily as a placebo treatment, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself; and how they typically described placebo treatments to patients."

The authors concluded that "internists and rheumatologists commonly recommend 'placebo treatments.' Vitamins and over the counter analgesics are the most commonly prescribed. Physicians who use placebo treatments may not be fully transparent with their patients about their use."

Surely people with diabetes are now wondering "does my doctor do that?"

Well, in the many years I was in diabetes practice, I cannot ever recall prescribing placebos, nor can I recall any other physicians doing so for management of diabetes. Are there any physicians prescribing placebos for the management of diabetes? Although I doubt it, perhaps some patients have been falsely reassured that their concoctions of herbs and vitamins and minerals were treating their diabetes. Dunno.

But with the myriad of effective medications and insulins available for treatment of diabetes, there is no place for the use of placebos in the treatment of diabetes.

Period.