Survey: Half of US doctors use placebo treatments

[mkemse]

LONDON – About half of American doctors in a new survey say they regularly give patients placebo treatments — usually drugs or vitamins that won't really help their condition. And many of these doctors are not honest with their patients about what they are doing, the survey found.

That contradicts advice from the American Medical Association, which recommends doctors use treatments with the full knowledge of their patients.

"It's a disturbing finding," said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. "There is an element of deception here which is contrary to the principle of informed consent."

The study was being published online in Friday's issue of BMJ, formerly the British Medical Journal.

Placebos as defined in the survey went beyond the typical sugar pill commonly used in medical studies. A placebo was any treatment that wouldn't necessarily help the patient.

Scientists have long known of the "placebo effect," in which patients given a fake or ineffective treatment often improve anyway, simply because they expected to get better.

"Doctors may be under a lot of pressure to help their patients, but this is not an acceptable shortcut," said Irving Kirsch, a professor of psychology at the University of Hull in Britain who has studied the use of placebos.

Researchers at the NIH sent surveys to a random sample of 1,200 internists and rheumatologists — doctors who treat arthritis and other joint problems. They received 679 responses. Of those doctors, 62 percent believed that using a placebo treatment was ethically acceptable.

Half the doctors reported using placebos several times a month, nearly 70 percent of those described the treatment to their patients as "a potentially beneficial medicine not typically used for your condition." Only 5 percent of doctors explicitly called it a placebo treatment.

Most doctors used actual medicines as a placebo treatment: 41 percent used painkillers, 38 percent used vitamins, 13 percent used antibiotics, 13 percent used sedatives, 3 percent used saline injections, and 2 percent used sugar pills.

In the survey, doctors were asked if they would recommend a sugar pill for patients with chronic pain if it had been shown to be more effective than no treatment. Nearly 60 percent said they would.

Smaller studies done elsewhere, including Britain, Denmark and Sweden, have found similar results.

Jon Tilburt, the lead author of the U.S. study, who is with NIH's bioethics department, said he believes the doctors surveyed were representative of internists and rheumatologists across the U.S. No statistical work was done to establish whether the survey results would apply to other medical specialists, such as pediatricians or surgeons.

The research was paid for by NIH's bioethics department and the National Center for Complementary and Alternative Medicine.

The authors said most doctors probably reasoned that doing something was better than doing nothing.

In some cases, placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also gave antibiotics to patients with viral bronchitis, knowing full well that a virus is impervious to antibiotics, which fight bacteria. Experts believe overuse of antibiotics promotes the development of drug-resistant strains of bacteria.

Some doctors believe placebos are a good treatment in certain situations, as long as patients are told what they are being given. Dr. Walter Brown, a professor of psychiatry at Brown and Tufts universities, said people with insomnia, depression or high blood pressure often respond well to placebo treatments.

"You could tell those patients that this is something that doesn't have any medicine in it but has been shown to work in people with your condition," he suggested.

However, experts don't know if the placebo effect would be undermined if patients were explicitly told they were getting a dummy pill.

Brown said that while he hasn't prescribed sugar pills, he has given people with anxiety problems pills that had extremely low doses of medication. "The dose was so low that whatever effect the patients were getting was probably a placebo effect," he said.

Kirsch, the psychologist, said it might be possible to get the psychological impact without using a fake pill. "If doctors just spent more time with their patients so they felt more reassured, that might help," he said.

Some patients who had just seen their doctors at a clinic in London said the truth was paramount.

"I would feel very cheated if I was given a placebo," said Ruth Schachter, an 86-year-old Londoner with skin cancer. "I like to have my eyes wide open, even if it's bad news," she said. "If I'm given something without being warned what it is, I certainly would not trust the doctor again."

Anyone suprised by this survey?? Keep in mind it was done in London and not here in the USA

[lucy]

And many of these doctors are not honest with their patients about what they are doing, the survey found.

Well, if a doctor tells the patient it's a placebo, it isn't a placebo anymore, isn't it?
And placebos in fact can help, whereas telling a patient "sorry, but i can't help you with your problem" which would often be the right and honest thing to do would also just make the patient move on to the next doc.

However, i think using actual drugs like painkillers and especially antibiotics is definitely wrong.

[mkemse]

Well, if a doctor tells the patient it's a placebo, it isn't a placebo anymore, isn't it?
And placebos in fact can help, whereas telling a patient "sorry, but i can't help you with your problem" which would often be the right and honest thing to do would also just make the patient move on to the next doc.

However, i think using actual drugs like painkillers and especially antibiotics is definitely wrong.

If I am in extreme pain do to chronic back problem, a very bad cold ect, I would not want a Placebo ,I want the real thing, yes there are cases where a Placebo may trick the mind to believe it feels better, but in the Case of Servere Chronic Back Pain, the Flu ect I want the real thing not a Sugar Pill
But then again I have had the same Internest for 30 years so there is no question in my mind whether I trust or believe in him

[fetishdj]

A placebo will indeed not work if the patient knows it is a placebo... this has been shown time and again in trials. So the initial accusation is indeed a little off.

I do agree that spending more time with patients may be better than placebos, however... though I cannot see it happening anytime soon with the level of work most GPs have to deal with normally...

[Flaming_Redhead]

I'll start out by saying I've worked in hospitals for many years, although I'm not a doctor or nurse. People these days go to doctors requesting pills. They see commercials on TV and run to their doctor to try it. My ex-mother-in-law was somewhat of a hypochondriac and was always wanting the doctor to do something for her bursitis and arthritis, both chronic problems. He told her that she would just have to live with it. She didn't want to hear that, but neither did she want to do what he told her to do. She didn't want physical therapy or exercise or weight loss. She wanted pills, but she never liked what he gave her, either narcotics or anti-inflammatories. She wouldn't take narcotics because of her fear of becoming addicted, and she wouldn't take the anti-inflammatories because she said it was like taking Tylenol. Her internist believed that most of her complaints were anxiety-related, so the doctor tried repeatedly to place her on different meds for it. As soon as she discovered what it was for (anxiety/depression), she discontinued it, saying that she didn't have anxiety or depression. I very much believe she DID. *nods a lot* The problem with people is that they don't want to be proactive in their health or hear the truth. They want a magic pill. I don't blame the doctors for giving it to them. It's been proven that positive thinking helps chronic conditions, so if they think they're getting something to help them and want to believe that it works....it will.

[fetishdj]

High levels of cortisol can cause problems with healing injuries/tissue damage/reducing infection or preventing cancer. Cortisol is a stress hormone. You do not get high levels of Cortisol if you are happy and relaxed... so there is clearly a benefit here from the placebo effect and it is more than 'mind over matter'. Whether the pill itself does anything is irrelevent - the effect is entirely mediated from within.

[mkemse]

I would trust my Docotor that i have had for 30 years in subscribing me medication and not a placebo but doctors should be honest with their patients annd telel then what they are recieinving and not just simply give them a placebo

[MMI]

The whole idea of giving a placebo is to trick the patient. If you tell him/her, as lucy points out, it ain't gonna trick anyone.

I suspect the doctors are only going to use a placebo where there's no available (or affordable) medicine that will work and the patient is awkward or insistent, such as Redhead's ex mother-in-law, or just to make the patient think that something is being done, even though it isn't - and maybe can't be (... is that the same thing?).

Anyway, I don't see it as harmful, and it's only deceitful in the same way as saying to a patient suffering from a terminal disease, We're doing everything we can to make you better ...

[SadisticNature]

It can be very harmful if:

Doctor A doesn't have a real solution so gives a placebo and the patient would have otherwise gone to Doctor B who knows of a different solution that would actually work for that patients problems.

Also prescribing placebos will look pretty horrible in a court case if the doctor ever gets sued, and if 60% of them are doing it its not a surprise the malpractice insurance is expensive.

[DuncanONeil]

Why does SadisticNature always look for the lead lining?

[denuseri]

Maby becuase its ussually there and needs to be discussed as well Duncan.

Placebos also bring to mind the studies involved with noetic sciences in these avenues.

[DuncanONeil]

Maby becuase its ussually there and needs to be discussed as well Duncan.

Placebos also bring to mind the studies involved with noetic sciences in these avenues.

I don't know; "Doctor A doesn't have a real solution so gives a placebo", seems like more than covering all the bases.

[SadisticNature]

So its acceptable for doctors to trick patients into paying for something that's only value to them is psychological?

Lets try that in the finances, would you agree with the following statement?

"It's ok for a financial banker to trick someone about how safe their investments are as long as they believe the person will make money?"

To me these situations seem comparable, you're deliberately tricking someone, and justify it by believing you are doing it for their own good. You might be right (and lots of data shows placebo's can help), but you might be wrong as well (you might prevent them from pursuing a better course of treatment).

If someone actually wanted a placebo let them sign up for a research study, they'll either get a placebo or something that potentially works and is safe enough for testing on humans.

[DuncanONeil]

Economics and medicine can in no way provide an adequate comparison.
Much of medicine is in the mind even when a drug is prescribed. The complaint against your offer was that there may be nothing wrong with the patient, yet they insist that there is and some drug will help them. With no evidence of an underlying malady you are opposed to the doctor prescribing a placebo. Or in the case where the patients desire for a specific advertised drug is also not indicated for their "condition" the doctor can not exercise his training and "treat" HIS patient in the manner that best suits HIS patient.
Part of the problem is again the assumption that if the patient is at the doctor that there must absolutely be something wrong!

So its acceptable for doctors to trick patients into paying for something that's only value to them is psychological?

Lets try that in the finances, would you agree with the following statement?

"It's ok for a financial banker to trick someone about how safe their investments are as long as they believe the person will make money?"

To me these situations seem comparable, you're deliberately tricking someone, and justify it by believing you are doing it for their own good. You might be right (and lots of data shows placebo's can help), but you might be wrong as well (you might prevent them from pursuing a better course of treatment).

If someone actually wanted a placebo let them sign up for a research study, they'll either get a placebo or something that potentially works and is safe enough for testing on humans.

[SadisticNature]

Economics and medicine can in no way provide an adequate comparison.
Much of medicine is in the mind even when a drug is prescribed. The complaint against your offer was that there may be nothing wrong with the patient, yet they insist that there is and some drug will help them. With no evidence of an underlying malady you are opposed to the doctor prescribing a placebo. Or in the case where the patients desire for a specific advertised drug is also not indicated for their "condition" the doctor can not exercise his training and "treat" HIS patient in the manner that best suits HIS patient.
Part of the problem is again the assumption that if the patient is at the doctor that there must absolutely be something wrong!

Patients are not the property of doctors. If nothing is wrong the doctor is allowed to within the confines of the law refuse to provide unnecessary treatments. Giving someone a placebo to shut them up is highly problematic. Particularly, because sometimes the doctors are actually wrong, and if they do the consequences are very serious.

There is a reason why prescribing placebo's is illegal, and that reason is a good one. Even assuming most patients are hypochondriacs or looking to score some painkillers, refusing treatment is a viable option, and its one that doesn't hinder the people who actually suffer from legitimate conditions. Often unexplained pain is an early warning sign for certain forms of cancer, and if a doctor treats it with a placebo resulting in a delayed diagnosis that's almost certain to be a massive lawsuit, and I wouldn't for a second think the patient was in the wrong.

[Bren122]

While I accept that some people suffer from migraines I do not believe it is as prevalent as it seems. I think that too many people confuse a bad headache with a migraine. I just tell people I don't believe in the condition; as a consequence the sickness rates in my department are about a quarter of that for the organisations I have worked for as a whole.
Similarly everyone used to have RSI and then that died down and was replaced with Chronic Fatigue Syndrome and then that died down and has been replaced with Depression. I personally think that they have all been overstated and, realistically, in twenty years of working I can only think of two people who had genuine RSI and one person with genuine depression. The rest were either trying to avoid work or were overstating their condition in order to get attention. I can just imagine how much worse it must be for a doctor who would see it on an hourly basis. People are convinced that if there is something wrong with them that it is the most serious thing possible and that they need to be booked into intensive care immediately. I imagine that most of these doctors prescribing placebos are doing so in order to get these people out of their clinics so that they can help people with real problems.

[DuncanONeil]

Sounds a bit like my perception of "stress". Something I refuse to accept as a "condition".

While I accept that some people suffer from migraines I do not believe it is as prevalent as it seems. I think that too many people confuse a bad headache with a migraine. I just tell people I don't believe in the condition; as a consequence the sickness rates in my department are about a quarter of that for the organisations I have worked for as a whole.
Similarly everyone used to have RSI and then that died down and was replaced with Chronic Fatigue Syndrome and then that died down and has been replaced with Depression. I personally think that they have all been overstated and, realistically, in twenty years of working I can only think of two people who had genuine RSI and one person with genuine depression. The rest were either trying to avoid work or were overstating their condition in order to get attention. I can just imagine how much worse it must be for a doctor who would see it on an hourly basis. People are convinced that if there is something wrong with them that it is the most serious thing possible and that they need to be booked into intensive care immediately. I imagine that most of these doctors prescribing placebos are doing so in order to get these people out of their clinics so that they can help people with real problems.

[fetishdj]

There is no such thing as a 'mugraine', like 'IBS' it is a term which means 'collection of conditions with unknown cause which has a set of similar and overlapping symptoms'. If you look at the symptoms and causes of many 'migraines' you in fact see different causes (some are caused by bright light, some by loud noise, some by different food allergies, some by stress) and a vague set of symptoms which vary a lot between patients. This is why some migraine sufferers respond to 'migraleive' and similar drugs while others do not - they are actually different conditions.

There are many conditons which doctors cannot treat, and I am not talking here about the biggies like cancer or AIDs (which we are getting better at treating, its just that often the treatment is worse than the disease). Mainly this is because we do not understand the underlying mechanism of that disease because the medical profession is reliant on the rather subjective and uninformative process of patient self reporting of symptoms ('What seems to be the problem?' 'I have a headache and stomach ache' 'How bad is the stomach ache?'...). Doctors have got very good at teasing out truth and lies and relevant information from the rather vague information that patients tell them but it is still not a great tool. Sometimes you get a patient with no actual serious symptoms - possibly some minor stress related problems that are clearly not linked to any underlying problem which can be treated more directly. In this case, the best thing you can do is alleviate the stress (and giving a placebo will achieve this) in the hope that this solves the problem. If it doesn't, you can look at more direct intervention.

The old adage is true - medicine really is the process of amusing the patient while the body treats itself.

[denuseri]

Duncan you should hear doctors,,surgeons in paticular (especially ortho docs and nurses) talk about patients some time when they think the patient can't hear.

Often refering to themselves as mechanics.

Interpersonal relations and politically correct bs aside.

Paitients are often spoken of in very inpersonal manners, I know a dozen nurses who can't remember their paitents names from day to day, but can put whats wrong with them to the room numbers where they are. The tv version of the weepy nurse or doctor is a far cry from the reality sometimes. Its not that we dont feel sorry for them, or hold their hand and cry mabey even (time permitting) , but if you let that rule you, you will burn out real quick and wont be able to do your job.

[DuncanONeil]

I still think my comment; "Also you continue to assume that the doctor has no understanding of the patient they are seeing nor any understanding of how they can be helped.
Comparing people to cars is insulting, cars can not think or feel!", stands.

I did use the term understand not compassion. The car comment was directed at something Sadistic said. But your rebuttal does not seem to have the medicos referring to patients in the manner they "refer" to themselves. As for remembering, we all give differing portions of the data we are assailed with different priorities. I know I do! Things that are in a given place, readily available to me, does not require me to have those items in priority memory files.
Further I agree that being a member of the Grey school of medicine vs the Yang school can use you up very fast! But the thing we want doctors to do most of all is "fix" us. Why? Because there is something "wrong". After that I expect them to talk to me not at me.

Duncan you should hear doctors,,surgeons in paticular (especially ortho docs and nurses) talk about patients some time when they think the patient can't hear.

Often refering to themselves as mechanics.

Interpersonal relations and politically correct bs aside.

Paitients are often spoken of in very inpersonal manners, I know a dozen nurses who can't remember their paitents names from day to day, but can put whats wrong with them to the room numbers where they are. The tv version of the weepy nurse or doctor is a far cry from the reality sometimes. Its not that we dont feel sorry for them, or hold their hand and cry mabey even (time permitting) , but if you let that rule you, you will burn out real quick and wont be able to do your job.

[SadisticNature]

I still think my comment; "Also you continue to assume that the doctor has no understanding of the patient they are seeing nor any understanding of how they can be helped.
Comparing people to cars is insulting, cars can not think or feel!", stands.

I did use the term understand not compassion. The car comment was directed at something Sadistic said. But your rebuttal does not seem to have the medicos referring to patients in the manner they "refer" to themselves. As for remembering, we all give differing portions of the data we are assailed with different priorities. I know I do! Things that are in a given place, readily available to me, does not require me to have those items in priority memory files.
Further I agree that being a member of the Grey school of medicine vs the Yang school can use you up very fast! But the thing we want doctors to do most of all is "fix" us. Why? Because there is something "wrong". After that I expect them to talk to me not at me.

I still find the idea that you think doctors should be able to give placebo's to patients is grossly inconsistent with your stated desire to lower malpractice claims.

I'm not saying doctors are going to be wrong often with placebo's but I think even if they are wrong 1 time in 1000 patients that is going to be a large number of lawsuits. I think the claim that doctors aren't perfect is rather reasonable and backed up by the data.

Even if 999 out of 1000 patients that are given placebo's do better than those who are not, the doctors have no business giving out placebo's because when they are wrong its going to be a serious mistake.

What kind of damages do you think an insurance company will have to pay when the following situation occurs:

(i) Doctor diagnoses patient as a hypochondriac
(ii) Doctor proscribes placebo
(iii) Patient thinks placebo is working and doesn't see a doctor again until their next regular checkup.
(iv) Patients symptoms were actually related to cancer which is discovered at this checkup roughly a year later.
(v) Patient eventually dies as a result of the cancer.

In situations like this the damages can be colossal because for many cancers survival rates are very good for early diagnosis, while for later diagnosis survival rates are far worse. Cases like these are easy to win and easier to get a big settlement on, because the doctor is involved in deceiving the patient which results in them not seeking other treatments or care.

[Thorne]

(i) Doctor diagnoses patient as a hypochondriac
(ii) Doctor proscribes placebo
(iii) Patient thinks placebo is working and doesn't see a doctor again until their next regular checkup.
(iv) Patients symptoms were actually related to cancer which is discovered at this checkup roughly a year later.
(v) Patient eventually dies as a result of the cancer.

One problem I have here, though. If the patient's symptoms are relieved by the placebo, then their is not problem. If it's cancer, or some other serious disease, the placebo would not work. He might feel some relief for a brief time, perhaps, but as the disease progresses the placebo effect falls off. Chances are the doctor would not let him go for a year anyway, but have him check back in a week or two. If at that time the symptoms are relieved THEN he might diagnose hypochondria, not before.

And I doubt that any reputable doctor would go right to placebos anyway. He'd have to have some kind of indication from the patient's history before taking that step.

[DuncanONeil]

One problem I have here, though. If the patient's symptoms are relieved by the placebo, then their is not problem. If it's cancer, or some other serious disease, the placebo would not work. He might feel some relief for a brief time, perhaps, but as the disease progresses the placebo effect falls off. Chances are the doctor would not let him go for a year anyway, but have him check back in a week or two. If at that time the symptoms are relieved THEN he might diagnose hypochondria, not before.

And I doubt that any reputable doctor would go right to placebos anyway. He'd have to have some kind of indication from the patient's history before taking that step.

Agreed! I thought to, but did not mention the return visit. I have yet to visit a doctor for a medical complaint that has not included a return within a short period of time!

[DuncanONeil]

In this age of defensive medicine, where doctors run every possible test for every possibility, the likelihood of a misdiagnosis is small. When all science says there is nothing wrong and the patient essentially demands medication what is a doctor to do? Follow the science, do nothing, allowing the patient to seek a doctor that may have less ethics and prescribes an actual medication from which the patient dies of a side effect?
In the realm of malpractice "claims", many of them have nothing to do with the practice of medicine. The data reflects that most are without merit and have the appearance of an attempt to engineer a lottery win. Most of which goed to the legal community!

I still find the idea that you think doctors should be able to give placebo's to patients is grossly inconsistent with your stated desire to lower malpractice claims.

I'm not saying doctors are going to be wrong often with placebo's but I think even if they are wrong 1 time in 1000 patients that is going to be a large number of lawsuits. I think the claim that doctors aren't perfect is rather reasonable and backed up by the data.

Even if 999 out of 1000 patients that are given placebo's do better than those who are not, the doctors have no business giving out placebo's because when they are wrong its going to be a serious mistake.

What kind of damages do you think an insurance company will have to pay when the following situation occurs:

(i) Doctor diagnoses patient as a hypochondriac
(ii) Doctor proscribes placebo
(iii) Patient thinks placebo is working and doesn't see a doctor again until their next regular checkup.
(iv) Patients symptoms were actually related to cancer which is discovered at this checkup roughly a year later.
(v) Patient eventually dies as a result of the cancer.

In situations like this the damages can be colossal because for many cancers survival rates are very good for early diagnosis, while for later diagnosis survival rates are far worse. Cases like these are easy to win and easier to get a big settlement on, because the doctor is involved in deceiving the patient which results in them not seeking other treatments or care.

[SadisticNature]

I think this falls into the realm of opinion. I certainly feel its a hassle to get doctors to run tests they ought to rather than the other way around.

The doctor isn't responsible for what other doctors choose to do. The consequences of actions are not justified by "oh someone else would have done it anyways, but worse".

As for your opinion that the data reflects most claims are without merit and have the appearance of an attempt to engineer a lottery win, I certainly feel this is not the case from the actual examples you gave. Waking up cut open on a table is certainly a valid complaint and is a situation that can do serious psychological harm.

The numbers can be interpreted in many ways. It could be that 90% of the cases that go to court are being lost because the standard of proof is incredibly high to patient disclaimers, and that proving negligence can be difficult. It could also be that 90% of the cases that go to court are lost because there are too many opportunists who file flimsy cases. This doesn't say most of the cases are flimsy though, maybe the medical insurance companies are smart enough to settle the good cases and only push on the bad ones.

It is incorrect to say there is no opportunism in this area, but its also incorrect to say that because there is some opportunism there are no legitimate cases.

In this age of defensive medicine, where doctors run every possible test for every possibility, the likelihood of a misdiagnosis is small. When all science says there is nothing wrong and the patient essentially demands medication what is a doctor to do? Follow the science, do nothing, allowing the patient to seek a doctor that may have less ethics and prescribes an actual medication from which the patient dies of a side effect?
In the realm of malpractice "claims", many of them have nothing to do with the practice of medicine. The data reflects that most are without merit and have the appearance of an attempt to engineer a lottery win. Most of which goed to the legal community!

[Bren122]

There's a scene in Scrubs where a doctor has to tell a family his patient died; one of the characters makes the point that there is only one person in that room who is going back to work that day and he needs to do what it takes to get him over the loss of a patient and concentrate on the next one. Really made me stop and think what a shitty job most doctors and nurses have.

[denuseri]

Should placebos be illegal accross the board or not? Some say yes and some say no. Ok, big deal, opinions stated, shall we perhaps move on then and purpose some actual solutions?

How does one regulate something that requires the patient have no idea its being used outside of whats allready in place internally at medical ethics review boards?

I purpose that we could simpley have all patients sign a waiver stating that placebos may be used by diagnosticans as they deem appropriate as part of standard medical paperwork at all facilities, as was allways "assumed" to be part of a medical practicions own ethical requirments before big money insurance companies and lawyers got into the mix and ruined everything.

[SadisticNature]

Should placebos be illegal accross the board or not? Some say yes and some say no. Ok, big deal, opinions stated, shall we perhaps move on then and purpose some actual solutions?

How does one regulate something that requires the patient have no idea its being used outside of whats allready in place internally at medical ethics review boards?

I purpose that we could simpley have all patients sign a waiver stating that placebos may be used by diagnosticans as they deem appropriate as part of standard medical paperwork at all facilities, as was allways "assumed" to be part of a medical practicions own ethical requirments before big money insurance companies and lawyers got into the mix and ruined everything.

I like this solution. Allows individual choice, those who want placebo's can sign up for them, and those of us who actually want the truth don't have lies forced down our throats.

[DuncanONeil]

But would that not then defeat the purpose of them?

I like this solution. Allows individual choice, those who want placebo's can sign up for them, and those of us who actually want the truth don't have lies forced down our throats.

[DuncanONeil]

What do you call three lawyers, or solicitors as the case may be, at the bottom of the ocean?

Should placebos be illegal accross the board or not? Some say yes and some say no. Ok, big deal, opinions stated, shall we perhaps move on then and purpose some actual solutions?

How does one regulate something that requires the patient have no idea its being used outside of whats allready in place internally at medical ethics review boards?

I purpose that we could simpley have all patients sign a waiver stating that placebos may be used by diagnosticans as they deem appropriate as part of standard medical paperwork at all facilities, as was allways "assumed" to be part of a medical practicions own ethical requirments before big money insurance companies and lawyers got into the mix and ruined everything.