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Placebos in pediatrics: A cross-sectional survey investigating physicians' perspectives
Vanda Faria1, Cameron Talbert2, Nathan Goturi2
1Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany; Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Insights
Pediatricians find placebo treatments acceptable but rarely recommend them. Developing clear ethical guidelines could increase the use of placebos to improve pediatric care and harness their beneficial effects.
Area of Science:
- Pediatric Medicine
- Psychosomatic Medicine
- Clinical Research Ethics
Background:
- Placebo responses are notably higher in children compared to adults.
- This suggests a potential, yet underutilized, therapeutic avenue in pediatric healthcare.
- Understanding physician perspectives is key to clinical translation.
Purpose of the Study:
- To investigate pediatric physicians' current practices regarding placebos.
- To assess their opinions, knowledge, and future likelihood of recommending placebos.
- To explore barriers and facilitators for placebo use in pediatrics.
Main Methods:
- A cross-sectional web-based survey was distributed to 1157 physicians at Boston Children's Hospital.
- The survey assessed attitudes, perceptions, and practices related to placebo use in pediatric care.
- Data were collected between October 2021 and March 2022.
Main Results:
- Only 109 out of 207 (18%) returned surveys were fully completed.
- 79% of physicians believed enhancing placebo response components could improve pediatric care.
- 62% found placebo treatments permissible, but only one-third recommended them; 87% would recommend them with guidelines.
Conclusions:
- Physicians perceive placebo treatments as permissible in pediatric care.
- Systematic incorporation of placebo effects requires the development of safety and ethical guidelines.
- Such guidelines are crucial for physicians to confidently integrate placebo benefits into pediatric practice.
Objective:
Placebo responses are significantly higher in children than in adults, suggesting a potential underused treatment option in pediatric care. To facilitate the clinical translation of these beneficial effects, we explored physicians' current practice, opinions, knowledge, and likelihood of recommending placebos in the future.
Methods:
A cross-sectional web-based survey administered by REDCap was conducted at Boston Children's Hospital between October 2021 and March 2022. Physicians (n = 1157) were invited to participate through an email containing a link to a 23-item survey designed to assess physicians' attitudes and perceptions towards the clinical use of placebo in pediatrics.
Results:
From 207 (18%) returned surveys, 109 (9%) were fully completed. Most respondents (79%) believed that enhancing the therapeutic components that contribute to the placebo response may be a way of improving pediatric care. However, whereas most (62%) found placebo treatments permissible, only one-third reported recommending them. In pediatrics, placebos are typically introduced as a medicine that "might help" (43%). The most common treatments recommended to enhance placebo effects are physical therapy, vitamins, and over-the-counter analgesics. Physicians most frequently recommend placebos for occasional pain, headaches, and anxiety disorders. Finally, the great majority of physicians (87%) stated they would be more likely to recommend placebo treatments if there were safety and ethical guidelines for open-label placebos.
Conclusions:
Placebo treatments seem permissible to physicians in pediatric care, but the development of safety and ethical guidelines may be necessary before physicians systematically incorporate the benefits of the placebo effect in pediatrics.
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