IMPORTANCE: General practitioners (GPs) sometimes initiate a treatment despite not expecting it to improve patients' symptoms by any physiological mechanism. These essentially placebo treatments are ethically controversial, and their frequency is unclear. They involve risks for patients, but to estimate these, more data are needed. OBJECTIVE: To develop a more precise overview of the rate at which GPs prescribe essentially placebo treatments. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study included currently practicing GPs from 20 European countries and Israel who responded to online questionnaires. The online questionnaires were taken between December 12, 2019, and August 4, 2021, and analyzed on April 28, 2022. Respondents were contacted by national representatives, either through personal networks (convenience sampling) or an existing database (volunteer sampling). MAIN OUTCOMES AND MEASURES: The main outcome was the rate of essentially placebo prescriptions, given as the rate per week and the proportion of consultations. Secondary outcomes were the associations between this rate and GP background characteristics (gender, age, education about placebos, years of experience, patients seen, and working hours per week). RESULTS: A total of 952 practicing GPs responded (453 of 745 [61%] female; mean [SD] age of 48.02 [11.95] years), and 669 answered all questions. Overall, 689 of 818 respondents (84%) indicated they had prescribed an essentially placebo treatment at least once. Overall, the median (IQR) rate of essentially placebo prescriptions was 0.5 (0.1 to 2.0) per week or 0.67% (0.06% to 2.50%) of consultations. The prescription rate was higher in men (β = 1.94 [95% CI, 0.58 to 3.29]; P = .005), those with more work experience (β = 0.12 [95% CI, 0.06 to 0.18]; P < .001), and those who work fewer hours per week (β = -0.08 [95% CI, -0.13 to -0.03]; P = .001). CONCLUSIONS AND RELEVANCE: In this survey study of GPs across 21 countries, essentially placebo prescriptions featured in a small minority of consultations, but they nevertheless occurred regularly for most GPs. Rates varied only slightly by GP background characteristics. This suggests that essentially placebo prescriptions were common at a population level, which poses risks for the patient-GP relationship and creates medical risks for patients. Future research should further investigate the decision-making process behind these prescriptions and their effects on patients.

Center for Primary Health Care Research Department of Clinical Sciences Lund University Malmö Sweden

Center for Public Health and Healthcare Department of Medical Psychology German Center for Lung Research BREATH Hannover Hannover Medical School Hannover Germany

Department of Family Medicine and Population Health University of Antwerp Gouverneur Kinsbergen Centrum Antwerp Belgium

Department of Family Medicine Faculty of Medicine Semmelweis University Budapest Hungary

Department of Family Medicine NOVA Medical School Lisboa Portugal

Department of Internal Medicine of Postgraduate Education and Training Centre of Family Medicine Bogomolets National Medical University Kyiv Ukraine

Department of Medical Informatics AP HP Hôpital Européen Georges Pompidou Paris France

Department of Medicine and Optometry Faculty of Health and Life Sciences Linnaeus University Kalmar Växjö Sweden

Department of Psychiatry Leiden University Medical Center Leiden the Netherlands

Department of Public Health and Primary Care Ghent University Ghent Belgium

Department of Social Medicine Charles University Faculty of Medicine in Hradec Králové Hradec Králové Czech Republic

Department of Urology and General Practice Faculty of Medicine Medical University of Plovdiv Plovdiv Bulgaria

Division of Research Methodology Department of Nursing Faculty of Nursing and Midwifery Wroclaw Medical University Wrocław Poland

Faculty of Medicine Tel Aviv University Tel Aviv Israel

Health Center Zagreb Centar Zagreb Croatia

Institute of Family Medicine and Public Health University Tartu Tartu Estonia

Institute of Primary Health Care University of Bern Bern Switzerland

Irish College of General Practitioners Dublin Ireland

JZNU Dom zdravlja Dr Mustafa Šehović Tuzla Tuzla Bosnia and Herzegovina

Keele University School of Medicine Keele Staffordshire United Kingdom

Leiden Institute for Brain and Cognition Leiden University Leiden the Netherlands

LUMC Center for Medicine for Older People Department of Public Health and Primary Care Department of Internal Medicine Leiden University Medical Center Leiden the Netherlands

Medical Delta Erasmus University Rotterdam Leiden University and Delft University of Technology Delft the Netherlands

Research Unit for General Medicine and Primary Health Care Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece

Stoneygate Centre for Empathic Healthcare Leicester Medical School University of Leicester Leicester United Kingdom

Unit Health Medical and Neuropsychology Leiden University Leiden the Netherlands

Université Paris Cité Sorbonne Université Inserm Centre de Recherche des Cordeliers Paris France

University of Medicine and Pharmacy of Craiova Craiova Romania

doi: 10.1001/jamanetworkopen.2025.32678 PubMed

Zobrazit více v PubMed

Hróbjartsson A, Norup M. The use of placebo interventions in medical practice—a national questionnaire survey of Danish clinicians. Eval Health Prof. 2003;26(2):153-165. doi: 10.1177/0163278703026002002 PubMed DOI

Nitzan U, Lichtenberg P. Questionnaire survey on use of placebo. BMJ. 2004;329(7472):944-946. doi: 10.1136/bmj.38236.646678.55 PubMed DOI PMC

Sherman R, Hickner J. Academic physicians use placebos in clinical practice and believe in the mind-body connection. J Gen Intern Med. 2008;23(1):7-10. doi: 10.1007/s11606-007-0332-z PubMed DOI PMC

Tilburt JC, Emanuel EJ, Kaptchuk TJ, Curlin FA, Miller FG. Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists. BMJ. 2008;337(7678):a1938. doi: 10.1136/bmj.a1938 PubMed DOI PMC

Fässler M, Gnädinger M, Rosemann T, Biller-Andorno N. Use of placebo interventions among Swiss primary care providers. BMC Health Serv Res. 2009;9:144. doi: 10.1186/1472-6963-9-144 PubMed DOI PMC

Fässler M, Meissner K, Schneider A, Linde K. Frequency and circumstances of placebo use in clinical practice—a systematic review of empirical studies. BMC Med. 2010;8:15. doi: 10.1186/1741-7015-8-15 PubMed DOI PMC

Fässler M, Gnädinger M, Rosemann T, Biller-Andorno N. Placebo interventions in practice: a questionnaire survey on the attitudes of patients and physicians. Br J Gen Pract. 2011;61(583):101-107. doi: 10.3399/bjgp11X556209 PubMed DOI PMC

Meissner K, Höfner L, Fässler M, Linde K. Widespread use of pure and impure placebo interventions by GPs in Germany. Fam Pract. 2012;29(1):79-85. doi: 10.1093/fampra/cmr045 PubMed DOI

Howick J, Bishop FL, Heneghan C, et al. Placebo use in the United Kingdom: results from a national survey of primary care practitioners. PLoS One. 2013;8(3):e58247. doi: 10.1371/journal.pone.0058247 PubMed DOI PMC

Linde K, Atmann O, Meissner K, et al. How often do general practitioners use placebos and non-specific interventions? systematic review and meta-analysis of surveys. PLoS One. 2018;13(8):e0202211. doi: 10.1371/journal.pone.0202211 PubMed DOI PMC

Louhiala P, Hemilä H, Puustinen R. Impure placebo is a useless concept. Theor Med Bioeth. 2015;36(4):279-289. doi: 10.1007/s11017-015-9336-6 PubMed DOI

Howick J. The Power of Placebos: How the Science of Placebos and Nocebos Can Improve Health Care. Johns Hopkins University Press; 2023. doi: 10.56021/9781421446387 DOI

Fent R, Rosemann T, Fässler M, Senn O, Huber CA. The use of pure and impure placebo interventions in primary care—a qualitative approach. BMC Fam Pract. 2011;12:11. doi: 10.1186/1471-2296-12-11 PubMed DOI PMC

Kumar S, Little P, Britten N. Why do general practitioners prescribe antibiotics for sore throat? grounded theory interview study. BMJ. 2003;326(7381):138-138. doi: 10.1136/bmj.326.7381.138 PubMed DOI PMC

Howick J. Why it can be ethical to use placebos in clinical practice. In: Papanikitas A, Spicer J, eds. The Handbook of Primary Care Ethics. CRC Press; 2017. doi: 10.1201/9781315155487-4 DOI

Annoni M, Miller FG. Placebos in clinical practice: an ethical overview. Douleur Analg. 2014;27(4):215-220. doi: 10.1007/s11724-014-0400-1 DOI

Bostick NA, Sade R, Levine MA, Stewart DM Jr; American Medical Association Council on Ethical and Judicial Affairs . Placebo use in clinical practice: report of the American Medical Association Council on Ethical and Judicial Affairs. J Clin Ethics. 2008;19(1):58-61. doi: 10.1086/JCE200819109 PubMed DOI

Streit S, Verschoor M, Rodondi N, et al. Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries. BMC Geriatr. 2017;17(1):93. doi: 10.1186/s12877-017-0486-4 PubMed DOI PMC

van der Ploeg MA, Streit S, Achterberg WP, et al. Patient characteristics and general practitioners’ advice to stop statins in oldest-old patients: a survey study across 30 countries. J Gen Intern Med. 2019;34(9):1751-1757. doi: 10.1007/s11606-018-4795-x PubMed DOI PMC

Jungo KT, Mantelli S, Rozsnyai Z, et al. General practitioners’ deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatr. 2021;21(1):19. doi: 10.1186/s12877-020-01953-6 PubMed DOI PMC

American Association for Public Opinion Research . Best practices for survey research. Accessed June 22, 2025. https://aapor.org/standards-and-ethics/best-practices/

Mundfrom DJ, Perrett JJ, Schaffer J, Piccone A, Roozeboom M. Bonferroni adjustments in tests for regression coefficients.

McAvoy BR, Kaner EFS. General practice postal surveys: a questionnaire too far? BMJ. 1996;313(7059):732-733. doi: 10.1136/bmj.313.7059.732 PubMed DOI PMC

Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemlol. 1997;50(10):1129-1136. doi: 10.1016/S0895-4356(97)00126-1 PubMed DOI

Kellerman SE, Herold J. Physician response to surveys. a review of the literature. Am J Prev Med. 2001;20(1):61-67. doi: 10.1016/S0749-3797(00)00258-0 PubMed DOI