title: Placebo Trends across the Border: US versus Canada.
abstract: BACKGROUND
  Physicians around the world report to using placebos in a variety of situations and with varying degrees of frequency. Inconsistent methodologies, however, complicate interpretation and prevent direct comparisons across studies. While US- and Canada-based physicians share similar professional standards, Canada harbours a less-litigious universal healthcare model with no formal placebo-related policy-factors that may impact how physicians view and use placebos.
  
  
  METHODS
  To compare American and Canadian data, we circulated an online survey to academic physicians practicing in Canada, collected anonymous responses, and extracted those of internists and rheumatologists for comparison to US data obtained through parallel methodologies.
  
  
  RESULTS
  Whereas our data show overall concordance across the border-from definitions to ethical limitations and therapeutic potential-differences between American- and Canadian-based placebo practices merit acknowledgement. For example, compared to 45%-80% among US-based respondents, only 23±7% of Canada-based respondents reported using placebos in clinical practice. However, 79±7% of Canada-respondents-a figure comparable to US data-professed to prescribing at least one form of treatment without proven or expected efficacy. Placebo interventions including unwarranted vitamins and herbal supplements (impure placebos) as well as sugar pills and saline injections (pure placebos) appear more common in Canada, where more doctors described placebos as "placebos" (rather than "medications") and used them as a "diagnostic" tool (rather than a means of placating patient demands for treatment).
  
  
  CONCLUSIONS
  Cross-border variation in the use of clinical placebos appears minor despite substantial differences in health care delivery system, malpractice climate, and placebo-related policy. The prevalence of impure placebos in both Canadian and US clinics raises ethical and practical questions currently unaddressed by policy and warranting investigation.
authors.affiliation: Department of Biology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Cory S
authors.initials: CS
authors.lastname: Harris
authors.affiliation: Department of Psychiatry, McGill University, Montréal, Québec, Canada.
authors.forename: Natasha K J
authors.initials: NK
authors.lastname: Campbell
authors.affiliation: Department of Psychiatry, McGill University, Montréal, Québec, Canada.|Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Raz
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000941:ethics*; D010919:Placebos / Q000627:therapeutic use*; D028321:Plant Preparations / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000941:ethics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D010919:Placebos; D028321:Plant Preparations; D014815:Vitamins