Table 2. Benefits and Harms of Placebo-Prescribing as Discussed in Focus Groups.

Perceived Consequence of Placebo-Prescribing	Illustrative Quotation
Benefits
Financial – for the NHS	Can I just go back to what you were saying, that that is an issue isn't it now, with the cost of the NHS; if a placebo is costing you a pound to give out and they're [patients are] paying £7.40, that could bring a lot of revenue for the NHS. (FG2)
Alleviate discomfort	‘‘I’d want them (an elderly person) to feel as comfortable as possible’ FG5
Benefits for carers	‘I have a parent who's crippled by arthritis and it's very severe, very nasty now, I think it's probably past the point of, very much, of being able to do very much about it; but I feel that by administering a placebo to one parent, the other parent probably benefits on the care side of things as well' FG2
Feeling cared for, supported	“Or is the doctor treating the needs of his patients? He knows that some people just say ‘right, I'll work through a cold’. whereas that patient needs a bit of caring, that little bit of showing - by giving them the tonic it's showing caring for his - and treating it like it is a real illness, so maybe there is an element of benefit in that. You know sometimes people want to be listened to or felt that someone's helping them, that could be a consideration, that the tonic, while it's not medically helping them, it's emotionally helping them.” (FG2)
General mood	I:OK. What effects do you think a placebo can have on people?
	MP: Just your general mood, if you believe you're being treated for something that's going to lift your spirits a little bit (FG11)
Symptom improvement	But she might believe it and then - be happy. Might relieve her pain when nothing else is available to do that. (FG7)
Avoids risk of addiction associated with pharmaceuticals	‘if the alternative to a placebo is something strong, like morphine, then I'd rather the placebo first, as morphine is addictive’. (FG5)
No adverse effects	You've also got that - the other advantage of - by giving them a pill they think they feel better, they're also not getting any of the side-effects. (FG2)
Maintain some hope	It's good to give her a little bit of hope. (FG11)
Reduce need for medicines	I just think GPs should never tell you, and just say take this and you're going to get better by the power of your own mind then you'll never have to take medicine again. (FG1)
Harms
Financial – for the patient/NHS	MP: It's disingenuous in today's context where you're paying for a prescription and presumably if it's sugar water it doesn't come as expensive as a prescription charge does anyway, so he should tell him to go away and buy a tonic or whatever, you know, non-prescription drug because with the way that prices and costs of prescriptions are, if the chap finds out that he's being given something which is, you know, nothing really, he might be quite cross with the doctor even though he is feeling better later on. So -
	P: I hadn't thought of prescription charge, because it is a lot.
	P: What is a prescription charge?
	P: Seven pounds twenty.
Risk of missed/delayed diagnosis	“You've hit the nail on the head. It isn't about like - if it was a cold, it's a cold, it's a cold. It'll be a cold. But if it was like - if it was that he thought it were a cold and it turns out you had TB, then that's a completely different situation but as [other participant] says, that's where you kind of flit into malpractice.” (FG6)
If used as an alternative to proven treatment	“Well the only negative effect I'd say is when it's like a critical illness, where a fatality could be a consequence and there is a medicine that they could take which can battle the cancer and the doctor decides to do a placebo that has no effect.” (FG7)
False hope	“If someone's turned around and given you false hope and said these will help cure your cancer, then it's a different matter.” (FG11)
Patient feels disrespected	I would want the truth, I really don't like being fobbed off as if you're a nitwit. (FG3)
Threatens trust in doctor if deceit is discovered	‘I suppose that if he finds that they're only placebos or sugar pills, then you know, you lose trust in the doctor’. (FG11)
Put off going to doctor in future	“I think there's a danger though if he's found out that the doctor tricked him then he might not go to the doctor next time when it's something more serious.” (FG8)
Encourages over medicalization of minor illness	“But isn't it just going to lead to him going to the doctors again because he wants more tonic because he's got another cold?” (FG7)
Panders to patients' reliance on doctors	‘Somebody then becomes dependent on them and going to the doctor and getting one of those and that is what I mean about it being sinister because the whole society's expecting that something will make them better from whatever they've got all the time’ (FG5)
Unlikely to be effective	“But surely a placebo would only work with a handful of cases.” (FG8)
Removes patient choice	“What goes into my body; it's my body, it's up to me to decide, it's up to nobody else at all, you know, they are there to facilitate my healing, they are not in control of it.” (FG2)