Ethics Alert: Many Doctors Prescribe Placebos
A disturbing study has been published indicating that many doctors prescribe placebos instead of efficacious medications to their patients. From the story:Many rheumatologists and general internal medicine physicians in the US say they regularly prescribe "placebo treatments" including active drugs such as sedatives and antibiotics, but rarely admit they are doing so to their patients, according to a study on bmj.com...
The authors report that among the 679 physicians (57%) who responded to the survey half of them said they prescribed "placebo treatments" on a regular basis. Most physicians (62%) believed the practice to be ethically acceptable and were happy to recommend or prescribe placebo treatments.
The most commonly used placebo treatments prescribed in the past year were over the counter painkillers (41%) or vitamins (38%). Some of the physicians reported using antibiotics (13%) and sedatives (13%) as placebos, only 3% reported using sugar pills.
Interestingly, among those who prescribe placebo treatments, most doctors (68%) said they typically describe the placebo treatments to patients as "a potentially beneficial medicine or treatment not typically used for their condition", only rarely did they admit to explicitly describing them to patients as "placebos".
Yes, I know there is such a thing as a placebo effect, which is why they are used in human medical trials, where they are appropriate. But even if this does work once in a while, it is wrong.
posted by Wesley J. Smith @ 1:59 PM
6 Comments
6 Comments:
That is sickening (parden the pun)! This shows two things in particular:
1. Doctors are often SO arogant (I am speaking from experience here). They often just think that if they don't know what your problem is, then you're crazy. But people really do experience things that no one can figure out, I know a whole bunch of them!
2. Americans are far too trusting of their doctors. Every time I am prescribed a medication, I do at least a little research on it, if only it is just reading the liturature the pharmacy provides... that alone should alert someone if they're getting something that won't help them!
Thanks for this, I didn't know doctors actually prescribed placebo's sometimes.
I agree. Giving placebos is the role of alternative medicine (homoeopathy, reiki, acupuncture).
If a doctor truly thinks a patient can benefit from a placebo, they should recommend one of those instead of using up medications that could actually help others.
Even the alternative medicine folks ought actually to _believe_ that what they are giving is objectively helpful or else they are charlatans. I tend to believe many of them _are_ charlatans (I have relatives who are way too much into the alternative medicine scene) but I'm not going to excuse charlatanism. I agree, though, that it's even more disturbing to find it in the supposedly mainstream medical field.
Tangentially related: I wonder if nursing schools have now stopped teaching "therapeutic touch." Talk about a placebo! Anybody else remember when that girl did a double-blind study as her high school science project that showed no effect from "therapeutic touch"? Her mother was studying to be a nurse, and the girl got curious about whether "that stuff really works."
I commented on this at bioethics.org but they moderate comments, so who knows.
My daughter had school-related tummyaches in 7th grade. The pain was real and I didn't want to assume anything so I took her to the pediatrician. He palpated her stomach and said he felt some constipation and trapped gas - which will cause real pain of course - but when I said I must have been wrong about it being schoolitis he said, "I wouldn't be too sure about that."
Anyway, he told us she needed to drink Celestial Seasonings Tummy Mint Tea and take acidophilus and Vitamin C. This did help her stomach aches. But how much was the calming effect of the chamomile and peppermint, or the probiotic acidophilus, and how much was placebo? And does it matter?
If you pinned him down, he probably couldn't say. Are there clinical studies to show that these things help? Probably not. My inclination is that if there's not a disorder that needs treating, and there's an alternative medicine that's not expensive or harmful and might help, what the heck. The placebo effect is real, that's why they have to include placebos when they study drugs. Of course, if you know what you're taking is a placebo, it won't work.
My kid's in college, by the way, and she makes sure to have some of that tea on hand.
I really need to share this with you. I am not totally opposed to placebos. My mother is 70 and has been living with me for 5 years. Since I can remember she has complained of several different types of ailments--usually pain related--pain in her neck, pain in her stomach, pain in her legs, pain in her back, etc. At each juncture she has been put on one medication or another to treat her illness and eventually the situation worsens or she needs stronger meds. Often times she exchanges one ailment for another. She doesn't "believe" that naturally remedies help, but she often believes her "pills." I have bought many OTC pills for her claiming the Dr prescribed it. Older Americans are notoriously over medicated---at one time my mother was taking 21 different medications prescribed by different Drs. I appreciated the day, the Dr. prescribed her placebos. I don't worry about her so much now. How many ailments does my mother have? Who knows. But she's happy and complains a lot less when she thinks she's taking a "real" pill.
this is misleading.
"Overthecounter"painkillers aren't "placebo.
For years, I took prescription Anaprox...it is now Alleve, sold Over the counter...
. Over the counter is is half the dose but for many of my patients, it's just easier to write the prescription so that their insurance pays for it.
And often we order vitamins for pain (neuropathic pain vitaminB, bone pain, vitamin D) not as a placebo but to insure our patients are getting proper doses.
Finally, the FDA takes forever to "approve" of a drug. I saw one article lamenting about the "fake" data on neurontin..but neurontin works for neuropathic pain, and I started using it on my patients years before it was approved, because nothing else worked. I mean, when patients preferred neurontin to Codiene, you figure it must be more than placebo effect...
Of course, in studies, the only "pain killer" that works better than placebo is morphine...but as someone who had chronic pain for years, I just don't believe that is true in real life...maybe in an "acute" situation, but what about those of us who hurt for years?
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