A BMJ study is catching the eye of mainstream media (or is this a case of “gotcha” journalism?), with headlines blaring that half of American doctors regularly prescribe placebos to patients. Those unethical bastards:
The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.In most cases, doctors who recommended placebos described them to patients as “a medicine not typically used for your condition but might benefit you,” the survey found. Only 5 percent described the treatment to patients as “a placebo.”
Couple of points.
# Antibiotics and sedatives are horrible choices for placebo medication. They have very real risks and side effects, such as increasing the incidence of drug resistance bacteria with the former and falls with the latter.
# Telling your patients that you’re giving a placebo defeats the whole purpose of prescribing one.
# Many alternative medical therapies are suspected to have a strong placebo component to their supposed effectiveness.
# Placebos have been shown to work in cases of depression, hypertension and pain. However, ethically incorporating the power of the placebo effect in everyday medical practice remains a challenge.
Related posts:
- Homeopathy: "Selling placebos wrapped in ritual"
- Placebos in the emergency department
- Should you routinely treat an elevated CRP with Crestor?
- Worker’s comp: "The amount of fentanyl prescribed is just stunning"
- Should hospitalized patients be routinely screened for MRSA?
- Expensive = better?
- Give ‘em 3 Tylenols
{ 2 comments }
The real story here is that the AMA says that something is “unethical” which is actually common practice–the AMA does not represent doctors and is not the authoritative voice on what is and is not ethical practice.
Lying to patients presents ethical problems. But sometimes it is possible to give placebos without actually lying. What is wrong with a treatment with a high response rate and no medical risks? Placebos have been an established part of a good physician’s practice for thousands of years.
Using placebos is fraud, plain and simple. Using drugs with dangerous side effects as placebos is malpractice. The idea that any positive result you don’t understand or can’t explain is due to placebo is ignorance. At any given time, a patient is either feeling better, the same, or worse. To attribute the taking of some pill or therapy to placebo whenever it results in apparent “improvements” and not simple variation in the course of any illness or disorder, wishful thinking on the part of the patient, desire to please the doctor or other reasonable explnations is unscientific. A placebo effect should have to be profound, long term and repeatable before it is labeled as such. That is rarely the case.
Comments on this entry are closed.