One Pill Makes You Larger And One Pill Makes You Lie

 

A person critical of chiropractic recently told me he believed the only reason chiropractic showed any effectiveness was entirely placebo effect.  He was wrong.  I’m not getting into that in this article.  However, it looks like he could have made a similar statement about many medical practices and not been too far off the mark.

It turns out, according to a recent study published in the British Medical Journal (BMJ), almost half of U.S. medical doctors use placebos with their patients.

If your doctor has prescribed antibiotics for the flu or told you to try B-12 vitamins for fatigue, those treatments were just a placebo — an unproven therapy offered with the hope you would feel better if you took something…anything.

Treatment with placebos is far more common than you might think, according to the national survey about 58 percent of U.S. physicians admitted using placebos regularly. Only 5 percent said they tell patients explicitly that they are doing so. The survey was sent to 1,200 internists and rheumatologists with a response rate of about half of them. 

Classic examples of placebos are sugar pills, saline injections and other treatments that seem to inspire confidence even though they are inert. But the physicians surveyed were far more likely to use active agents as placebos, including over-the-counter painkillers, vitamins, sedatives and antibiotics.  What classified them as placebos was the context. If the recommended treatment hasn’t been shown, physiologically, to work for the condition in question, then it was a placebo.

Two years ago, the American Medical Association said it was wrong to use placebos without a person’s knowledge.  But some make a case for what they call “benevolent deception” — letting a patient believe she’s getting a useful treatment because, paradoxically, it might work.  I think that when placebos involve medications like antibiotics and sedatives there is a line that has been crossed.  Furthermore, when the AMA code of Ethics states that “a physician shall … be honest in all professional interactions” I don’t see the wiggle room in there to tell Mrs. Smith that the garlic tablets you gave her will have a chance at curing her cancer.

So what’s to be done with patients who insist on a prescription for something they don’t need?  I say, educate them, don’t lie to them.  Tell them why they don’t need an antibiotic, give them a lollipop and send them home.

What do you think?

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2 Comments

  1. cmnacnud said,

    October 25, 2008 at 5:40 pm

    First of all using a drug that has known side effect, (any at all) as a placebo, is wrong. It is wrong to possibly endanger a person like that. Where is the risk benefit analysis?

    I am not however opposed to sugar pills, vitamins, or good for you anyway pills. I just don’t know what if any appropriate time exists to use them or any form of placebo. Placebo is oddly enough, effective treatment for many things. I don’t think we should throw out a useful treatment tool. But I’m not sure of a way to appropriately use it. If anyone out there knows a good way to take advantage of the mind with placebo let me know.

  2. Amy Hengst said,

    November 6, 2008 at 6:07 pm

    One thought I had about this recently, after pondering the research a few days, is that we expect that drugs take a few days to work. Maybe people say the placebo is working because they feel improvement happening naturally, then attribute that to the drug they’re given. It’s not that people psychologically dupe themselves and feel better if they’re given a placebo — they just attribute the cause of the improvement differently. That’s just an idea, because I hate thinking people are psychologically making themselves better just based on a pill they swallow.

    I blogged this research a while back and my suggestion for doctors is that instead of prescribing a placebo for psychologically-induced problems, doctors can suggest other treatments that will help work on the patient’s psychological state— meditation, yoga, other exercise, massage, or other types of stress relief.

    It seems to me that Americans seem to have a strong work ethic, and sometimes just need to be given doctor’s permission to relax and take care of themselves, along with some options for how to do so productively.


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