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Is Your Doctor Prescribing A Placebo?

JEMJJEM Posts: 32
edited 06/11/2012 - 8:24 AM in Pain Medications
http://www.citynews.ca/news/news_28432.aspx

Is Your Doctor Prescribing A Placebo?

Friday October 24, 2008

By Maria Cheng The Associated Press

About half of American doctors in a new survey say they regularly give patients placebo treatments - usually drugs or vitamins that won't really help their condition. And many of these doctors are not honest with their patients about what they are doing, the survey found.

That contradicts advice from the American Medical Association, which recommends doctors use treatments with the full knowledge of their patients.

"It's a disturbing finding," said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. "There is an element of deception here which is contrary to the principle of informed consent."

The study was being published online in Friday's issue of BMJ, formerly the British Medical Journal.

Placebos as defined in the survey went beyond the typical sugar pill commonly used in medical studies. A placebo was any treatment that wouldn't necessarily help the patient.

Scientists have long known of the "placebo effect," in which patients given a fake or ineffective treatment often improve anyway, simply because they expected to get better.

"Doctors may be under a lot of pressure to help their patients, but this is not an acceptable shortcut," said Irving Kirsch, a professor of psychology at the University of Hull in Britain who has studied the use of placebos.

Researchers at the NIH sent surveys to a random sample of 1,200 internists and rheumatologists - doctors who treat arthritis and other joint problems. They received 679 responses. Of those doctors, 62 percent believed that using a placebo treatment was ethically acceptable.

Half the doctors reported using placebos several times a month, nearly 70 percent of those described the treatment to their patients as "a potentially beneficial medicine not typically used for your condition." Only 5 percent of doctors explicitly called it a placebo treatment.

Most doctors used actual medicines as a placebo treatment: 41 percent used painkillers, 38 percent used vitamins, 13 percent used antibiotics, 13 percent used sedatives, 3 percent used saline injections, and 2 percent used sugar pills.

In the survey, doctors were asked if they would recommend a sugar pill for patients with chronic pain if it had been shown to be more effective than no treatment. Nearly 60 percent said they would.

Smaller studies done elsewhere, including Britain, Denmark and Sweden, have found similar results.

Jon Tilburt, the lead author of the U.S. study, who is with NIH's bioethics department, said he believes the doctors surveyed were representative of internists and rheumatologists across the U.S. No statistical work was done to establish whether the survey results would apply to other medical specialists, such as pediatricians or surgeons.

The research was paid for by NIH's bioethics department and the National Center for Complementary and Alternative Medicine.

The authors said most doctors probably reasoned that doing something was better than doing nothing.

In some cases, placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also gave antibiotics to patients with viral bronchitis, knowing full well that a virus is impervious to antibiotics, which fight bacteria. Experts believe overuse of antibiotics promotes the development of drug-resistant strains of bacteria.

Some doctors believe placebos are a good treatment in certain situations, as long as patients are told what they are being given. Dr. Walter Brown, a professor of psychiatry at Brown and Tufts universities, said people with insomnia, depression or high blood pressure often respond well to placebo treatments.

"You could tell those patients that this is something that doesn't have any medicine in it but has been shown to work in people with your condition," he suggested.

However, experts don't know if the placebo effect would be undermined if patients were explicitly told they were getting a dummy pill.

Brown said that while he hasn't prescribed sugar pills, he has given people with anxiety problems pills that had extremely low doses of medication. "The dose was so low that whatever effect the patients were getting was probably a placebo effect," he said.

Kirsch, the psychologist, said it might be possible to get the psychological impact without using a fake pill. "If doctors just spent more time with their patients so they felt more reassured, that might help," he said.

Some patients who had just seen their doctors at a clinic in London said the truth was paramount.

"I would feel very cheated if I was given a placebo," said Ruth Schachter, an 86-year-old Londoner with skin cancer. "I like to have my eyes wide open, even if it's bad news," she said. "If I'm given something without being warned what it is, I certainly would not trust the doctor again."



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Comments

  • Interesting article, As an RN and who usually gives out all meds, I find this hard to believe. I had to give a placebo to a patient but then I was a student and felt bad and lied about the med. It would have to be a clinical study for a Dr. to give a placebo. Because mainly the Nurse gives the med. Over 20 years Nursing I've never given a placebo since. I now am an advocate for patients getting meds as I have to tell them what I'm giving and no lying. Especially first hand in having backpain and knowing of it's terrible pain, I advocate to the Doctor for this patient to get pain relief. It's not the patient's fault if they become addicted and there are programs out there to assist in rehab if the chronic pain is gone and the patient no longer needs meds. So unless this is a clinical trial, I would tell the Dr. to give the med himself as I want no part of lying to a patient and inject saline instead of a real drug. This is in no way medical advice and just my opinion as part of the system of an honest advocate. I'm not here to give any professional advice and just saying how I personally feel about this practice. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I think this is disgusting. I also think that it is bad that some doctors will lead the patient to beleive that they are being given a drug that will work for them when they no full well it will not work. From the doctors point there arte some patients out there who are under a delusion(hypocondriac) that they are ill when they are not, so in cases like these yes i do this it is a good thing to use the "sugar pill". I dont think someone who is genuine and needs pain relief or antibiotics should not be led this way, as they need the correct medication.


    Angie
  • I would be the type of person they would prescribe a placebo to. (Young construction worker type )And ive had alot of suspicious doctors(Wrongfully so as my pain has since been vindicated) Yet i have never received a placebo
  • :? :? :? :? :? JEM,

    Interesting off the charts post. I read it and thought there is no possible (legal) way this could happen! Sure nuff' called a local pharmacy (grocery chain) and posed the question, "Can you legally dispense a placebo?" "Yes we can she answered."

    I would (IF I ever thought or even doubted) be absolutely irate spending over 300$ on medication. How could I get upset IF I felt I were benefiting? CRAZY. My Dr. of 18yrs. knows all about it. The psychology and mind aspect is to say the least, amazing! You can read where even the color of a pill will have an affect on the mind which relays it to the body.

    THANK-YOU VERY MUCH! I am totally fascinated and intrigued by the post you started!
  • My sister was invited into a trial for her cancer which she accepted where the knowledge of the use of a placebo was not known to her, much academic research has been done on the use of placebos and it make for very interesting reading. The notion was that the move invasive the process of giving the medication and the size of the medication itself all had an impact on the results, statement s were given from the patients are too the perceived benefits from what they thought they had taken and the notion of improvement inferred a positive comment from the recipients.

    A big distinction should be made between where these were used and in what context; this may be acceptable in a clinical trial and with some disclosure and only a small percentage of the total usage.

    Patients go to the doctor with heightened expectation and by implication the use of a lower dose may be as effective for the patient than over-prescription.

    No sugar thanks, John
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