Half of American Doctors Often Prescribe Placebos

damn_registrars writes "'Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. The results trouble medical ethicists, who say more research is needed to determine whether doctors must deceive patients in order for placebos to work.' The study just quoted goes on to say that the drugs most often used as placebo are headache pills, vitamins, and antibiotics. Studies on doctors in Europe and New Zealand have found similar results."

Not placebo

[pls2917]

As the article points out, prescribing e.g. antibiotics is not truly placebo (something totally inert). Rather, they are looking for the placebo effect by prescribing something that's a real drug but not expected to help with the ailment in question.

Re:Antibiotics?!?

[nzg1983]

Placebos and Antibiotics are not the same thing. You say, " Tell your patients that a spoonfull of sugar will cure them in aproximately 1 week if you absolutely need to give them something." - that is essentially what a placebo is! There are tons of articles out there about how patients are becoming more resistant to medical advice because they are constantly on the internet looking for a cure and they come to their doctors with things that won't work but refuse to listen to the doctor, who spent years in medical school, because they feel they learned everything by doing some research on the internet for a little bit. I can understand why some doctors feel they have no choice but to prescribe a placebo. This article also highlights the power of the mind in healing oneself, albeit in a roundabout way. If a patient feels they have gotten a new drug, they can heal themself just by thinking they are getting better from the new "drug". Anyway, I went off on a tangent a bit, but I just think you should have read the article more closely. Placebos are not antibiotics.

Re:this pisses me off

[Artifakt]

There is some real evidence the placebo effect doesn't work the way everyone believes it does.
Tests were done with giving people an injectable opiate for pain or giving them a placebo injection. This had pretty much the effect most people would expect, that is many people got pain relief from the placebo. This went on for about a week to establish a regular pattern. Then an opiate blocker was added to block the injection's effects, and surprise surprise, it also turned out to block the placebo's pain killing effects. This is one of those oddities medicine really has no good explanation for. It does seem to fit somehow with what you mention as well.
        Various experiments where the persons giving medication were aware or not aware it was a placebo seem to give odd results as well, where people administering the drugs seem to give away indicators to the patients that they themselves presumably don't know. This has been a good area for designing double-blind tests, where researchers have come up with elaborate methods to deprive people of information, i.e. giving the nurses written instructions in advance, and having them enter an area to find the doses pre-laid out but no doctor present, so there was no human contact that would seem to be capable of passing on any non-verbal or body language clues from somebody who knew which ones were placebos and which real. Unfortunately, it is not considered good practice of late to leave opiates just laying around, so it would be very difficult to introduce these methods to a new round of the original opiate experiments that led to this line of research,

Re:this pisses me off

[Anonymous Coward]

This is what we call 'Third year syndrome'. It happens to medical students often in the third year of medical school when they start attending clinical rotations a lot. (Yes, I'm a doctor by the way, and I have prescribed placebo to my patients - in their best interests).

This is a crap study and Title is WRONG

[spineboy]

First of all, they polled internist and Rheumatologists, many of whom were treating patients with fibromyalgia. Rheumatologists often wind up treating patients that no one can figure out why they "hurt", and thus often get patients with psychosomatic illnesses. Fibromyalgia is a diagnosis that patients state they hurt in many different places in their body, and no test, MRI or CT scan can show anything wrong. These patients often have depression, and the problem is usually best treated with anti-depressant type medications.
So the population of doctors sampled in this study is not typical at all of a normal population of doctors anyway.
"Headache"pills, or anti-inflamatories, are quite useful in relieving body aches and pains, and to call them a placebo is just plain wrong. Just go tell the patient with bad bone on bone osteoarthritis that the pill really doesn't do anything, and see how wrong you are. They really work very well.
Surgeons often do peer review their procedures - at least orthopaedic ones The journals are filled with articals every month describing how well, or how poorly a technique works.

Re:This is a crap study and Title is WRONG

[Mastodon]

I.e., the following question is still open: is there a physical cause, or is the cause psychosomatic?

Unless you believe there is something going on in the brain that is not subject to the laws of physics, it is hard to make sense of that distinction.

It is more useful to ask whether the pain is triggered in the peripheral or the central nervous system. IAAMD, and most people I know think there is a significant central component. Bear in mind that pain is not a one way street, like a wire from your thumb to your brain. It's a circuit with amplifiers in it and some people seem to have the volume turned up too high.

Fibromyalgia is a vague concept with blurry edges but useful for classifying a bunch of people who present with similar symptoms. The medications given for it are not placebos; two (Lyrica and Cymbalta) have received FDA approval as superior to placebo. There are others that also work but do not have the financial backing to go through the FDA process because the patent has expired.

They probably work by modulating pain transmission / perception in the spinal cord / brain.