Half of American Doctors Often Prescribe Placebos 238
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."
Unfortunately, they have to. (Score:5, Insightful)
I have friends and relatives who get the Flu and run off to the doctor to get a prescription. I try to explain, that antibiotics won't help a viral infection but people just want to take a pill. It doesn't cost me any money for my time when I'm talking about it with them, but for a doctor time is money. He can lose money and potentially go out of business because every asshole who walks through the door wants or needs pills to feel better or he can just give them placebo and get on with his day.
LK
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They DO NOT have to prescribe antibiotics. There is NO excuse for that. Increasing the risk of creating superbugs that endanger everyone just to stay in buisness and get idiots out of your office is criminal, to say nothing of violating the hippocratic oath on a massive scale.
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They didn't have to so they dont... GP said doc gave out placebos. Its a situation arguing for them.
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Reading is your friend. Next time try to stick it out through the summary.
The study just quoted goes on to say that the drugs most often used as placebo are headache pills, vitamins, and antibiotics.
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Except that, the GM, to whom you replied originally, was talking about a specific set of circumstances to which your reply was invalid.
Sure, your reply applies to the article, but go reply to it instead then.
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Of course this is 100% bullshit. If you don't have a cure - just tell them so. No deception is necessary.
Modern medicine in USA is becoming shamanism. Too much uncontrolled power that people believe. No wonder medicine on Cuba is better than that of the USA.
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Placebo treatment is not a new thing - my mom was a nurse in the 60s and 70s and would occasionally give them out.
Medicine has always had an element of the shaman about it. We should acknowledge it, understand that the mind plays a huge role in wellness and that effective medicine involves more than the mechanical repair of tissue. Healing is not something that doctors and therapists do to a patient, but something that the patient performs with the support -
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But they do have a treatment, placebo, which has a well documented efficacy across hundreds of trials, for virtually every illness known to man.
Re:Unfortunately, they have to. (Score:4, Insightful)
No, they don't have to, they choose to. If all the doctors took the hard line when it came to not doing the things you suggested, then it wouldn't be a problem. Any doctor who is prescribing medication when they know it's unnecessary and potentially harmful because they want more business shouldn't be practicing.
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Antibiotics are NOT a placebo (Score:3)
this pisses me off (Score:2, Interesting)
How can doctors get away with this? With the cost of medicine, how dare they make people go out and buy something they don't need. How about honesty and good bedside manner? Is that too difficult to provide outside of looking over a patient, writing out a prescription and charging 75 bucks for the visit?
Re:this pisses me off (Score:5, Insightful)
How can doctors get away with this?
They're "getting away" with it because frequently it's in the best interest of their patients.
With the cost of medicine, how dare they make people go out and buy something they don't need.
They don't *make* people go out and do anything.
Most likely, people go to the doctor and expect to walk away with a prescription. The doctor has two choices:
1. give them a placebo, and tell them what to do to really fix the problem (bed rest or more exercise, as applicable to the situation.)
2. explain to them that a pill won't fix anything, and what they need to do to fix the problem.
If the doctor tells them 1, the patient walks away happy.
If the doctor tells them 2, the patient resents the doctor and ignores the advice about what to do to really get healthy.
How about honesty and good bedside manner?
Honesty and good bedside manner don't go very far when people are told by big pharmaceutical companies that there is a pill to cure everything.
Re:this pisses me off (Score:5, Insightful)
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It is not clear that you have to deceive anyone. Some research shows the placebo effect (reduced but existing) even when people know it's a placebo. IMHO, that's ethical.
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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 killin
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That's very interesting--I would not have known that.
I would have liked to see a link to the published study, but searching for "opiate blocker pain relief placebo" reveals that this is commonly accepted as true.
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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.
Adding a narcotic blocker to a placebo injection would also block the bodies natural endorphins and thereby blocking the natural pain relief mechanism. Opiates are not as good a pain reliever as people think, especially for some types of pain, for a good old fashioned everyday tension headache a couple tylenol or aspirin works wonders, but a vicoden wouldn't touch it. Motrin is the best pain reliever bar none for dental pain.
Re: "Strong Placebo" (Score:2)
Science has tricked itself into a tradition that is only just starting to change. We don't like to "accept" any procedure that "doesn't work". So tons of subtle practices that can't hurt and very likely help tap into body defenses are discarded as junk.
The patient has been conditioned that "since we got rid of the quacks back in 1925, every pill at least sorta does something". So patients come to want an *edible* placebo.
If the doctor doesn't have a classical cure, I would prefer to be advised to try an "ac
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One word: Homeopathy.
There's a whole wealth of potent-sounding mostly harmless compounds that can be prepared in pill form.. and already are.
Agreed on the antibiotics. A good placebo shouldn't actually do anything at all.
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But you have simplified the situation too much, because often placebos don't work at all, or they may work for a while, then stop. There is lots of research going on with the placebo effect and it suggests that it's all a bit more complicated than what people have previously assumed. Not to mention that your first sentence is a false premise -- that doctors prescribe something doesn't always mean they're sure it will help.
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Right. Because everyone always follows up with their doctor on everything to let them know how well it turned out. But I'm sure it's all working just fine like you say.
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If you want to see insignificance, go take a look at those screwball homeopaths.
Re:this pisses me off (Score:4, Interesting)
How can doctors get away with this?
Posting anonymously because this is kinda embarrassing, but I have suffered a bout of hypochondria recently. I'm not the type of person who runs to the doctor with every illness, and I have, in fact, gone for 5-6 years without doctor's visits (I'm in my mid-20's and in pretty good health, so I feel I can skip the check-ups).
Well, this all changed when I got some abdominal pains. Went to the doctor, he ran tests for the dangerous stuff, nothing was found. Then he ran tests for the more common stuff, nothing was found. He sent me home with instructions to wait a week to see if it got better, or to return earlier if it got worse. Naturally I got pissed off, because I was still in pain, and felt like I needed to do some research to see what it could be. I hit webmd.com
Fucking bad idea. As I found symptoms that matched mind, and read about the additional symptoms that came with the diseases, I actually started feeling the new symptoms. So I went back to the doctor with them. More tests were made, nothing was found, I would do more 'net research, start getting worse with new symptoms again, go back to the doctor run more tests, find nothing again. Eventually I realized what was happening, and calmed the fuck down. All the symptoms disappeared within a week, but not before I spent a few thousand dollars in deductibles and went through the literal pain in the ass of a colonoscopy as a 20-something year-old for no reason whatsoever.
This type of hypochondria is something medical students [wikipedia.org] go through, and is something you can expect more of the general population to go through now that we all have access to things like webmd.
So when you show up at a doctor's office, and the doctor eliminated the possibility that you need urgent medical attention, and can't find anything wrong with you...there's some value to the patient in just prescribing a cheap placebo and calming him down.
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After all, your body repairs a lot of stuff without help from doctors. There are reasons why you're not falling apart as rapidly as an AIDS patient.
Go ask Doctors - even cancers can just vanish in some cases, cancers that were proven to exist etc.
And that's why the many good doctors don't like to do so many tests. Because with all the tests you can do, you'r
Re:this pisses me off (Score:4, Funny)
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It depends. The problem is human, not only is the physician human, the patient is too.
I think it can be a good way to diffuse a potentially tense situation. There is a recognized problem where sometimes parents bring their children in for sniffles and demanding antibiotics. Parents, being overzealous, ignorant or just plain adamant, don't think their children are getting proper attention if they aren't getting antibiotics, but giving out antibiotics when it isn't merited, or cause more problems. Excessiv
Re: SuperPlacebo? (Score:2)
Wow.
Last I knew, the classical placebo was for the *patient* to feel better. You just described a scary variant, the placebo to make the *mother* of the patient feel better!
Re:this pisses me off (Score:4, Interesting)
How about honesty and good bedside manner?
When drug manufacturers stop spending millions on advertising campaigns to convince patients that the latest and greatest drug (which is really exactly the same as the generic but with added ibuprofen or whatever) is essential, doctors might start getting honest information from their patients about what they really need.
About fifteen years ago, looking at med school as an option, I did work experience with a doctor. It was cold season. 95% of his patients were there because they had little more than a cold and a desire to stay home from work. He told me to watch. For the first five minutes he would do everything in his power to just give them the treatment they really needed. After that, if not satisfied, he'd write them a prescription for exactly the same thing but with a more impressive name, that they'd have to buy over the counter, that would cost them twice as much as the off the shelf for exactly the same thing.
The first five minutes they were pissed. What did he mean, he didn't think they needed a prescription?! That off the shelf drug couldn't possibly help someone as sick as them. They were angry. They were outraged.
Then he agreed with them, admitted he was wrong, that he'd underestimated and was going to write them a prescription for a new drug that's just come on to the market. With an impressive new name, essentially a reformulation of what he'd been trying to give them, they left happy.
Honesty and a good bedside manner are worth slightly less than zero when people are bombarded by dozens of commercials a day telling them how only the drug with the obviously happier people, with the cool smiling bumble bee, and the blisteringly fast side-effects in 0.001 point text can really make everything OK.
Re: "Honesty less than worthless" (Score:2)
Enter Robin Cook.
That's already a complicated definition of "medical truth". Then add some human failing and the story writes itself.
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"over the counter" and "off the shelf" are the same thing. I don't want to be an ass but I figured I'd point that out.
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Off the shelf is stuff you can pick up, take to the counter, and buy.
However, there are other drugs that don't need a prescription, but that you have to ask the chemist for, and they'll ask you a few questions to make sure you need it, that it won't interact with other drugs you might be taking, etc.
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It really depends on what they prescribe for the placebo effet. They shound NOT prescribe antibiotics that way, nor should the prescription be expensive.
On the other hand, if they prescribe aspirin, the prescription costs about what OTC aspirin costs, and the patient feels better because it's "prescription strength", what's the harm?
If you want the extended sympathy for the flu, it would cost a lot more than aspirin.
At one time, people didn't even consider seeing the doctor for colds and flu (or sprains, et
but the patients really do need pills (Score:2)
My guess would be anti-psychotic medication.
In any case, some sort of psychiatric medication
is appropriate. Lots of people are borderline nuts,
and a good number are more than that.
Ethical Challenges Remain (Score:5, Insightful)
So sayeth the article. But I ask you, do the ethical challenges concern doctors fobbing patients off with placebos, or the existence of an environment where a doctor is afraid or unable to legitimately tell hypochondriacs that they are not sick and send them home?
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Note that placebos have been shown to have significant effects on non-faked problems. There are cases where a person will actually improve when given a fake drug and told it is real when they would not if they were told to "stop faking".
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Part of the problem is that hypochondriacs will simply find another doctor who will give them what they "need".
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Placebos work well, even on people who aren't hypochondriacs. There's a reason why clinical studies have to test against a placebo group and not just an untreated control group.
Prescribing placebos is as old as medicine itself, and until fairly recently was probably it's most successful treatment.
this pisses me off (Score:5, Insightful)
Antibiotics shouldn't be prescribed all willy-nilly. It just helps in the creation of super bugs.
Re:this pisses me off (Score:5, Insightful)
Antibiotics shouldn't be prescribed all willy-nilly. It just helps in the creation of super bugs.
Depending on age, 14% to 30% of patients either skip doses or do not finish their regimen of antibiotics.
That is much more worrisome than the over prescription of antibiotics, because when someone sick doesn't finish their meds, you know that whatever is leftover gets stronger.
Antibiotics?!? (Score:5, Insightful)
For the love of non-antibiotic resistant tuberculosis, WHO are these doctors STILL giving out antibiotics when they don't need to? Is it not illegal for a doctor to prescribe medicine when it's not needed, and WHY AREN'T WE PUTTING THEM IN JAIL when they give out antibiotics for the cold etc? I know it must get annoying to deal with idiots asking for drugs they don't need, but that's your damn job, it's even more annoying if you get infected with superbugs you're making. Tell your patients that a spoonfull of sugar will cure them in aproximately 1 week if you absolutely need to give them something.
Seriously, it should be a felony to be giving out antibiotics when they're not needed.
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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.
I think YOU should have read my post a bit more carefully before responding :-P
I know antibiotics and placebos are not the same thing, that's why I suggested an ACTUAL placebo, sugar, be used as a placebo instead of antibiotics. And just in case the placebo effect didn't completely work for curing the common cold, the full week needed for it to "work" would. Problem solved without creating antibiotic-resistant bacteria.
I guess I should have said something about how if they absolutely have to prescribe s
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People frequently get bacterial secondary infections along with common viral primary infections and dealing with the secondary infection allows the body to dedicate more immunological resources to fighting the primary infection.
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That wouldn't be a case of prescribing antibiotics for no reason, which the article isn't talking about. Giving people antibiotics when there's no sign of a secondary bacterial infection though seems dangerous and stupid.
Re:Jail is geting off easy... (Score:5, Insightful)
It occurs to me that killing half of all doctors might have unpleasant consequences for society.
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That's crazy talk! What are you? A terrorist?
>It occurs to me that killing half of all doctors might have unpleasant consequences for society.
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>> It occurs to me that killing half of all doctors might have unpleasant consequences for society.
It occurs to me that killing half of the society thinking about invulnerability and always-right of doctors is mandatory to make the society to be civilized. Doesn't hurt to kill all the idiots who believe in shamans, right?
Not placebo (Score:4, Informative)
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:Not placebo (Score:5, Interesting)
I was going to post exactly that. Good job.
Although, they do give sugar pills sometimes at the hospital. Also, people, don't forget that this placebo effect actually HELPS the patient to recover more quickly.
Everyone does it. Even the medics sometimes use little tricks. They have 3 or 4 to save lives. I know of one: If you are extremely nervous and are almost hyperventilating, they give you a mask and tell you to breath the oxygen... yet they never open their bottle. The patients immediately calm down after that...
The medics never wanted to tell me the other tricks since they might eventually use them on me to save my life.
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The reverse placebo effect works, right? Clearly what we need to do is spread the myth that antibiotics make you fat. Then there will be zero demand to take them when it's not needed.
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You're thinking about the nocebo effect. http://en.wikipedia.org/wiki/Nocebo [wikipedia.org]
You're idea is interesting but people might actually become obese when they truly need the pills :P
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You're idea is interesting but people might actually become obese when they truly need the pills :P
Obvious solution: sell them sugar pills and tell them THOSE pills will help them lose antibiotics-related weight.
Oh crap, I've started thinking like a doctor!
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Hahaha, yes you did. Not a bad idea. But if you sell these, there WILL be a demand for antibiotics AND for these sugar pills.
We're back at square 1.
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Yeah! We get 200$!
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Why wouldn't they open the bottle? O2 fills are cheap, especially compared to pretty much everything else they could do, and a few minutes of oxygen therapy isn't going to hurt anyone.
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If you add four parts H to your O2 then I'll convert it to waste myself.
Re: Sugar Pills (Score:2)
I have occasionally used a modified variant of this I call "Chaining". Hot Tamales stuffed inside something like a Licorice twizzler are a good example. Classical placebos are tasteless. If you had a placebo with a real kick in the taste department it would "feel like doing the duty of following doctor's orders".
Sam E is a legitimate medicine in its own right. But does it ever have the nastiest kickback of any part of my supplement repetoire. I kinda like that. "This is Medicine, Capital M, so don't mess wi
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not truly placebo (something totally inert)
Actually, something totally inert isn't an ideal placebo for most purposes. What you want is a psychoactive placebo like niacin(vitamin B3). Something that gives a mild side effect(eg: dry mouth, increased thirst, etc...).
The presence of some side effect helps convince the patient that the Magic Wonder Drug must really be powerful and doing a great job! After all, see how it's making me feel all weird?
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You found the other half of my post above. This time the "chain element" is actually a medical event, rather than subjective.
I still think all of these topics are fragmented weaker versions of the much deeper problem of science's history of reductionism. We worked so hard culturally to reduce debris & distractions in medicine, which got us a long way.
But at the very end, in emergent chaotic systems, there is a holistic level that vanishes when you break up the parts. You could simply combine "all four f
Age old practice (Score:2)
My grandfather was a company doctor for a mining company on the western slope in Colorado (near Gunnison & Crested Butte). He mixed sugar water with food dye in the kitchen for those who insisted they were sick, but for which he could find nothing wrong. Perhaps they needed a day off. In any case, the placebos worked.
drug company sponsored? (Score:2)
I would like to know the funding behind this study, as I have seen this all over of late. It seems as though the goal is to "get the word out" to people that there is a chance their doctor is prescribing them a placebo, which is entirely possible of course because it is an accepted medical fact that placebo's work on 33% of all medical complaints.
It seems to me that the party most interested in reversing or minimizing this would be drug companies who are sick of the placebo effect working and are wanting Do
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Also, it's the same thing with all the alternative medicines. Crystals, magnets and all that create the placebo effect too.
Though, scary voodoo magic and dark rituals bring the nocebo effect...
Psychology can be a remedy, and a weapon...
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Actually, I suspect it's probably alternative medicine practitioners, particularly the herbal industry. They don't want the competition.
And the worst part is... (Score:2, Funny)
So? (Score:2)
I really don't see the problem with this. It's undeniable that the human mind is a finicky thing and what we believe strongly effects what we actually feel. It hasn't been absolutely proven that placebos do any good, but I can believe that if you make a person believe they're better than they really can be.
Antibiotics are a risky thing to bomb someone with all the time, but a z-pack every couple years might do a person some incidental good, like if they have gastroenteritis and think it's just what they're
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It hasn't been absolutely proven that placebos do any good
What? And why would studies of new cures be tested against control groups that are taking a PLACEBO then?
FAIL
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Wait, what?
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Placebos have been proven to do good for a long time. So much that they must take the placebo effect into account when pharmaceutical companies want to test new products in order to make sure their new medicine is NOT simply a placebo.
What they do is that they compare the new drug being developped to a fake drug that has no effects. So, one group of testers take the real pills, the other group takes the fake pills. Of course, nobody knows if their own pill is real.
So if the new drug is having better health
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I mean using the placebo as a replacement for actual medication, not for control study. I believe it would be useful for many people, but I don't know of any studies proving it's practical to hand out antibiotics to make a patient better from their own foolishness.
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Taking a placebo would help more than not taking anything, but it would help less than taking a known cure. That placebo could be a sugar pill, or an antibiotic, it's irrelevant since the only important thing is what the patient believes.
So what I was saying is that we already proved that a placebo is effective. If you give out antibiotics as a placebo, we know that it works since it IS a placebo. The only important thing for the patient is that they swallowed something.
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Right, that's what I said, so why did you say it again?
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What they do is that they compare the new drug being developped to a fake drug that has no effects.
And, if cures or alters a disease that we already have drugs for, one would hope they compare it to the best known drug(s) for treating that disease to see if it's worth using.
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And sometimes it's not in your head, but your head can fix it anyway.
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Everything's in my head, so are you.
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For some definitions of head.
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For some definitions of head.
Or rather... for very large definitions of head.
In other news... (Score:2)
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This has been going on for many years (Score:3, Interesting)
It was most effective when prescriptions didn't state what the medicine was. Putting the identity of the medicine on the container has only been done for about 30 or 40 years.
My cousin was a pharmacist, and he had to be careful to charge the patient an amount that would be appropriate for a non-placebo prescription.
Placebos did the job. Some people expect to be given medication for ailments that aren't curable by medication. However, the placebo effect can apparently be powerful.
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Do you really think its ethical to charge people for this, when it isn't a viable, effective form of treatment?
The issue is that although the medicine is fake the treatment is viable and effective. They only use this treatment for certain kinds of psychologically based conditions
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Ethical issues? (Score:4, Funny)
I hear there is a pill for that now.
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Cite! I know plenty of people who have received useless drugs. I cannot think of a single person I know who have had surgery that did not immediately have a dramatic positive effect on their condition.
Re:Many surgical provedures are placebos. (Score:5, Funny)
Vasectomies don't really make your little guys stop running around, they just make you think they're not supposed to anymore.
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I got your citation right here, AC.
search on Arthoscopic knee surgery (Score:2)
like this [google.com], for example.
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The only time it is ethical to conduct a randomized controlled trial is when the outcome's risk or benefit is so unclear as to merit randomization.
To even run such a trial on cataract surgery vs placebo would be impossible due to the immediate and enormous differences between actual treatment and placebo; it may well be unethical, too.
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I'm aware that anecdotes do not constitute evidence. But there's an enormous difference between taking some homeopathic remedy and "feeling better" (meanwhile thousands take them and feel nothing) and having a large and immediate success rate with something like lens replacement surgery for cataracts. Cataracts do not get better by themselves, not even with a placebo. Surgery to replace the clouded lens produces rapid and highly effective results.
To my mind, what you're saying is essentially like saying tha
This is a crap study and Title is WRONG (Score:5, Informative)
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 (Score:5, Interesting)
The problem was in elderly rats, they found that the pain didn't go away after the string dissolved. On top of that, they found that even though there was nothing sending the signal to the spinal chord to signal pain, after the rats reached a certain age, the spinal chord would still continue to send the signals to the brain even though there was no original pain stimulus. I.E. The spinal chord was creating a pain stimulus without a cause. A dorsal rhizotomy didn't fix it, pain medication helped for a bit (but like all pain meds became ineffectual over time. People with fibromyalgia don't have pain because they depressed, if anything it's the other way around - they are depressed because they are often in agonizing pain.
The paper will be published pretty soon. I'll post a link later if anyone cares.
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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 t
Re:First Post! (Score:4, Funny)
Nah, just a little bit off the top.
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Probably. Have you ever seen a doctor not laughing all the way to the bank?