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."

Comments

Re:FRIST PSOT!!

[Anonymous Coward]

Forget to post AC and look up how spell "First" or "Post" again?

Many surgical provedures are placebos.

[Anonymous Coward]

There's very little if any peer review of surgical procedures. And many times, when there is, the procedure is found to be ineffective at best: sometimes they cause more problems.

Re:Many surgical provedures are placebos.

[Free the Cowards]

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.

[Aphoxema]

Vasectomies don't really make your little guys stop running around, they just make you think they're not supposed to anymore.

Re:Many surgical provedures are placebos.

[Anonymous Coward]

[Citation Needed]

Re:Many surgical provedures are placebos.

[Aphoxema]

I got your citation right here, AC.

Re:Many surgical provedures are placebos.

[Mr. Slippery]

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.

Google "placebo surgery.

The first time this was tested was in 1959, when a placebo-controlled trial of a then-popular technique for treating angina, involving tying off the an artery in the chest, was found to be no better than a placebo technique. Other techniques so tested include stem cell implants for treating Parkinson's, arthroscopic surgery for knee osteoarthritis. I think there might have been one or two others.

Every surgical procedure that has been been tested versus placebo surgery, has proven to be no better than the placebo. (It is curious that many "skeptics" who demand rigorous double-blinded studies of "alternative" medical techniques, will go under the knife without a second thought.)

Re:Many surgical provedures are placebos.

[Free the Cowards]

Every surgical procedure that has been been tested versus placebo surgery, has proven to be no better than the placebo.

And just how many have been so studied? Has surgery for removing wisdom teeth, replacing a lens full of cataracts with an artificial one, or removing the appendix been studied? Because those are all procedures which have been done on people I know quite well, and which have been enormously effective in the end. If what you say is true then it is because only a small number of surgical procedures have been so studied, and the ones that get studied are the ones for which there is already a great deal of doubt over their effectiveness.

If someone's appendix is infected and about to burst and this is surgically removed, are you going to tell me that it's no better than a placebo surgery which leaves the infected appendix in the abdomen? If someone can't see because their eyes are full of cataracts, are you going to tell me that surgery to replace their lens and restore clear vision is no better than a placebo surgery? Seriously?

Re:Many surgical provedures are placebos.

[SUB7IME]

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.

Re:Many surgical provedures are placebos.

[Mr. Slippery]

Because those are all procedures which have been done on people I know quite well, and which have been enormously effective in the end.

You do realize that we can find testimony from people who will say that homeopathy or Scientology or Lourdes water were "enormously effective" for "people they know quite well", right? The folks who got results from the placebo surgeries in these tests also found them to be enormously effective.

Let me introduce you to the concept of anecdotal evidence.

If someone's appendix is infected and about to burst and this is surgically removed, are you going to tell me that it's no better than a placebo surgery which leaves the infected appendix in the abdomen?

I'm telling you that, scientifically, the proposition is untested.

Yes, it's amazing to think that some portion of the response to cataract surgery or appendectomy might be a placebo effect. But it's no less amazing to think that a type of brain surgery is no better than a placebo. The placebo effect covers several different things that may be at play.

As for appendectomy, the last time this topic came up my Google-ing found this little gem, a fascinating look at the subject from a century ago. The author finds a mortality rate of 6.6% in the period before appendectomy was used, and of 7.8% in the first few decades of its use. Of course the mortality rate is much lower today; but if mortality rates actually climbed after appendectomy was first introduced, then clearly the situation is complex than "cut, baby, cut!" (When all you have is a scalpel, everybody looks like a surgical candidate.)

Which is not to say that, under the right circumstances, I'm going to refuse an appendectomy. The surgery is a pretty good gamble. But is a real procedure more effective than a sham one? We cannot say.

Re:Many surgical provedures are placebos.

[Free the Cowards]

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 that the sun rising in the East because of the Earth's rotation is scientifically unproven because nobody has ever tried stopping the Earth's rotation to see if it actually changes anything.

I'll certainly grant that surgical procedures should be tested for validity and that there are some which do not have the desired effect or a success rate to justify performing them. But most surgeries correct blatantly obvious mechanical defects. Has anyone ever performed a scientific study on the effectiveness of replacing a worn-out car transmission? Have you ever doubted that a transmission replacement is effective when it's clear that the original transmission is broken?

Re:Many surgical provedures are placebos.

[Mr. Slippery]

But there's an enormous difference between taking some homeopathic remedy and "feeling better" (meanwhile thousands take them and feel nothing)

If most people took them and felt nothing, they wouldn't be so wildly popular.

Cataracts do not get better by themselves, not even with a placebo.

You have to be careful about sweeping statements regarding the human body.

Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body.

Spontaneous reduction and absorption of cataracts in childhood.

Spontaneous cataract absorption in patients with leptospiral uveitis.

Reversible cataracts in diabetes mellitus.

Now, would I expect a controlled study of cataract surgery to show that it is more effective than a placebo technique? Yes, I'd put my money on that. But as a matter of sound scientific knowledge, we can't say it's a proven technique; we have to admit the possibility that there's some other factor at work.

But most surgeries correct blatantly obvious mechanical defects.

I'm sure that those doing the arthroscopic debridement and lavage procedures on the knee that were found to be no better than a placebo thought they were correcting blatantly obvious mechanical defects.

Has anyone ever performed a scientific study on the effectiveness of replacing a worn-out car transmission?

A car transmission does not have self-repair capability. A human body does.

Re:Many surgical provedures are placebos.

[Free the Cowards]

Now, would I expect a controlled study of cataract surgery to show that it is more effective than a placebo technique? Yes, I'd put my money on that. But as a matter of sound scientific knowledge, we can't say it's a proven technique; we have to admit the possibility that there's some other factor at work.

Well, we really agree. This is the crucial part. Do they work? Almost certainly yes. Are they proven beyond any doubt? No.

This is not what the original post said, however. The original post claimed that "And many times, when there is [peer review], the procedure is found to be ineffective at best" and implied that surgery as a whole is not very useful.

Most surgical procedures are highly effective. Maybe not in the "is it absolutely certain that there isn't something else going on" sense, but in the "would I pay a gigantic pile of money to have it done to me if I needed it" sense they are. If surgeries which are clinically studied tend to be ineffective, it's because of a selection effect on which surgeries get studied, not because surgery as a whole is a bunch of crap.

And an aside: homeopathy, wildly popular? Not in my universe.

Re:Many surgical provedures are placebos.

[Mr. Slippery]

Well, we really agree. This is the crucial part. Do they work? Almost certainly yes.

Hold on, there, friend. We agree about cataract surgery, perhaps. There are other techniques I'm much more skeptical about. There are some orthopedic procedures that I would not be very surprised to see a placebo-controlled study find little or no value in.

I also wonder about cardiac bypass surgery, I wouldn't be surprised if a controlled study found it only beneficial for certain classes of high-risk patients - but I'd be very surprised if a such a study were ever conducted, since CABG is one of the High Rituals of the Church of the Holy Scalpel. And I think there's a significant chance that in the next twenty years someone will do a placebo controlled study of bariatric surgery and find it no better than a placebo technique. In these cases, it seems possible to me that the surgical experience may help the patient make significant post-operative changes in lifestyle that have more to do with the outcome than the cutting and sewing do.

On the other hand, I'm pretty sure we don't need to do a placebo trial of surgical reattachment of amputated extremities, I'm willing to accept that one at face value. :-)

If surgeries which are clinically studied tend to be ineffective, it's because of a selection effect on which surgeries get studied, not because surgery as a whole is a bunch of crap.

That's a hypothesis worthy of investigation. And I'm not saying surgery as a whole is a bunch of crap; I'm just saying that it over-promises and under-delivers. And I'm saying that if we set the bar of "acceptable evidence" low enough to admit surgical techniques that have not been tested with controlled studies, it's irrational to exclude CAM techniques that have the same level of evidence.

And an aside: homeopathy, wildly popular? Not in my universe.

Note: I am not endorsing homeopathy. However, according to one market research group, it is trusted by "64% of people in India, 58% Brazil, 53% Chile, 49% Saudi Arabia, 49% United Arab Emirates, 40% France, 35% South Africa, 28% Russia, 27% Germany, 25% Argentina, 18% of America, and 15% Great Britain."

Re:Many surgical provedures are placebos.

[ultranova]

Well, we really agree. This is the crucial part. Do they work? Almost certainly yes. Are they proven beyond any doubt? No.

It is impossible to prove anything beyond any doubt. Failing all else, I can simply claim that all experiments conducted this far weren't actually conducted, but were merely hallucinations, and thus don't prove anything; I can also claim the same for any and all logical proofs you'd care to make, demanding that they are re-examined, and then simply repeating the same when they have been.

X-Treme Scepticism makes for a pretty efficient trolling technique :).

Re:Many surgical provedures are placebos.

[Free the Cowards]

I agree that clinical trials of more surgical procedures would be a good idea. But I disagree with the original implication (which you didn't make, and perhaps I misinterpreted) that this means that surgical procedures in general are not worthwhile. But it would be great to have better statistics on them like we do with most drugs.

As for homeopathy, I stand corrected. Half of India and China alone is enough to qualify.

Re:Many surgical provedures are placebos.

[plague3106]

I can explain your mortality rate and appendectomy; in 1908, they didn't exactly have the cleanest conditions to perform surgery. I'm willing to bet those that died passed as a result of infection during the surgery. Oh.. you might want to realize that the book you've sighted itself is 100 years old. So um, get some current facts.

Re:Many surgical provedures are placebos.

[Mr. Slippery]

I can explain your mortality rate and appendectomy; in 1908, they didn't exactly have the cleanest conditions to perform surgery.

Duh. As I said: "Of course the mortality rate is much lower today".

Oh.. you might want to realize that the book you've sighted itself is 100 years old. So um, get some current facts.

Um, if you want to know what happened 100 years ago, a book published 100 years ago is a pretty good source.

Re:Many surgical provedures are placebos.

[plague3106]

Duh. As I said: "Of course the mortality rate is much lower today".

Yet you're trying to use that information to say that surgery isn't any better than a placebo.

Um, if you want to know what happened 100 years ago, a book published 100 years ago is a pretty good source.

Again, the problem is that you then say "see, surgery isn't any better han placebo." Which isn't accurate.

Re:Many surgical provedures are placebos.

[Mr. Slippery]

Yet you're trying to use that information to say that surgery isn't any better than a placebo.

I'm saying that it's unknown if appendectomy is any better than a placebo operation.

I'm also saying that there is no surgical procedure that has been demonstrated in a controlled study to be more effective than a placebo.

Neither of these are the same as saying that "surgery isn't any better than a placebo".

Re:Many surgical provedures are placebos.

[Muad'Dave]

'Overprescribed' stents are being called into question.

The evidence indicates overuse of stents may be leading to thousands of heart attacks and deaths each year, whether stents are being used in relatively mild cases where drugs should be prescribed instead, or because patients are receiving drug-coated versions where simpler, cheaper bare-metal devices might work just as well.

Re:Many surgical provedures are placebos.

[plague3106]

I'm saying that it's unknown if appendectomy is any better than a placebo operation.

No, it is known. Just look at TODAY'S numbers.

I'm also saying that there is no surgical procedure that has been demonstrated in a controlled study to be more effective than a placebo.

Neither of these are the same as saying that "surgery isn't any better than a placebo".

Yet that's what you're hinting at. Stop trying to play with semantics. Bypassing a blocked artiary is going to be more effective than pretending to do the bypass. We already know because people that don't get the bypass die. It's really pretty simple.

Re:Many surgical provedures are placebos.

[Mr. Slippery]

No, it is known. Just look at TODAY'S numbers.

And how do TODAY'S numbers address the question of whether an appendectomy would be better than a placebo procedure? We don't have any numbers - from today or from yesterday - about how effective a placebo treatment would be!

Placebo surgeries were effective in treating angina, osteoarthritis, and Parkinson's; we cannot dismiss out of hand that one would be effective in appendicitis.

Yet that's what you're hinting at. Stop trying to play with semantics.

I am not "hinting" at anything, nor am I trying to play with semantics. I'm expressly making a specific and precise point.

Bypassing a blocked artiary is going to be more effective than pretending to do the bypass. We already know because people that don't get the bypass die.

No, in fact, we don't know that.

The differences in survival rate of CABG patients versus those who are treated with drugs, are not huge, on the order of about 5%; so saying "people that don't get the bypass die" is inaccurate.

Well, it is trivially true that people who don't have bypass surgery, die. So do people who do get bypass surgery. So do people who never get heart disease. But I assume you meant "die soon".

And many people receive CABG not because of imminent death, but as a treatment for angina. But we've already seen that a placebo surgery was effective in treating angina.

The evidence for the effectiveness of bypass surgery is suggestive, certainly, but not conclusive. The only way to get conclusive data about the results of coronary artery bypass versus a placebo surgery would be to actually do a placebo surgery.

If we're doing a scientific investigation of the question, we must consider the possibility that some people who benefit from bypass surgery are actually benefiting more from an enforced period of rest under skilled nursing care, plus improved psychological state, plus post-surgical therapies and lifestyle changes, then from the actual plumbing work.

Unfortunately, they have to.

[Lord Kano]

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

Re:Unfortunately, they have to.

[fbjon]

Care can smooth recovery though, and it doesn't work without the visit and/or placebo. It's not a useless service, at least sometimes.

Re:Unfortunately, they have to.

[philspear]

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.

Re:Unfortunately, they have to.

[Anonymous Coward]

Reading comprehension is your friend.

Re:Unfortunately, they have to.

[xstonedogx]

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.

Re:Unfortunately, they have to.

[MikeBabcock]

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.

Re:Unfortunately, they have to.

[sw155kn1f3]

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.

Re:Unfortunately, they have to.

[SoupIsGoodFood_42]

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.

Re:Unfortunately, they have to.

[Jens Egon]

... endanger everyone just to stay in buisness and get idiots out of your office is criminal, ...

Mod parent up, please.

Giving patients effective medicines, when you can't find anything wrong with them is inviting disaster.

I fear though, that they are just trying to cover themselves. It's propably better to "mistakenly" having given someone the wrong medicine, then to by genuine mistake having given a placebo.

"Better" that is, as in "easier to make a jury sympathize with".

All that is off course disregarding any real world ambiguity: What about people who come to the doctor with something that is propably nothing. Should the doctor then treat the "nothing"? Or the unlikely real problem?

Re:Unfortunately, they have to.

[Anonymous Coward]

Actually, I usually get sinus cavity infection (which are of bacterial origin) after a viral flu which prepares a way for it. Although I don't take antibiotics, they would probably help.

Re:Unfortunately, they have to.

[Idiomatick]

They didn't have to so they dont... GP said doc gave out placebos. Its a situation arguing for them.

Re:Unfortunately, they have to.

[Akaihiryuu]

Doctors that prescribe antibiotics as a placebo for a viral infection should be removed from practicing medicine. If they want to prescribe things like aspirin or vitamins for a placebo, fine...that won't hurt anything. But using antibiotics in this way is dangerous. If you do not have a bacterial infection that requires you to take an antibiotic, then they should NOT be used. Misuse of antibiotics like this is breeding strains of antibiotic-resistant super-bacteria. I pity anyone who doesn't have a very strong immune system if this keeps up - within a few decades antibiotics won't work anymore and the only solution to bacterial infections will be "your immune system will make you well on your own, or you will die".

Re:Unfortunately, they have to.

[Mr. Slippery]

Modern medicine in USA is becoming shamanism

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 - physical and emotional - of the community.

Re:Unfortunately, they have to.

[shawb]

I know you are AC and so probably won't be back to check this, but there are things you can do to reduce the chances of secondary sinus infection after a primary viral one. Stay hydrated, take long hot showers, and take a deep whiff of fresh horseradish. The last one should burn a bit, but the burn goes away really quickly unlike the pain of sinus infection. You can also replace smelling horseradish with eating something spicy. The basic premise of these three is it will help drain the mucous out of your sinuses, hopefully pulling enough bacteria out that your immune system can handle the rest.

On a side note, this method can also help reduce the headache of a hangover from a smokey bar. The dehydration from the alcohol means your sinuses won't produce enough mucous to flush out the tar/etc that you were breathing in all night. The result is a sinus headache, which starts to go away once you manage to fill a couple kleenex with a truly vile looking substance.

Re:Unfortunately, they have to.

[Lord Kano]

Why go through all of that when you could just irrigate your sinuses with a nettie pot?

Whenever I think I'm battling a sinus infection, I rinse out as much of the bacteria laden mucus as I can. It usually works.

LK

Re:Unfortunately, they have to.

[Surt]

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.

[Anonymous Coward]

What, like this guy?

Re:Unfortunately, they have to.

[shawb]

A nettie pot can be effective, although you do have to be careful to use clean water otherwise you may be introducing more pathogens. I personally would go with sterile saline irrigation for this. It can be picked up pretty inexpensively from most drugstores. And nasal irrigation is also very compatible with drinking a couple glasses of water and taking a hot shower. People that I know who use nettie pots use them in the bathroom anyways... having a sink or toilet nearby is pretty much necessary.

Adding "take a whiff of horseradish" onto this may not be overkill for someone who is very prone to sinus infections or even regular sinus headaches. Depending on your preferences, this can take the form of suhi with plenty of wasabi. It can also mean opening a jar, breathing deeply, and grabbing a Kleenex. By "fresh" I didn't really mean grabbing a grater and a horseradish root, I meant more "not horseradish sauce." Although in a pinch, stopping at Arby's and getting some horsie sauce to dip your fries in can help clear your sinuses if you aren't afraid of fast food in the first place. Also, eating spicy food of any variety (Mexican, Indian, Thai... whatever your choice) can help, but often I've found that the headache will briefly get worse before it goes away. Even a couple drops of straight hotsauce on your tongue can help your sinuses, in addition to impressing the ladies (Note, you are more likely to impress your male friends with this than ladies you are attracted to.)

The burn I was talking about really shouldn't be all that bad... no more uncomfortable than using plain or cold water for nasal irrigation. And I happen to have some Eastern European blood which makes the mild burn of horseradish almost pleasurable. For most people horseradish is more readily used as a cure than spicy food because horseradish is spicy enough to instigate mucous production and thinning, but the burn goes away right away unlike capsid burn which lingers for a while.

Re:Unfortunately, they have to.

[Anonymous Coward]

Reading comprehension is your friend.

Re:Unfortunately, they have to.

[philspear]

Reading comprehension is EVERYONE'S friend. And for the record I have no idea what the AC was specifically talking about if anything. I have no problem with doctors giving out placebos, I have a big problem with doctors giving out antibiotics needlessly to get rid of people with viral infections.

Re:Unfortunately, they have to.

[bill_mcgonigle]

Any doctor who is prescribing medication when they know it's unnecessary and potentially harmful because they want more business shouldn't be practicing.

But that's the thing about the placebo effect - it does work. People don't just think it works, it really does. And we pretty much have no idea how.

Re:Unfortunately, they have to.

[SoupIsGoodFood_42]

Did you not read the part about doctors prescribing antibiotics to people with a virus?

Re:Unfortunately, they have to.

[bill_mcgonigle]

Did you not read the part about doctors prescribing antibiotics to people with a virus?

Yes, that's one potentially harmful subset of the entire situation.

Re:Unfortunately, they have to.

[SoupIsGoodFood_42]

Well, the article says a "significant number also reported prescribing antibiotics and sedatives". The way you put it makes it sound as if it's nothing to be concerned about.

Re:Unfortunately, they have to.

[Anonymous Coward]

If it's just a classic placebo (sugar pill) and they demand a pill then just go ahead (unless your patient is a diabetic, then its not really a placebo either, anyway)

Or use the modern day placebo: vitamin C (ascorbic acid)

It would be better to teach them about the different kinds of infections, personaly I'll try it anytime.

If they actually had the Flu, there would be meds for that, but most of the time it will just be a common cold. And thats mostly caused by viruses. The only exception being Streptococcus, mostly type A, mostly causing tonsillitis or otitis media.

And if you think it's a strep infection do at least a quick test, material costs about 1-2$.

Giving away anitbiotics away like candy is just stupid, plain stupid. And dangerous, for the one taking the drugs and for the society as a whole (antibiotics resistencys)

Re:Unfortunately, they have to.

[bill_mcgonigle]

Well, the article says a "significant number also reported prescribing antibiotics and sedatives". The way you put it makes it sound as if it's nothing to be concerned about.

I wouldn't be too concerned about the sedatives, they don't harm the population. The antibiotics, they harm both the patient and the population if they're not necessary. It would be best if we understood the placebo effect and could exploit its mechanism more rigorously, but we don't and can't. However, I don't think we should completely abandon trying because we don't have perfect knowledge, when there's demonstrated outcomes benefit for trying.

Re:Unfortunately, they have to.

[SoupIsGoodFood_42]

Some sedatives can be very addictive. There is some more advanced research going on with the placebo effect, BTW. I think some researches are now looking at experiments where they give someone an "active" (or something like that) placebo, where it does cause a notable side effect, in addition to pills that have no effect and what ever drug they are actually trying to test. They've also done experiments where they've given IV drug users (morphine, I think) saline injections and had some of them get relief from that. So don't get me wrong here.

is this...

[Anonymous Coward]

further proof that laughter is the best medicine?

Re:is this...

[Yvan256]

Probably. Have you ever seen a doctor not laughing all the way to the bank?

Re:is this...

[SUB7IME]

Have you ever seen a doctor laughing?

Re:is this...

[Yvan256]

You don't know Dr. Hibbert?

this pisses me off

[nEoN nOoDlE]

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

[schon]

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

[Farmer Pete]

If placebos didn't work, then doctors wouldn't prescribe them. I guess the better question is how can we give people placebos without them realizing it's a placebo? I don't personally agree with giving out antibiotics as placebos. The trick is, with the internet, deceiving your patients is getting pretty hard.

re:this pisses me off

[Anonymous Coward]

1) Patients come for help. If whatever doctor does works, his/her job is done. You (usually) get paid for work.

2) Get a freaking health care system or move to a country with one.

3) Every (almost) time someone brings up ethics God kills a kitten. Pleas people, don't make Baby Jesus cry.

Re:this pisses me off

[Anonymous Coward]

My brother was taking medicine for a condition and swore it worked. He then found out that it may have been a placebo. His response? "I don't really care if it was a placebo or not; it worked.".

It has been shown over and over that placebos can be effective for certain conditions; especially if it require some sort of perception/feelings. eg pain, anxiety..

A doctor looks at the side effects / risks of a placebo vs a traditional medication; placebos usually have low to almost no side effects while the traditional medication may have higher risks/addiction potential. They may also look at the cost of the traditional medication (can be very expensive vs the placebo).

A good doctor will consider a placebo in certain conditions. You pay $75 expecting positive results and if a placebo gets you there with minium risk then $75 well spent.

I should note I do not think doctors should be prescribing antibiotics as a placebo for know resistance reasons.

Re:this pisses me off

[Anonymous Coward]

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 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.

Re:this pisses me off

[flyingsquid]

Placebo(TM): the name trusted by half of America's doctors! Ask your doctor if Placebo(TM) is right for you.

Re:this pisses me off

[Jeff DeMaagd]

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. Excessive antibiotic use is what has given rise to antibiotic resistant bacteria. Antibiotics aren't even effective against a virus, which is what a cold is. If the case is where the patient or guardian is unwilling to listen, then I have no problem with the physician relenting in the form of prescribing a placebo.

Re:this pisses me off

[Jamie Lokier]

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.

Re:this pisses me off

[nick_davison]

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:this pisses me off

[TubeSteak]

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.

Re:this pisses me off

[Anonymous Coward]

I suspect half the time my doctor prescribes a blood test as a pseudeo-placebo on the grounds that he's at least doing something! :)

(Plus, he's often on me to watch my cholesterol levels, which are increasing.)

Of course, I'm actually aware enough to cope with a doc straight up telling me 'drugs won't do any good'. But so often I have to tell friends of mine that 'colds are viruses. Antibiotics don't help.'

Re:this pisses me off

[zippthorne]

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.

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

[sjames]

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, etc). They reserved that for when they were getting sicker or didn't seem to be getting better.

These days, people will actually browbeat a doctor for prescription something even when all they have is a mild flu and nothing will actually make it go away any faster.

The interesting thing in those cases is that unlike an active drug, the placebo might ACTUALLY make the patient feel better. Isn't that what they wanted?

Re:this pisses me off

[piojo]

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.

Re:this pisses me off

[plover]

What's funnier is the Faux News spin on the dispensing of placebos. "About half of American doctors in a new study regularly give their patients placebo pills without telling them."

Wow. You've sure demonstrated a firm grasp of the 'placebo effect', Faux news! What's next, "Half of all bank robbers aren't told the police will respond when the alarms are tripped?" Freakin' geniuses over there.

Re:this pisses me off

[Anonymous Coward]

Can this Miracle drug Placebo cure my Hypochondria?
I have no idea what it is but my doctor said I have it and now I'm worried.

Re:this pisses me off

[plover]

In those experiments did the opiate blocker truly block only the opiates, or does it work on the dopamine level? A study has shown that a dopamine receptor antagonist can interfere with the function of the opiates, so unless the opiate blocker was known to only match the opiates being given, it's possible the blockage agent also blocked the dopamines generated by the placebo effect.

Re:this pisses me off

[budgenator]

  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:this pisses me off

[BrokenHalo]

+1 Interesting and well said. Your story is one that I have observed in a number of other people, but is not one I have ever heard anyone ever admitting with regard to themselves.

Re:this pisses me off

[niw]

If the case is where the patient or guardian is unwilling to listen, then I have no problem with the physician relenting in the form of prescribing a placebo.

That would be a good use for it, as long as the placebo is really harmless in the real definition of placebo, not real drugs but useless for the symptoms (some with rather severe side affects) as is used in the the summary/article.

Re:this pisses me off

[hairyfeet]

Yeah,using antibiotics is a really bad idea,as the last thing we need is more superbugs. That is why I thought my family doc was brilliant with what he does.

My sis is "one of those people" that if she doesn't get something,preferably in a nice pill form,she is convinced she won't get better. So the doc tells her(and later chatting up one of his nurses I found out this is a pretty standard routine with him) that the reason most folks get run down and sick is because they aren't getting the right kind of sleep. They aren't getting enough,or not enough deep sleep,etc. So he gives her a note to take to the health food store down the street and the give her Valerian root pills which,wouldn't you know,made her feel a whole lot better. The brilliant part is the fact that he is telling the truth. The simple fact is most folks would feel better if they would quit stressing and get a good night's sleep,so I don't even know if you would call it a placebo effect or not.

Re:this pisses me off

[Anonymous Coward]

I guess the better question is how can we give people placebos without them realizing it's a placebo?

Perhaps doctors could prescribe a real drug, but at a tiny (insignificant) dosage.

Re:this pisses me off

[Jedi Alec]

Antibiotics aren't even effective against a virus, which is what a cold is.

Afaik, cold = bacteria, flu = virus?

Not that I'd ever take anti-biotics for a cold, there's a reason mankind invented warm sweaters.

Re:this pisses me off

[Anonymous Coward]

If you have taken Placebo(TM) and were later diagnosed with a heart attack, a stroke or have suffered decreased
libido or erectile dysfunction, you may be entitled to a large monetary award. Please contact our office at the
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Re:this pisses me off

[roguetrick]

If you want to see insignificance, go take a look at those screwball homeopaths.

Re:this pisses me off

[SoupIsGoodFood_42]

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.

Re:this pisses me off

[Anonymous Coward]

> 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.

Aren't those the same worry? I mean, now we have a larger set of people that we're taking 14-30% of that all have a disease that's not finished off but which has been selected for resistance to that antibiotic...

Re:this pisses me off

[Anonymous Coward]

Ugh, you disgust me. The fact that a consumer "resents" someone selling something to him or ignores what he is sold is not any excuse whatsoever to defraud the consumer. When a doctor does it, he also breaks the Hippocratic oath and helps the spread of disease (if antibiotics are chosen).

I've had thousands of satisfied customers in my business, the odd rightly dissatisfied one (I admit to being imperfect - try that one sometime, doctors!), and the odd unreasonable ass. I remain honest and polite with the unreasonable ass, even when I could lie to placate them - I know it'll cost me their business, but... so what? I'm good enough at what I do to not need their business, and they are a hassle to me anyway; what's more, if I'm going to be dishonest with them to gain more business (i.e. more money) I might as well just ask my secretary to out-and-out steal from any belongings they leave in our offices.

What it comes down to is that you're arguing that it's OK to deceive and steal from the ignorant if they annoy you. The prescription of one placebo at any time to any free man should be a reason for discipline. I would cheer on any patient who discovers he has been prescribed a placebo and seeks full costs back from the doctor, as well as any consequential loss - not "emotional distress" but due to known side effects that may reduce productivity.

Medical researchers have sufficient difficulty identifying when a drug prescribed in good faith is merely having a placebo effect without the waters being muddied by intentional dishonesty.

Re:this pisses me off

[mmxsaro]

Mod parent up.

Re:this pisses me off

[im_thatoneguy]

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.

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).

Re:this pisses me off

[Anonymous Coward]

Rhinoviruses are the most common viral infective agents in humans, and a causative agent of the common cold. There are over 110 serologic virus types that cause cold symptoms, and rhinoviruses are responsible for approximately 30% to 50% of all cases. So, colds are indeed caused by viruses. Don't you have access to wikipedia, or are you too lazy to look anything up?

Re:this pisses me off

[Anonymous Coward]

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.

I understand the point here and agree advertising contributes to the issue. However the article suggests similar results in the UK where pharma aren't allowed direct to consumer access to 'push' many of the prescriptions referred to.

Re:this pisses me off

[Anonymous Coward]

If you have taken Placebo(TM) and have suffered a
heart attack, a stroke, or had loss of libido or
erectile dysfunction, you may be entitled to a
large monetary award. Contact our experienced
attorneys at our toll free 800 number....

Re:this pisses me off

[stormguard2099]

"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.

Re:this pisses me off

[Anonymous Coward]

What if you had a real medical condition that had intermittent symptoms that come for a short period of time and then temporarily go away and then come back again that the doctors completely missed?

Re:this pisses me off

[Anonymous Coward]

Placebo(TM): the name trusted by half of America's doctors! Ask your doctor if Placebo(TM) is right for you.

May cause headaches, nausea, vomiting, diarrhea, remission, emission, blurred vision, alertness, tiredness, pregnancy, birth defects, loss of consciousness, loss of bowel control, .... people with heart problems, high blood pressure, low blood pressure, gastro-intestinal problems and women who might not be pregnant should not take Placebo(TM).
Warning: People taking Placebo(TM) should not operate heavy machinery or go out-of-doors.

Re:this pisses me off

[Anonymous Coward]

A small excerpt from the book "Three men in a boat":

I went to my medical man. He is an old chum of mine, and feels my pulse,
and looks at my tongue, and talks about the weather, all for nothing,
when I fancy I'm ill; so I thought I would do him a good turn by going to
him now. "What a doctor wants," I said, "is practice. He shall have me.
He will get more practice out of me than out of seventeen hundred of your
ordinary, commonplace patients, with only one or two diseases each." So
I went straight up and saw him, and he said:

"Well, what's the matter with you?"

I said:

"I will not take up your time, dear boy, with telling you what is the
matter with me. Life is brief, and you might pass away before I had
finished. But I will tell you what is NOT the matter with me. I have
not got housemaid's knee. Why I have not got housemaid's knee, I cannot
tell you; but the fact remains that I have not got it. Everything else,
however, I HAVE got."

And I told him how I came to discover it all.

Then he opened me and looked down me, and clutched hold of my wrist, and
then he hit me over the chest when I wasn't expecting it - a cowardly
thing to do, I call it - and immediately afterwards butted me with the
side of his head. After that, he sat down and wrote out a prescription,
and folded it up and gave it me, and I put it in my pocket and went out.

I did not open it. I took it to the nearest chemist's, and handed it in.
The man read it, and then handed it back.

He said he didn't keep it.

I said:

"You are a chemist?"

He said:

"I am a chemist. If I was a co-operative stores and family hotel
combined, I might be able to oblige you. Being only a chemist hampers
me."

I read the prescription. It ran:

"1 lb. beefsteak, with
  1 pt. bitter beer
every 6 hours.
1 ten-mile walk every morning.
1 bed at 11 sharp every night.
And don't stuff up your head with things you don't understand."

I followed the directions, with the happy result - speaking for myself -
that my life was preserved, and is still going on.

Re:this pisses me off

[TheLink]

Sometimes though there might actually be something wrong, but before the docs figure it out after weeks of tests, the mind+body has repaired it already.

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're almost certain to find something wrong especially with someone more than 20 years old.

Then the trouble is, you don't know if the body is going to repair it or not, and there's great pressure to go do something about it, and sometimes that something is quite damaging - e.g. chemotherapy (which often does work, but it typically nearly kills you in the process or should I say as part of the process ;) ).

That's also why sometimes they say - ok let's just monitor it and see what happens in a few months - because if the body repairs it, or it turns out to be benign, there's no need to do some _crude_ modern medical procedure (like slit him open and rip it out and hope he doesn't get infected[1] by that super hospital bacteria that we can't kill our antibiotics).

Cars rarely repair themselves but bodies do it most of the time.

On the flip side sometimes there really is something wrong, but the medical tech isn't good enough to detect it yet - though the patient has noticed something is not quite right. So the doctors have to wait till it gets bad enough or the patient recovers by himself/herself ;).

Lastly, given the strength of the placebo effect - actual chemicals and hormones are released, I'm not surprised if your mind can make you physically sick - just by believing you are sick.

[1] Don't let them touch your tubes and stuff if they clearly haven't washed their hands...

Re:this pisses me off

[caluml]

Nope, not in the UK at least.
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.

Re:this pisses me off

[Mr. Slippery]

Afaik, cold = bacteria, flu = virus?

No. Cold=rhinovirus, or one of a couple others.

However, a cold is often accompanied by an opportunistic bacterial infection in the sinuses.

Re:this pisses me off

[raduf]

My mother (dentist) used to tell me how every med student "gets" at least half the diseases he's studying in his first year.

As for the subject at hand, it's definitely justified in some cases. The question is how often it happens, and if it's ever used as a solution for an uncertain/difficult diagnosis.

Re:this pisses me off

[SUB7IME]

TITCR

Re:this pisses me off

[Anonymous Coward]

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.

It is precisely the fact that patients fail to adhere to prescribed antibiotics regimens that makes over prescription so worrisome. You might have some hope of getting doctors to be more careful about prescribing antibiotics. You have no hope of getting patients to be more careful about taking them.

Re:this pisses me off

[shawb]

This could be a very bad thing when it comes to antibiotics. Low doses are better at creating antibiotic resistance than high doses as it provides a more gentle slope for evolution to take its course. Of course microdose Pyridoxine should have a low enough deleterious side effect rate, yet sound technical enough that your average person wouldn't know the difference. Of course, this all goes to pot in this day and age where the vast majority of people will google any drug they are prescribed. Especially the people who I suspect would be likely to badger a doctor into unnecessary treatment.

Re:this pisses me off

[Anonymous Coward]

Given that Valerian Root is a STRONG sleep medication, I don't think you can call that a placebo for better sleep. It is in fact a sleeping pill.

Pure Valerian root smells awful and tastes worse, but 1 ounce will knock out a large adult quickly and for a long time. 8-10 hours easily.

Re:this pisses me off

[JeffAMcGee]

80% of the antibiotics we use in America don't even go to humans to treat illness. Instead, factory farms feed it in low doses to all of their animals because it makes the animals grow a little faster. This is a complete waste of antibiotics, and it is significantly worse than over-prescription.

Re:this pisses me off

[Farmer Pete]

Well, placebos should never be a first choice, but if there is someone who either doesn't need any real treatment or if all other courses of action have failed, then a placebo should be an option available to doctors. Will it cure everyone? No. If it cures even 5% of people who otherwise wouldn't have been cured, even if only for a short time, is it worth it? I believe it is. Obviously I wouldn't want the drug to have any bad effects, and I would also want it to be as cheap as possible.

Re:this pisses me off

[TheLink]

Placebo(TM) has been shown to benefit at least 35% of patients in clinical trials.

Re:this pisses me off

[Shotgun]

I had a conversation with a one of my wife's friends once concerning generic vs. name-brand drugs. My contention was that the active ingredients and each constituent percentages are listed on the label. If both have the same percentages of the same active ingredients, then they are the same. Each will have the same effectiveness. She was adamant that the name brand drugs would have INACTIVE ingredients that would make them work better. I pointed out that would make the inactive ingredient an active one, but she would have none of that. This is the same airhead that bragged about paying $160 for a shirt.

I learned something that day. You can't fight stupid. Just smile, give them a placebo, and take their money. It's just easier on everyone.

Re:this pisses me off

[SoupIsGoodFood_42]

I would hope that any placebo would be very cheap, if not fully subsidised. As for the cost of the doctors visit, you are paying for their consultation time, not paying them to write a prescription. It would be nice if all doctors were experts at everything with perfect bedside manner and all patients were completely honest and understood everything they were told. Then you could argue that there is very little space for placebos. But in reality, it does seem like a useful thing if the doctor is acting in the patient's best interest (as opposed to just being lazy).

Ethical Challenges Remain

[ObsessiveMathsFreak]

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?

Re:Ethical Challenges Remain

[Anonymous Coward]

That's only part of the issue.
It might be hard for the generally science-minded Slashdot commenter to fathom, but Placebos actually work. For example in a recent slashdot post on unpublished medical trials, it turned out that in one trial Prozac was less effective than the placebo.

Re:Ethical Challenges Remain

[ucblockhead]

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".

Re:Ethical Challenges Remain

[eht]

Part of the problem is that hypochondriacs will simply find another doctor who will give them what they "need".

Re:Ethical Challenges Remain

[Anonymous Coward]

Maybe the doctors should refer patients with symptoms they do not see a cause for to a specialist? My mom's MS went undiagnosed for over a decade because doctors told her it was "stress". I've seen doctors disregard what I tell them too, though I don't always call them on it. Just because a doctor doesn't know what is going on doesn't mean it is all in the mind--and if it were in the mind, find a shrink for the person. When I doctor "handles" me I don't stop hurting, I just stop getting medical help.

Re:Ethical Challenges Remain

[Anonymous Coward]

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?

Dude, you don't really understand hypochondria. They're not faking their symptoms, they really are in misery, like this poster. Telling them they're not sick and sending them home is only going to make them worse.

If you're so troubled about something that you're manifesting physical symptoms, they're not going to go away until you can calm down and you can only do that if you believe that you're doing something to fix your health problem.

Re:Ethical Challenges Remain

[ceoyoyo]

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.

Re:Ethical Challenges Remain

[In hydraulis]

It's true! I saw it on M*A*S*H!

Re:Ethical Challenges Remain

[mog007]

If a placebo is shown to be effective as a real treatment for a problem, then the process of placebo trials demands that the "real" treatment not be a real treatment. The whole idea of an effective treatment is to have something that can work BETTER than your body's natural methods of fixing things.

Re:First Post!

[Lord Kano]

I'm not and I'm still rather fond of mine. What's your point?

LK

this pisses me off

[MadUndergrad]

Antibiotics shouldn't be prescribed all willy-nilly. It just helps in the creation of super bugs.

Antibiotics?!?

[philspear]

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.

Re:Antibiotics?!?

[Anonymous Coward]

Problem is:

There is no test for 'a cold' (I assume you mean a viral infection). Yes, there is a probability involved. If for instance, there is a 5% chance the infection is bacterial - Do you give an antibiotic or does it have to be 25 or 50%? There is no consensus. So here's the kicker - If you are wrong and said pateint now has a bad outcome and you did NOT give an antibiotic - guess what - now YOU are at fault. Get rid of baseless lawsuits and doctors will not have to practice defensive medicine.

Re:Antibiotics?!?

[Anonymous Coward]

One, I don't think it is really "illegal" but who knows, many silly things can get you arrested.

Second, yeah, lets put them in jail and make medicine even more expensive, bring more lawsuits and more insurances for doctors.

Now, how about if we kill the problem from the root, lets make illegal to advertise antibiotics as the cure-all pill, then your doctor may just let joe-sixpack go with some acetaminofen and he'll be happy.

How about better antibiotic use education for doctors?, but no, this is America, everything is solvable with lawsuits and jail.

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:Antibiotics?!?

[budgenator]

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.

Re:Antibiotics?!?

[philspear]

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 something, it should be an anti-histamine, or saline nasal spray. I guess some doctors are prescribing sedatives, which seems a bit dangerous, but as it's only harming the people who are demanding antibiotics for the flu, it's better they put only themselves at risk than everyone.

But yeah, you basically disagreed with me to agree with me. Everyone comes down with it at some point. I'll prescribe some zithromax, should clear that shame right up.

Re:Antibiotics?!?

[philspear]

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:Antibiotics?!?

[Anonymous Coward]

The patients who don't take their medication as prescribed, and the lack of adequate public health programs with enough resources to track them and to ensure that they do take their medication are the reason for drug resistant TB, not the over prescribing of antibiotics for colds by doctors. Patients with TB used to be confined against their will into sanatariums if they were contageous, in order to keep them isolated from the general population. That wouldn't go over very well now days.

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:Not placebo

[Bragador]

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.

Re:Not placebo

[philspear]

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.

Re:Not placebo

[Bragador]

You're thinking about the nocebo effect. http://en.wikipedia.org/wiki/Nocebo

You're idea is interesting but people might actually become obese when they truly need the pills :P

Re:Not placebo

[philspear]

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!

Re:Not placebo

[Bragador]

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.

Re:Not placebo

[zippthorne]

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.

Re:Not placebo

[Bragador]

Oh, they could I guess. But, why waste O2 since it's not necessary?

Re:Not placebo

[Kandenshi]

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?

Re:Not placebo

[TaoPhoenix]

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 forms" of the exterior-meta-treatments and then choose not to obsess why the synergy works.
(Doctor care - classical placebo
(subjective taste etc for mind to fix on
(secondary medical event, again for the mind to fix on
(conceptual activity like relaxation exercise
))))

This is just beginning to be explored in recent literature in the last decade.

Re:Not placebo

[Anonymous Coward]

Actually, they probably do give them oxygen, even if it doesn't seem necessary. I was an EMT, and they trained us to just give it to anyone, unless they have COPD.

Re:Not placebo

[Anonymous Coward]

> they give you the mask and tell you to
> breathe the oxygen

If they do this, then it's not completely placebo, it's diminishing the percentage of O2 in the air you breathe.

Re:Not placebo

[Bragador]

I'm not too sure about that since the masks have holes.

Re:Not placebo

[Yvan256]

We're back at square 1.

Yeah! We get 200$!

Re:Not placebo

[Yvan256]

If you add four parts H to your O2 then I'll convert it to waste myself.

Re:Not placebo

[zippthorne]

Billing. I paid, retail, $50 for my last 40 ft^3 fill. This was technically medical-grade O2, though I don't use it medically. I'm sure that "emergency O2 administered" when billed to an insurance company is quite a bit more profitable than "plastic mask administered" alone would be.

And, come to think of it, if the O2's not running, a mask or nasal cannula will just make normal breathing slightly more difficult.

...Antibiotics??

[Anonymous Coward]

Headache medicine and vitamins I can understand, they won't cause any harm to the patient. But prescribing antibiotics when someone doesn't actually have an infection is a really bad idea.

Overprescribing antibiotics is part of what leads to drug-resistant infections. It can also kill off beneficial bacteria, leaving your body open to infection (thrush and yeast infections are two common examples of this). They're also much more likely to have side effects or cause allergic reactions.

It just seems to me like you would want to use something that's essentially inert if you're going to prescribe placebos. I can't think of any good reason to use an antibiotic for that.

Re:...Antibiotics??

[fi1th]

Try homeopathy as a medication. It can, when prescribed correctly by a well practised homeopath, do wonders for the human body.

The strength of my body's immune system is strong as a result of being given homeopathic remedies as a child.

mod up I'm no troll

Age old practice

[mschuyler]

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?

[JeffSh]

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 Doctor's to prescribe whatever the latest brand name drug is. Consumer and patient (often the same person, mind you) is a huge factor, and if people stop trusting their Doctor's and start trusting these sorts of studies or even advertisement, then the effectiveness of placebo treatment will inevitably decline.. In it's place, a placebo effect caused by ineffective brand name medications.

If it works, what is the big deal? Doctor's should be prescribing placebo medications (excepting, of course, antibiotics)

-Jeff

Re:drug company sponsored?

[Bragador]

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...

Re:drug company sponsored?

[Anonymous Coward]

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 ... .

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 Doctor's to prescribe whatever the latest brand name drug is.

-Jeff

As for me, I don't see the appeal of many of the latest greatest drugs except those intended for treatment of genuinely life-threatening ailments.

For the drugs intended for non-life-threatening ailments the long lists of possible side-effects are certainly off-putting.

Reading all of the possible side-effects of some of them leads me to conclude that just manning up and living with the ailment would be better than some of the side-effects.

Re:drug company sponsored?

[ceoyoyo]

Actually, I suspect it's probably alternative medicine practitioners, particularly the herbal industry. They don't want the competition.

Re:drug company sponsored?

[Celarnor]

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.

The word SHOULD be getting out. It's entirely unacceptable to forgo real treatment. Are you seriously saying it's perfectly acceptable to do nothing based on a statistic? You really want to leave people screaming in pain in the emergency room while you tell them they're getting treatment when they're really not? What about when the nurse forgets to write somewhere that the IV labeled "Hydromorphone 10ml" is really just saline, and you continue to writhe around in pain while everyone tells you that you can't have any more "hydromorphone" because you've already had the full dose.

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 Doctor's to prescribe whatever the latest brand name drug is. Consumer and patient (often the same person, mind you) is a huge factor, and if people stop trusting their Doctor's and start trusting these sorts of studies or even advertisement, then the effectiveness of placebo treatment will inevitably decline.. In it's place, a placebo effect caused by ineffective brand name medications.

Good. I'll trust whoever is going to give me real treatment for my condition. I have fibromyalgia; if I have a choice between getting sugar pills from my doctor or getting actual treatment for my debilitating neuropathic pain, you bet I'm going to want to be paying the $27 copay on my $3-a-pill perscription to actually get something worth that that will help.

As incredible as it sounds, some people actually NEED treatment for their medical conditions rather than "Here, take this fake version of the pill for your condition".

If it works, what is the big deal? Doctor's should be prescribing placebo medications (excepting, of course, antibiotics).

You say that now. Will you still say that when you get prescribed a placebo for pain for your kidneystone, complain that your "percocet" isn't working, get labeled a drug addict on your records and can't get any kind of meaningful pain treatment for the rest of your life?

Jail is geting off easy...

[ztcamper]

I say line em up in a file. I'll go get a rail gun.

Re:Jail is geting off easy...

[philspear]

It occurs to me that killing half of all doctors might have unpleasant consequences for society.

Re:Jail is geting off easy...

[chrispycreeme]

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.

Re:Jail is geting off easy...

[steelmaverick]

What a great find, sherlock.

Re:Jail is geting off easy...

[sw155kn1f3]

>> 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?

Re:Jail is geting off easy...

[Rennt]

:s/doctors/lawyers and consequences might be surprisingly pleasant. Surely its worth a try?

Well, yes.

[Anonymous Coward]

The interesting thing is that from various studies, the well-being of people is shown to be increased when they've been told whatever they've been given is the cure to their ailments.

What do you want from your doctor? Satisfaction and a feeling of well-being, or an actual cure from your ailment? Sounds like a simple thing, but usually one is easy to provide (placebo and well-being) and one is difficult!

obecalp

[DirtySouthAfrican]

http://blogs.lifestyle.aol.ca/2008/06/20/obecalp-placebo-meds-for-kids/ Start them off young!

And the worst part is...

[elgol]

...they don't even tell the patients that they are getting a placebo!!!

So?

[Aphoxema]

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 eating making things difficult.

It really is just in your head sometimes.

Re:So?

[Bragador]

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

Re:So?

[Aphoxema]

Wait, what?

Re:So?

[Jamie Lokier]

And sometimes it's not in your head, but your head can fix it anyway.

Re:So?

[Bragador]

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 benefits than a placebo, the new drug is accepted and made into an official medicine.

If the placebo effect wasn't known to be effective, they would simply compare the effect of their new drug to a group that wouldn't be taking anything.

Re:So?

[Aphoxema]

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.

Re:So?

[Aphoxema]

Everything's in my head, so are you.

Re:So?

[Bragador]

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.

Re:So?

[Jamie Lokier]

For some definitions of head.

Re:So?

[nitehawk214]

For some definitions of head.

Or rather... for very large definitions of head.

Re:So?

[niw]

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.

The only problem is using real drugs that are not a cure for the ailment causes other problems. In the case of antibiotics, it help creates super bugs. It would be better if the doctors were prescribing real (sugar) placebos.

Make them taste horrible if necessary. Say they are a newly developed drug that seems to help cure the ailment, such as ColdFX.

Re:So?

[Aphoxema]

Right, that's what I said, so why did you say it again?

Re:So?

[dcollins117]

The problem is that as a patient you are supposed to have the right to informed consent about your treatment options. Prescribing a placebo is inherently deceptive and arguably unethical.

How is this much different from a car mechanic who, upon finding nothing wrong with your vehicle, replaces parts anyway so that you'll feel like your car has been "repaired"?

Re:So?

[jonaskoelker]

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.

Re:So?

[Bragador]

Because we obviously don't listen to each other?

Antibiotics used non-theraputically all the time..

[lotho brandybuck]

You do know it's legal to put low dose antibiotics in animal feed? Actually, I think it's harder to get processed feed w/o antibiotics than with them! On the human side of things, check out what our local teaching hospital is asking for volunteers for. I think this is crazy and should be illegal. But if somebody can make money off of it, who is the government to regulate it in general society's interest?

In other news...

[LoverOfJoy]

Half of American patients report their prescriptions are ineffective.

Re:In other news...

[Bragador]

A placebo is effective. Just not as much as a real medicine.

This has been going on for many years

[grandpa-geek]

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.

Re:This has been going on for many years

[Celarnor]

Good for those people.

What about the rest of us who have treatable medical conditions? Are we supposed to go through extra appointments and pay extra money just so I can get by the initial "Here's some fake treatment" phase?

Do you really think its ethical to charge people for this, when it isn't a viable, effective form of treatment?

Re:This has been going on for many years

[grandpa-geek]

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

Re:This has been going on for many years

[borizz]

Your doctor is probably better at deciding which ailment is actually in need of treatment and which is not. People going to the doc for a cold and demanding antibiotics should be given sugar-pills for everybodies good.

Re:This has been going on for many years

[Celarnor]

No, people going to the doctor for things like a cold should be told to go home, rest, and take some dayquil. Those general practitioners, who are the PCPs for a great many people, should be dealing with their patients serious problems, not coddling everyone with a sore throat and a runny nose.

If that were true, I don't think this would be as much of an issue.

Re:This has been going on for many years

[Celarnor]

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

How do you know that? If this is allowed to continue, there's an incredible financial incentive on the medical industry to pass of a prescription of a 90-day supply of $0.005 sugar pill as a $2.50 pill ($1.35 versus $675 for a 90-day prescription of my most expensive medication). That's a huge profit margin for them.

Re:This has been going on for many years

[ivan256]

People should be taught by our public school system how to know if they're sick enough to need the doctor. If they have a cold they should stay home instead of driving up the costs of our healthcare.

Ethical issues?

[xstonedogx]

I hear there is a pill for that now.

Re:FRIST PSOT!!

[Anonymous Coward]

You also can't spell your name!

SNOW OWL!

[Alex Belits]

more research is needed to determine whether doctors must deceive patients in order for placebos to work

SNOW OWL! SNOW OWL! SNOW OWL!

(with words "O RLY" overlayed on the photo)

Placebo should be the preferred treatment.

[Anonymous Coward]

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.)

But the trouble is they are not giving them a placebo at all, they giving drugs. Most often they are giving anti-biotics to cure a flu. While the effect might be a placebo, the actual drug has a high level of toxicity.

What should be allowed if for doctors to prescribe sugar-pills marketed under a fancy name, or perhaps homeopathic remedies (ie water). Yes it might be deceptive, but the very best cure is a placebo cure effected with a non active agent. The patient both gets cured and their exposure to toxicity is minimized.

Re:Placebo should be the preferred treatment.

[niw]

What should be allowed if for doctors to prescribe sugar-pills marketed under a fancy name, or perhaps homeopathic remedies (ie water). Yes it might be deceptive, but the very best cure is a placebo cure effected with a non active agent. The patient both gets cured and their exposure to toxicity is minimized.

Yep I think would be a good idea, but as mentioned in the article:

But, Dr. Brody said, doctors should resist using placebos, because they reinforce the deleterious notion that âoewhen something is the matter with you, you will not get better unless you swallow pills.â

This is the real reason that we are having this discussion at all.

That said, a lot of the "health" problems are psychological, like one of my aunts.

Re:Placebo should be the preferred treatment.

[Celarnor]

That's all well and good, up to the point where someone who is sick gets sicker and sicker because they keep getting prescribed placebo versions of medicines and telling specialist after specialist that they've been taking the medications they were told they were taking, not knowing that they were receiving fake versions of it.

This is a terrible, terrible idea and should be made illegal as soon as possible.

WebMD

[Anonymous Coward]

I recommend checking out webmd.com when a doctor gives you a drug that you don't recognise. I was introduced to this site via a psychology lecturer, who had been given some pills that had a half-life substantially longer than the time period between taking the pills — the end result of which meant she was bouncing off the walls after a few days.

I've found it useful for looking at potential side-effects and things it's a really bad idea to take the drug with.

Re:WebMD

[Convector]

If your medication actually has a finite half-life, then it's probably not something you want to be ingesting regularly.

but the patients really do need pills

[r00t]

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.

Re: "Strong Placebo"

[TaoPhoenix]

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 "action based placebo" such as meditation. Then the additional benefits over placebo such as conceptual structural clarity, etc. can provide the additional benefit.

Re: SuperPlacebo?

[TaoPhoenix]

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: "Honesty less than worthless"

[TaoPhoenix]

Enter Robin Cook.

That's already a complicated definition of "medical truth". Then add some human failing and the story writes itself.

Re: Sugar Pills

[TaoPhoenix]

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 with it".

search on Arthoscopic knee surgery

[nido]

like this, for example.

Re:search on Arthoscopic knee surgery

[Free the Cowards]

Thanks. So now there's one procedure which may be ineffective, and about a million extremely effective ones. Not quite enough to prove the original poster's point. I suppose it's a start though.

Re:search on Arthoscopic knee surgery

[Anonymous Coward]

A lot of heart patients die on the operating table, or soon thereafter. I wouldn't call that "extremely effective".

Some patients always do poorly with surgery. For them, surgery is worse than doing nothing at all.

Re:search on Arthoscopic knee surgery

[OwnedByTwoCats]

Arthroscopic knee surgery may be a placebo for Osteoarthritis, but it is effective for treating injuries.

I tore my meniscus (skiing accident; binding didn't release) last February. Had the surgery in early May. In March and April, I was only barely mobile; walking very carefully so as to not twist my knee at all. Six weeks after surgery, I was again running. Still am. Surgeon warned that I would be at increased risk for osteoarthritis later (compared to an uninjured knee? Or my torn meniscus? Not clear...)

Anyway, my dilemma is whether or not to buy my own skiis and a season pass at the slopes this winter.

Re:search on Arthoscopic knee surgery

[nido]

very interesting anecdote - thanks for posting.

I wonder

[solweil]

I wonder if these same placebo-prescribing doctors scoff at the 'quackery' of acupuncture or chiropractics.

They're prescribing effective remedies

[91degrees]

People take a placebo and feel better. If they just want the symptoms to be treated, then the symptoms are being treated. The placebo works. Why does it matter if it's psychological or physical.

Placebos work

[iminplaya]

Mark 5:34

Re:First Post!

[Anonymous Coward]

Nah, just a little bit off the top.

Why dont we just hack mind=P

[Recursive42]

isn't the ratio scary? I think placebo effect can be stimulated without giving non-necessary drugs. I heard that every antibiotic pill makes little damage to your liver.

These are not Placebos

[edibobb]

(1) It's not a placebo if the doctor explains what he is prescribing and why. (2) "Headache pills," or more specifically NSAIDS, frequently help a wide variety of conditions. This is hardly a placebo. (3) A patient who keeps pressing for additional treatment can expect to recieve prescriptions less directly related to the ailment.

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

[wamerocity]

One of the professors at my med school gave a presentation that these psychosomatic problems of fibromyalgia are anything but. She summed up her research showing what happens if you tie a string around the dorsal root of one of the spinal nerves (the sensory part) which caused incredible pain. The string dissolves in a few weeks and they measured how long it takes for the pain to subside. They would measure the pain by touching the paw of the rat with a very small probe to see how much pressure it would take before it would lift its foot (or the pain became too much). Even using the largest gauge (smallest probe) the rat would lift its paw, but gradually it would allow more pressure as time went on the the string dissolved.

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.

Re:This is a crap study and Title is WRONG

[SUB7IME]

That would be interesting, particularly since the person who discovered and named the entity known as 'fibromyalgia' now believes it's not a real diagnosis.

Re:This is a crap study and Title is WRONG

[Surt]

Define does not believe it's a real diagnosis? Because to my understanding, what they don't believe is that they are understanding the phenomenon, not that the phenomenon doesn't exist, and that to call it 'diagnosed' is therefore misleading. Clearly the phenomenon exists, as patients report it. Patients are suffering, doctors just don't know WTF to do about it, or what the cause is. This causes them embarrassment, and for some doctors a desire to deny that the patients are suffering, but that doesn't mean the patients aren't suffering.

Re:This is a crap study and Title is WRONG

[SUB7IME]

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

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.

Re:This is a crap study and Title is WRONG

[SUB7IME]

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.

Physicians make this distinction all the time. If you abstract only to the useful limit, as opposed to ad infinitum, as you have done, then the concept is easy to grasp.

Re:This is a crap study and Title is WRONG

[I cant believe its n]

First of all, I do not suffer from fibromyalgia or even know anyone who claim to do, but I do find it funny when people claim that they know more than sufferers.

Surely some of these people will be crazy but there will also be a lot of people who become depressed/neurotic through suffering. You don't think being in pain affects you mood and outlook on life?

Terrible example: Lets say that someone was going to hit you in the face every day for five years time and that there was no way for you to avoid this. Should you be called a neurotic if you where depressed by this or would you just be a normal person responding normally to reallity?

Do you remember all the neurotics who got themselves ulcers by stressing too much? You know the ones that doctors said caused their own symptoms? I'm convinced you know that there where two guys who got a Nobel prize for discovering that you could treat this bacterial infection, some years ago. All of a sudden, doctors forgot that they had for many years called former patients neurotics, causing their own disease.

(I myself admit to being a tin-foil-hat-rash sufferer.)

Re:This is a crap study and Title is WRONG

[Anonymous Coward]

So? They also used to believe that migraines were psychosomatic. Now they're advanced enough to know that they're essentially chemical and electrical changes in an unstable nervous system (and to see the changes in the brain structures of long-time migraine sufferers).

Just because someone doesn't believe in something doesn't mean it doesn't exist. We simply may not understand it yet.

Re:This is a crap study and Title is WRONG

[Mastodon]

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.

Physicians make this distinction all the time. If you abstract only to the useful limit, as opposed to ad infinitum, as you have done, then the concept is easy to grasp.

I thought I had grasped it 30 years ago in medical school. Then I learned more about the nervous system.

This is not infinitely abstract at all. In the useful limit, you don't send a fibromyalgia patient to an orthopedist, but you don't send her to a psychiatrist either.

Re:This is a crap study and Title is WRONG

[lgw]

"Psychosomatic" is so commonly misused in popular discussion that it's hard to talk about "psychosomatic illnesses" rationally on a forum like Slashdot. To most people "psychosomatic" means "lying about being in pain to avoid work and get charity", or maybe "crazy". To clarify for /.ers: psychosomatic illnesses are real ilnesses (the pain is genuine; the source is not understood), and psychosomatic injuries are real injuries (e.g., blisters forming because you think you were burned - the blisters are quite real).

You can't be wrong about whether you feel pain. If you think you feel pain, you do, even if your doctor can't figure out why. It shouldn't be too surprising that normal pain medication works to relive some pain, even when we don't *understand* the cause of that pain. Maybe the pain was psychosomatic, and the placebo effect was all that was necessary, or maybe the pain had a physical origin that we don't yet understand - either way it's good medicine.

What's ethically questionable is lying about what medicine is proscribed in order to motivate the patient to actually take that medicine (telling you the pain medication is more exotic that it really is). Lying about proscribing a placebo because it won't work if the patient doesn't believe is interesting too: but that seems quite easy to test in double-blind studies for specific treatments and illnesses. If it's actually proven that the placebo effect works, and only works if you lie to the patient, than that sounds like good medicine - but lying to a patient on the basis of some assumption seems less good.

Re:This is a crap study and Title is WRONG

[SUB7IME]

Sure, h pylori is a big deal, but let's not forget about ulcers secondary to Zollinger-Ellison!

Also, "crazy" isn't really the word I'd use to refer to people who are experiencing extraordinary discomfort. Some have physical problems; some have psychiatric problems. The problem is in the breadth of the diagnosis, not in the truth of the patients' claims.

Re:This is a crap study and Title is WRONG

[SUB7IME]

"but you don't send her to a psychiatrist either"

^ Unless she actually has a psychiatric problem. One problem with the "definition" of fibromyalgia is that it is extraordinarily broad. Some people undoubtedly have a physical/neurological/etc problem; others quite likely have a psychiatric problem.

Re:This is a crap study and Title is WRONG

[The Chemist Black]

I would like a link to the paper. My mother suffers very badly from RSD. Its similar to fibromyalgia everyone has been talking about in this thread.

Re:This is a crap study and Title is WRONG

[wamerocity]

Sure thing. It'll probably be a few months. Long and short of it, the good news is that they think they might have found a few things that can prevent it, unfortunately there isn't much you can do post-onset. The summary is that there are certain types of anti-oxidants, that if received in a high enough dose, prior to damage, that the CNS would NOT fire the signals to the brain as much, and that the chronic pain would subside. (I don't recall the one of the specific one she mentioned, but I recall it having to do with a treatment for Parkinson's). There were 3 specific anti-oxidants that she spoke of in her research that were particular effective against the pain the is common among the elderly, although I don't recall which ones. Wait for the link.

Not Too Different from IT Admins

[akpoff]

Anyone on /. who finds this surprising should hand in their geek cards. How many admins out there have told users to reboot when they came kvetching about network being slow? Or told them to resend that lost email? It's really just helping people manage the day-to-day quirks of life.

We even have our own hypochondriacs and an analog to prescribing an unneeded antibiotic when users complain about insufficient disk space. A BOFH first offers self help: "try deleting some unused files". And then when annoyed, responds with:

# cd ~$complainer/random_dir
# rm -Rf *
There you go. 500MB free.

And let's not forget that like most admins, doctors have a god complex. Nope, not much difference between IT admins and doctors.

Antibiotics are NOT a placebo

[TheLink]

Antibiotics are NOT a placebo. In addition to the bacterial resistance problem, there are lots of potential nasty side effects with some antibiotics.

Placebin (TM)

[Anonymous Coward]

Placebin (TM)! Cures everything! So effective it is the standard that all other drugs are compared to in clinical trials!

prescription happy doctors

[Anonymous Coward]

Is it good or bad when the doctor prescribes you extra meds to offset the side effects of the orginal prescription? Doc gives me cholesterol medication and antidepressants at the same time!

So how do they prescribe it?

[Anonymous Coward]

Seriously, the doctor gives me a poorly written note, and I take it to the pharmacy. Does that note actually say "placebo" on it, or are there a crapload of code names for sugar pills that the pharmacist sees and gives a knowing wink to the other pharmacists over? How would I recognize this?

Re:So how do they prescribe it?

[narcc]

You can't tell just by looking at the prescription alone. Use the following checklist to see if you've got a placebo:

I went to the E.R. because I have:
[ ] a cold/flu
[ ] muscle aches/other very mild pain
[ ] frequent mild headaches that I call 'migraines'
[ ] a mysterious rash
[ ] no idea what 'emergency' means

Count the number of items you checked. If the total number is one or greater, you've got a placebo!

Re:FRIST PSOT!!

[johanatan]

Which name is it that you think I am attempting to spell?

IF it happens to be 'jonathan', then you may like to know that the name in its original language (Hebrew) is pronounced 'yohanatan' and can be spelled in Western languages with a 'j' instead of a 'y'. [I find that the spelling 'johanatan' is much more likely to be an available alias than 'jonathan' or 'yohanatan but YMMV].

[And BTW, Obama is a fucking communist].

Where are the pharmacists?

[pokerdad]

I don't live in the US, so maybe what I am about to say is irrelevent, but I can't imagine that prescribing legitemite medications as a placeobo would ever work here.

I buy pretty much all the medications for my household and with every purchase comes a long conversation with the pharmacist where he explains what the med is, what it does, how to take it and what the side effets are. Also, often when I first drop the presciption off there is a short conversation about what the ailment is (as a verification step I am sure). And finally with every bottle of pills comes a crapload of paperwork that explains everything there is to know about them.

Does all this not happen in the US or are doctors just assuming that their patients are idiots?