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

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.

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

[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

[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

[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

[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: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.

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: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: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.