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Most UK GPs Have Prescribed Placebos
Techmeology writes "In a survey of UK GPs, 97% said they'd recommended placebo treatments to their patients, with some doctors telling patients that the treatment had helped others without telling them that it was a placebo. While some doctors admitted to using a sugar pill or saline injection, some of the placebos offered had side effects such as antibiotic treatments used as placebos for viral infections."
antibiotic treatments used as placebos for vial infections
I'm sorry but a medical professional should flat out know better.
im all for giving a placebo to people where appropriate, they have been shown to be a powerful cure-all. However using antibiotics to treat a viral infection is only going to hasten antibiotic immunity, sure a doctor should know better than that.
Also, does this mean that pharmacists keep a stock of placebos?
How do you explain it to a patient without incurring a law-suit?
- A.B
By definition, antibiotics are NOT placebos. A placebo must have no pharmacological effect to be designated as such; which clearly rules out antibiotics. Full disclosure: I'm not a doctor. Not that one needs to be to understand what a bloody placebo is supposed to be.
"such as antibiotic treatments used as placebos for vial infections.""
With proper sterilization techniques, you wouldn't get infections from vials in the first place.
(or use new vials so there's no risk of contamination - which they do in US hospitals since they charge so much they have new everything.
I guess that might not be an option on the NHS
What is this Placeb operating system?
In Dr Irving Kirsch's book "The Emperor's New Drugs Exposed" he described how they are as effective as a class of anti-depressants, and of course they have fewer side effects! http://healthimpactnews.com/2012/fact-antidepressant-drugs-no-better-than-placebos/ Ben Goldacre in "Big Pharma" has written similar stories. http://www.huffingtonpost.com/irving-kirsch-phd/antidepressants-the-emper_b_442205.html
I believe that any Doctor that has prescribed placebos are "Quacks of the worst kind." I suffered from such quacks for 20 odd years for a lung infection, it took a young newly registered doctor that took his Hippocratic Oath serious to Diagnose, prove, and treat a fungal infection. It is no wonder so many so called doctors do not want patients to see their records.
as a placebo for viral - I'm assuming the OP had a typo - infections is a deplorable practice. However, many antibiotics once considered mainline treatments are now practically useless against many types of bacteria. Aside from the gastrointestinal side-effects and subsequent bacterial imbalance in the gut, they basically are placebos now. The side-effects themselves give a patient the feeling of "real" medication.
This seems quite similar to articles describing the side-effects of SSRIs (nausea, headache, libido changes) giving an impression of efficacy without actually relieving depression in many patients, though I know many people who do find they help depression and anxiety.
The British National Health service runs entire hospitals dedicated to placebo treatment.
The Royal College of GPs says there is a place for placebos in medicine.
The only place for placebos is in a controlled study where the patients understand they are part of a study. Prescribing a sugar pill to an actual patient while telling them it's anything else is outright fraud.
The reason doctors began wearing white coats was because there were so many mystics and quacks claiming to be doctors and healers, they found that this uniform brought the public's trust. It's a ruse designed to gain trust they haven't earned... the coat itself is a placebo.
I visited a UK GP recently with a stomach bug recently, I received a week supply of penicillin, laxatives and an Xray at the local hospital, No swabs stools sample. Never quite got that one.
Indeed. The correct way to deal with dirty bottles is to run them through the dishwasher.
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
A family friend, an old and wise ear, nose and throat doctor, mentioned at a dinner party, that about 25% of his patients had an emotional problem, not a physical one. He lamented that younger doctors did not take time to ask patients questions about how their life, family and job status were going. The younger doctors would just try to prescribe pills too quickly, and refer the patient to a specialist, like himself. A neurologist and another doctor at the table agreed.
Of course, now many doctors have time constraints for patient visits imposed by insurance companies. So prescribing a placebo is the easier choice than really talking to the patients, and dealing with more paperwork, for an extended consultation.
That was in the US; I don't know how that is in the UK.
Schroedinger's Brexit: The UK is both in and out of the EU at the same time!
It's completely unethical IMO - almost as bad as if a GP prescribed someone homoeopathic medicine. Perhaps some GPs consider it the lesser of two evils, that if they prescribe the person the placebo they're saving them from the potential side effects and risk that a real drug might bring along with it and also saving the NHS some money at the same time. Regardless of the reason, the proper answer is the GPs should work on their "bedside manner" to convey that there is nothing to be gained from prescribing something if the illness is either psychosomatic or wouldn't respond.
Perhaps the only way to stop it from happening is for chemists to refuse to fill such prescriptions or for the government to ban them from doing so except for clinical trials.
The major issue is that people as a rule are lazy so expect a simple quick fix to all their problems in life.
Illness, pop a pill
Fat, gastric band
etc, etc
As a previous poster mentioned most problems that a GP comes across will be fought and fixed by your body with a little assistance of paracetamol or ibuprofen to keep down temps.
We have become too reliant on an easy fix and need to return to eating properly, exercising and not being too clean.....
Build up your natural ability to fight illness, only go to a GP when you have a serious problem. The NHS generates this lazy reliance on the GP for everything!!
Being Mutual - Working together for a better society
"They are not very effective at reducing measurable symptoms, and not effective at improving outcomes. "
While we're on the topic why don't we just get it all out:
Mental illness is not a real illness.
People who suffer mental illness should just get the f*ck over it.
Real illness can be seen, touched, measured.
Placebos don't work, subjects just overwhelmingly report that they do.
Why placebos are dismissed by scientists and doctors is a mystery to me. We should be studying the mechanisms behind placebos, working out why a form of "positive thinking" (unfortunately that phrase has many new age connotations) works, and using the results to our benefit.
Potentially cheaper and less toxic than any other medication.
I'm astounded that anyone thinks this is an issue. Let's be clear of three things.
First and foremost. A doctor's job is to look after the health of their patient. There's nothing in the act of giving a placebo that goes against that.
Second. Giving a placebo is NOT "doing nothing". There's a huge body of research evidence that a placebo, given to the right person at the right time, can have positive clinical results, and in some cases results as good as any other available treatment. Which makes the placebo a tool in the clinician's armoury, and the considered prescribing of a placebo a perfectly reasonable medical choice.
Third. The moral issue - should your doctor ever lie to you? Dumb question. Unless you're a highly trained clinician yourself, your doctor *always* lies to you, if only by omission. Do they really tell you how unsure they are of what the problem is? No. Do they tell you all the obscure possibilities that occur to them? No. Do they mention all the unlikely complications that might occur? No. They tell you what they feel you need to know and can understand and handle, and no more. Sure, patients have a right to be involved in their treatment. But there's a real conflict of patient interest when the best treatment is either to do nothing for a while, or to head off behaviour that the patient is clearly reluctant to avoid. There's nothing inherently wrong or immoral in saying "I'm going to prescribe you some tablets," when the unspoken subtext is, "A placebo is as good a shot as any right now, and I can't come right out and tell you that, by definition."
Does anybody else research drugs you are given, or do people just swallow whatever the doctor gives them?
http://en.wikipedia.org/wiki/Doc_Martin
Glad to see they use things that work!
I'd bet that 25% is actually 0%.
Psychology got its start from a doctor who found a cure for some particular illness, but found that only about half of his patients responded to the cure and improved. So what did he take from this? Was his cure only effective half of the time? Did the other patients actually have some other illness that simply had the same symptoms? No, nothing like that. Instead, he assumed, there was actually nothing wrong with the patients at all, and it was all psychological.
Of course, science eventually figured out that the remaining 50% actually were ill, but by then the "science" of psychology had already been created. No longer did doctors have to deal with patients with problems they could not diagnose. Instead, if they couldn't figure out what was wrong, then indeed nothing was wrong. Suddenly every doctor could be a super-doctor who was never stumped by any case. Instead, the only thing that varies between doctors now is the percentage of their patients with psychological problems.
I got to deal with this a few years ago.
One day I get this sudden sharp pain between my thorax and my abdomen. So I go to the hospital, and an hour later when they finally get around to seeing me, the pain has disappeared. Fearful of a large hospital bill, after a previous encounter with the hospital in which they padded the bill with every test they could think of, only to come up with nothing, I elect to leave immediately.
However, I return in a few days with the same problem. Again, after waiting an hour to see a doctor, the problem has gone away, but I stay this time in order to see what they can figure out. They ask some questions, poke at me a bit, then one of the doctors spots on my chart that when I was in the hospital a decade earlier I was on an antidepressants and an antipsychotic. Then they conclude that I probably just had heartburn and overreacted, and recommend antacids, even though, not being a moron, I tried them both times the problem occurred and they had no effect whatsoever.
I return a few days later, and again, wait an hour to see a doctor (yes, this is the emergency room I'm talking about) who looks at my chart and concludes that I have really bad heartburn. They mention that they might have to run a scope down my throat at some point, but for the time being, just prescribe some more medications.
I return a few days later, and again, wait an hour to see a doctor, who again, looks at my chart and comes to the same conclusion, tells me to keep taking the medications, and sends me on my way.
I return a few days later, and again, wait an hour. Again, problem goes away, and I just get up and leave since there's essentially no point in staying.
I return a few days later, but this time just pace around the hospital debating whether or not I should even bother to check in. After an hour passes, the pain goes away, and I leave.
A few days later, it happens again, but this time far worse than before. I immediately get someone to drive me to the hospital again, and along the way feel as if my abdomen is about to explode. I vomit on the way to the ER examination room. There I lie on a bed, screaming from the pain, for half an hour, until it finally ceases. I then lie for another half an hour, so weak and exhausted from the intense muscle contractions of my body attempting to deal with the problem that I can barely roll myself over when I feel the need to move.
Finally a doctor comes to examine me, and in doing so, pressing on my abdomen in random places, finds that at one point it actually hurts, but not when he presses, but rather, when he releases. This gets his attention enough that he orders a CT scan, at which point they discover that the problem is gall stones. Apparently there's some blood test for the body's reaction to gall stones for which I'd later just about set a record.
So why did I have to wait until the things just about killed me to get a diagnosis? Well, the doctors clearly suspected gall
I live just next door in Ireland, and treatment for anything and everything goes something like this:
1) Hot whiskeys (at least 4 in a sitting)
2) Antibiotics
3) Stop antibiotics halfway through, save the rest
4) Wait until someone else gets sick then offer them your leftover half course of (possibly expired) antibiotics
As an American, I resisted #1, but eventually I took to it. However, I'm horrified every time I'm offered someone's leftover antibiotics.
I KNEW those pills looked an awful lot like Flintstones chewable vitamins!
It's because it is what the patient expects and not delivering that is damaging to the doctor/patient relationship. In the long run that damage can have a catastrophic impact on the patient's health.
That's incredibly short sighted. By prescribing unneeded anti-biotics you are encouraging anti-biotic resistance which in the long term can damage the health not only your patient but also of millions of others. Not only that but you risk damaging the doctor-patient relationship irretrievably because you are effectively lying to the patient that they need a treatment which they do not. If they ever find out not only have you destroyed that relationship but, if I was the patient, I'd report you to the relevant authorities.
I know that patients can be a really insistent at times - my dad was a GP - but his attitude was that he would never prescribe unneeded anti-biotics and if the patient didn't like that they could find another doctor. Speaking as a patient I'd much, much rather have a competent doctor who's primary concern is my health and not whether he might hurt my feelings by telling me I don't need a treatment. It might be irritating at the time but, as long as the decision is correct, over time those correct decisions will build trust which is a far stronger foundation for a relationship than unnecessary treatments.
One of my favorite columnists, Gregg Easterbrook, summed it up nicely:
"Therefore I plan to make my fortune by marketing the incredible new drug Placebon. A patented, proprietary formula consisting entirely of sugar, Placebon will revolutionize medicine. Elaborately packaged in individual foil doses, Placebon will be obtained only with a doctor's prescription. Placebon will be the subject of a multimillion-dollar marketing campaign consisting of costly television advertising and full-page magazine ads with hundreds of words in disclaimers. In the TV ads, smiling multicultural people will run through fields of wild flowers laughing and embracing, but the announcer will never give the slightest hint what the drug is for."
"Placebon will be extremely expensive, thus increasing demand. Pharmaceutical companies will treat doctors to lavish dinners, send them on all-expense-paid cruises and hand out handsome 'consulting' fees to get them to prescribe Placebon. Controlled clinical studies will fail to show that Placebon is any more effective than breathing, but the manufacturer will lobby the Food and Drug Administration not to report this. Celebrities will be hired to have public breakdowns, then make spectacular recoveries by taking Placebon. A saccharine version, Diet Placebon, will be marketed. Initially, many insurers will refuse to pay for Placebon. But as senior citizens stream across the Canadian border to buy low-cost government-subsidized Placebon, politicians will demand that insurers pay, and the health care share of the GDP will rise again. Eventually a generic will be available at discount, while the patent holder makes a tiny molecular change in order to maintain proprietary pricing of advanced Placebon 24", a longer-lasting version. By converting the placebo from cheap to extremely expensive, Placebon will expand the benefits of the placebo effect from a tiny few who participate in clinical trials to millions of Americans."
Warning: Do not take Placebon if you are pregnant or not pregnant. Product not suitable for anyone who is tall or short or not tall or not short. Side effects may include pneumonia, cancer, bubonic plague and amputation. If you had trouble getting dates in high school, Placebon may not be right for you. Do not operate tunnel-boring machinery or artillery after taking Placebon. Never take Placebon or any prescription drug without first paying a large sum to a doctor.
To my surprise, no one is bringing up the real problem here: Patients have a right to be informed about their treatments and about the risks and benefits of each treatment. If you give someone a placebo (outside the context of a medical study) you're deceiving them and that is a breach of medical ethics.
It *is* OK to give a placebo within a medical study, but that's a special circumstance which is governed by very strict rules. One rule is that the patient is fully aware that they are participating in a study and that their treatment is randomized-- they might be assigned a placebo or might be assigned an active drug. There are lots of other rules too (e.g., you can't randomize someone to placebo if there is a proven therapy for the illness they have; instead you have to randomize them to proven therapy vs. experimental therapy. Also, the whole study has to be approved by an institutional review board. Etc.)
They mix terms "placebo" and "unproven treatment" which is not good because:
So in the end, it seems like they are comparing apples and oranges thus mooting the point.
Hopefully, that's just bad reporting. Not bad research.
hany
I feel better just hearing that they do.
While some doctors admitted to using a sugar pill or saline injection
As long as the doctor can rule out an infection that needs treatment (ie.: patient is just being a whiny bitch and needs to suck it up), I can't see the downside to this.
There is no fraud here: placebo are efficient, sometime more than some drugs, and with fewer side effects
For instance, if you have high cholesterol, and your doctor gives you diet advices and a placebo, you will be healthier than the one that will get a statin anti-cholesterol drug, which is inefficient at preventing heart attacks, and will destroy your muscles, push you toward diabetes, and increase your chances of getting a cancer
Placebos are only given instead of an antibiotic in a clinical trial. In a doctor's practice, placebos can be given instead of a painkiller - analgesic -.
Interestingly, placebos sometimes have a higher incidence of headaches reported in these studies than the drug being tested.