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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.
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
It's the UK, a similar but different culture where talking to a lawyer is often the last resort, not the first.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
Windows 8.
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
While antibiotics won't stop a viral infection, one thing they can help with when infected is to prevent other infections. For instance, a bad viral lung infection might be treated with antibiotics to prevent an opportunistic bacterium like pneumonia from attacking.
And yeah, pharmacies used to carry placebos. When I worked in a pharmacy long ago, I did indeed dispense them. It was labelled with the chemical name (sucrose, lactose 50mg, etc), but may have been given unlabelled as a unit dose.
How about "I could have prescribed you the anti-depressant but I was worried about the small suicide risk so I gave you an equally effective sugar pill instead."
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.
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."
Here's the rub. A lot of people show up at the doctor for things which will take n days to go away - with or without treatment. The common cold, for example. They won't accept NOT getting any prescription and will hop from doctor to doctor until they get one.
Now the best thing would be educating the public about this issue. This is very, very hard to do. Barring that, it is actually better for the patients and cheaper to just prescribe placebos - they DO work in this case! (up to the placebo effect, as any other medicine would).
Unfortunately there is another issue involved: Most placebos (at least in Germany) are homeopatic. This lends credibility to the whole homeopatic industry, and THEY are nothing but quacks. And THAT is a bad thing.
So - either way you lose.
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!
Here's the rub. A lot of people show up at the doctor for things which will take n days to go away - with or without treatment. The common cold, for example. They won't accept NOT getting any prescription and will hop from doctor to doctor until they get one.
Can we give them a cyanide placebo in these instances?
Obviously these are the sort of idiots who should be culled for the benefit of the rest of us who have positive IQ's :D
Build a Man a Fire, and He'll Be Warm for a Day. Set a Man on Fire, and He'll Be Warm for the Rest of His Life.
On the flip-side, many people know that a cold will go away in n days with bed rest, but they're employer requires a "note from mom" after n-x days. Once at the doctors they'll usually think, "Well, I'm here, might as well get something for this headache/sniffle/uncontrollable-drool" and flash their blood-shot puppy eyes and whimper until the doctor gives them treats.
"I propose we leave math to the machines and go play outside" -- Calvin
Add a bittering agent to make the thing taste bad. It's not that otherwise it won't work, just that if it tastes foul enough (but not too foul) it'll work better.
In a sense there really should be a nicely packaged version with the usual warning sheet and everything. Possibly even a "low dosage" variant you can get at the druggist without prescription.
I'd start a venture producing them (already have a nice product name) if not for the heaps of regulatory red tape and the trouble with the required testing. Before I know it I'd get sued by animal welfare groups for needless animal cruelty or something.
im all for giving a placebo to people where appropriate, they have been shown to be a powerful cure-all.
PLacebos have been shown to be effective at reducing patient reported symptoms. They are not very effective at reducing measurable symptoms, and not effective at improving outcomes.
On the other hand, they are effective at reducing the patient's trust in their doctor, and bringing back the doctor paternalism of yore.
Get a new doctor.
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.
Prescribing a placebo can heal the patient. How is that unethical?
There's strong research backing this, btw.
This is not fraud. The placebo-effect is very real.
http://en.wikipedia.org/wiki/Placebo#Placebo_effect_and_the_brain
In fact, the use of placebos in controlled studies may even harm their outcome due to this placebo effect. A good controlled medicine-effectiveness study should therefore consist of at 3 groups: one getting the drug, one getting the placebo and one getting nothing at all.
0x or or snor perron?!
I agree.
Scientists tend to dismiss the placebo effect. We should be studying it. Trying to understand the mechanisms behind it, instead of taking more potentially harmful substances into our bodies.
Medical scientists study the placebo effect all the time. It is one of the most highly studied phenomenons in medicine, we study it with every condition we search for a drug for.
The point of the placebo effect is that it is entirely psychological. It is not clinically real - it is not physiological. It's important because a great deal of medicine is asking how the patient feels to diagnose, but we also know that simply paying attention to people often makes them feel better. If they have an actual underlying physiological condition, that will not improve. The patient will feel better - briefly - but they will not actually get better, and for something like a bacterial infection this is potentially fatal.
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
Medicine should be evidence based as much as possible. Fobbing someone off with a phoney treatment that has "helped" others is irresponsible.
Glad to see they use things that work!
Fourth: Placebos can be effective EVEN IF THE PERSON KNOWS IT"S A PLACEBO
Go back and read that a second time to make sure you get the gist of it.
The link is on my work computer (thus, not available at this time) but there are actual studies that demonstrate this fact. Maybe being under the care of someone else is all that is needed to do it, but a placebo is one of the tools that should be used (and explored) in medicine.
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 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.
The placebo effect has been objectively measured as being able to heal a patient.
It can and does happen.
Go check the research. It's very real. This is why for instance homeopathy treatments are assessed against whether they heal the patient, they're assessed against whether they heal the patient MORE than a placebo.
It is not clinically real - it is not physiological.
I'm not sure how you define "clinically real" but the placebo effect has been demonstrated to change brain patterns, lead to (e.g.) hormone generation and change perception of pain.
I'd call those clinical outcomes, and physiological changes.
for something like a bacterial infection this is potentially fatal.
Absolutely. But placebos aren't being prescribed for bacterial infections, lethal viruses, cancer, broken limbs and heart attacks.
Actually, they probably are part of some cancer treatments. But only as part of it.
Using a known effect to achieve genuine outcomes is an excellent use of resources, and allows prioritisation of more costly treatments for patients that actually need them.
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.
The placebo effect has been objectively measured as being able to heal a patient.
Nonsense. The only effect of a placebo is in someone's imagination. It might in some cases such as chronic pain take someone's mind off their condition sufficiently that they experience relief. Otherwise it does nothing. It absolutely under no circumstances heals anything. This is precisely why double blind controlled studies are tested against placebos. If one group receives a sugar pill and the other group receives the actual drug, the efficacy (or harm) of the actual drug can be measured accurately, accounting for psychogenic factors.
Go check the research. It's very real. This is why for instance homeopathy treatments are assessed against whether they heal the patient, they're assessed against whether they heal the patient MORE than a placebo.
Homeopathy treatments have been tested repeatedly against placebo and there is no difference in response. Not surprisingly since they're just sugar pills and water.
Homeopathy treatments have been tested repeatedly against placebo and there is no difference in response. Not surprisingly since they're just sugar pills and water.
Usually just water, but yes, that's my point. They're tested against the Placebo effect _because_ it demonstrates that they do fuck-all that wouldn't be possible with a placebo.
Nonsense. The only effect of a placebo is in someone's imagination.
Hmm. No. http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/April/putting-the-placebo-effect-to-work
While antibiotics won't stop a viral infection, one thing they can help with when infected is to prevent other infections.
If the doctor has diagnosed such an infection, then of course you should get antibiotics. But it is completely wrong to prescribe them because you *might* have an undiagnosed infection.
The only thing worse than a Democrat is a Republican.
The point of the placebo effect is that it is entirely psychological. It is not clinically real - it is not physiological.
Brains are body parts, just like noses, fingers, and spleens. It's only because the brain is so much more complicated (and therefore less understood) than the other parts that this psychological/physiological dichotomy exists.
There are valid reasons to prescribe placebos, usually it involves hypochondriac patients or those who come in with simple ailments like a cold and demand that they get some of the "good stuff". Sometimes "stay in bed, drink plenty of fluids and take some Dayquil if you need it" just isn't good enough. The real quacks are the ones who cave into their patients demands when they are unfounded.
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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.
Add a bittering agent to make the thing taste bad. It's not that otherwise it won't work, just that if it tastes foul enough (but not too foul) it'll work better.
And the more expensive placebos work better than the cheaper ones. I read a study where they had different colored placebos prices at different levels and they found this to be the case. Pretty interesting what the mind can do.
-- ssoorrrryy,, dduupplleexx sswwiittcchh oonn.. -Quote found on actual fortune cookie.
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
Antibiotics are properly used for prevention all the time. There's a tradeoff of damage a new infection can cause if it takes hold or gets worse while treating something else, and lung infections are a fine example: http://www.cdc.gov/hantavirus/technical/hps/treatment.html
Antibiotics are used improperly for prevention all the time, but that doesn't mean it's wrong to use them in all cases. If doctors waited for a diagnosis of infection on someone with hantavirus, that person would have a higher chance of simply dying.
The point of the placebo effect is that it is entirely psychological. It is not clinically real - it is not physiological.
Brains are body parts, just like noses, fingers, and spleens. It's only because the brain is so much more complicated (and therefore less understood) than the other parts that this psychological/physiological dichotomy exists.
Except most drugs aren't to treat brain conditions. The placebo effect is important for pain management, because that is a perception issue and doing anything about pain is a good outcome. But the placebo effect won't stop the group of Staphylococcus aureus dumping toxins into your blood stream from continuuing to do that till they've poisoned the local environment (killed you).
It is not clinically real - it is not physiological.
I'm not sure how you define "clinically real" but the placebo effect has been demonstrated to change brain patterns, lead to (e.g.) hormone generation and change perception of pain.
I'd call those clinical outcomes, and physiological changes.
for something like a bacterial infection this is potentially fatal.
Absolutely. But placebos aren't being prescribed for bacterial infections, lethal viruses, cancer, broken limbs and heart attacks.
Actually, they probably are part of some cancer treatments. But only as part of it.
Using a known effect to achieve genuine outcomes is an excellent use of resources, and allows prioritisation of more costly treatments for patients that actually need them.
The OP I was replying to was implying they should be, and many people believe the placebo effect somehow can treat diseases caused by infection or the like. The 20% number gets thrown around without realizing that it's only applicable to some classes of problem - i.e. pain management - where psychological perception is important, and where endorphins your body makes naturally in response to state of mind are actually pain suppressants.
But even in that case, if something turns out to be no better then a placebo, then targeted therapy to address state of mind will be better still. We can and do, for issues like that, get people into meditation or exercise or any number of other things.
But you are absolutely not going to find cancer stop growing because you gave someone a sugar pill, and the idea that "costly therapies" will be avoided by giving placebos is ridiculous (unless we don't care about saving/improving lives). If something is serious enough to require a costly treatment, placebos aren't going to remove the underlying problem.
Hmm yes. It's entirely psychogenic. It may be that if you give someone a fake injection, or a sugar pill which they think has curative properties it puts someone in a positive frame of mind that alleviates worry or fixation on the condition and provides some space for it to improve. It does not mean the placebo is doing it, or that it's acceptable to give someone magic sugar pills in place of an effective treatment. It's also not hard to find articles such this, which methodically demolish notions about placebos usually put about by homoeopaths.