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."

Comments

Antibiotic Placebo?

[thegarbz]

antibiotic treatments used as placebos for vial infections

I'm sorry but a medical professional should flat out know better.

Re:Antibiotic Placebo?

[Inoen]

A friend of mine is currently in the hospital with a simple infection, that would normally be easily treated with antibiotics. But this one has been resistant to everything they've tried. Worst case, they will have to take off his leg.

I agree; using antibiotics where they aren't needed is despicable.

Re:Antibiotic Placebo?

[Anonymous Coward]

I think it's more down to the public not knowing what antibiotics are used for and demanding them where they are not needed.

Re:Antibiotic Placebo?

[Jherek Carnelian]

I agree. This happened to me before, but it was an ear infection and I guess the doctor didn't know if it was viral or bacterial, so maybe he was just using a "shotgun technique".

Yes. I doubt that doctors are insincerely prescribing antibiotics as placebos. I expect it is more of a case of not being able to fully rule out a bacterial infection so they prescribe the anti-biotics to cover all their bases and to help the patient feel like their problems are being taken seriously.

My guess -- it is most common with ear infections for kids (which are the most common reason kids to go to the doctor). Societal pressure on mothers nowadays is super intense - it is hard for a mom to accept doing nothing but wait for the viral infection to run its course when their kid is crying all the time. And since a minority of ear infections really are bacterial, but testing for the type of infection is difficult, the doctor prescribes a mild anti-biotic (usually amoxicillin). That makes mom feel like she's done everything she can for her kid and if it really was bacterial it actually helps, if it wasn't bacterial the side-effects are rare and mild so the risk of making the kid worse is tiny. It is a win-win except for the long-term affect on rates of anti-biotic resistance.

I say this having seen my sister, a recent mother go through this stuff. Before the kid was born she was super on board with all the free-range kids type stuff, but once that baby popped out and she had to experience it first hand, it was a different story. To her credit she's been able to back off the helicopter type stuff as unavoidable accidents have happened and she saw that the kid came out fine. But the pressure from society to be a perfect mom teams up with those mom hormones and long-term thinking tends to be the loser. She still hasn't given the kid peanut butter, she's waiting to do it when she's in the lobby of the pediatrician's office - and now the research is starting to suggest the longer you wait to expose them, the more likely the kid is to develop a peanut allergy...

Re:Antibiotic Placebo?

[Let's All Be Chinese]

The problem with antibiotics, rather, is that you have to finish the entire run lest you'll end up merely training your infection to become resistant. So it's not strictly a problem of prescribing the stuff too often; it's that plus far too many people starting to feel fine then not finishing the cure.

Re:Antibiotic Placebo?

[Anonymous Coward]

The reason doctors prescribe antibiotics inappropriately in family medicine is almost never due to ignorance. 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.

Source: I'm a doctor.

Re:Antibiotic Placebo?

[Anonymous Brave Guy]

No qualified doctor should be prescribing medication just because a patient "demands" it. That would be both a fundamental failure of their duty of care to the patient and an abuse of their authority to legally prescribe controlled substances.

All of this goes double for antibiotics, because there is a real danger of overuse combined with people's tendency not to complete full courses of treatment contributing to the development of resistant strains like MRSA.

Re:Antibiotic Placebo?

[bigtomrodney]

That's exactly how I feel, but moreover logically that is why these medicines are prescription only.

As a European I was horrified to see that prescription medicines are routinely and frequently advertised on television in the USA instructing the viewer to ask their doctor to prescribe the medicine.

Re:Antibiotic Placebo?

[dcollins117]

As a European I was horrified to see that prescription medicines are routinely and frequently advertised on television in the USA instructing the viewer to ask their doctor to prescribe the medicine.

As an American I am equally horrified. Advertising by big pharma companies is one of the reasons medications are so expensive here. Also, I can't imagine telling a doctor what to prescribe. If he/she doesn't know already, then I'm going to the wrong doctor.

Re:Antibiotic Placebo?

[hackula]

I used to work in the ICU of a pretty large hospital. It seemed like 90% of the people there were in a coma after getting a mole taken off, not taking the full run of antibiotics, then getting an infection that looked like it was out of a horror movie. Throw in diabetes (and resulting neuropathy and lowered immunity from poor treatment) and most of those people ended up double amputees. People talk about how they could or could not work with the blood in a hospital, but walk into one of those rooms with someone with an infected leg or whatever and you will never complain about blood again. The smell is absolutely overpowering. I always take the full run of antibiotics now, that's for sure!

Re:Antibiotic Placebo?

[__aaltlg1547]

The problem isn't that antibiotics are used in animal husbandry. I have no problem with a vet prescribing antibiotics to save a sick cow or horse. Treat the cow the same way you would a human and it will be fine in a few days. The problem occurs when they chronically give antibiotics to a lot of animals that aren't sick. First, that's abuse of the drugs and the animals. Second, it doesn't kill off all the bacteria. It just gives a slight advantage to bacteria that are more resistant, thus creating the selection pressure to create resistant strains. Third, the antibiotics get in the milk and meat so resistant bacteria grow in that.

The law should say: (1) you can't give antibiotics to animals that are not sick (2) you can't sell edible animal products from animals that have been treated with antibiotics until after a waiting period (e.g. 10 days) to ensure that the antibiotics have cleared from their systems. (There would have to be randomized testing of products to enforce this.) (3) FDA clearance should be required to use drugs in animals at all and it wouldn't be given for classes of drugs that are needed to fight otherwise-resistant strains in humans.

Re:Is this reflected in your medical records?

[TapeCutter]

It's the UK, a similar but different culture where talking to a lawyer is often the last resort, not the first.

Re:PLACEBOS

[bugnuts]

What is this Placeb operating system?

Windows 8.

Re:antibioticas for viral = bad

[bugnuts]

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.

Re:Not a Placebo

[Richard_at_work]

The point here is that antibiotics won't do anything for a viral illness - but patients will demand antibiotics for anything and everything until they are blue in the face, many don't accept that the "wonder drug" class of antibiotics won't actually do anything for them.

My wife is a GP, and we literally just had this conversation :) GPs in the UK get 8 minutes with each patient, they can't afford to spend it arguing with the patient, so they issue antibiotics which have already lost their effectiveness due to prior overuse - we aren't talking about threatening working antibiotics.

Re:Fraud

[DaPhil]

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.

Doctors need to really talk with their patients

[PolygamousRanchKid]

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.

Re:Editors schmeditors

[quantumghost]

antibiotic treatments used as placebos for vial infections

I'm sorry but a medical professional should flat out know better.

As a physician, I agree.

The problem is that we are now subject to an "objective" review, where the MBA CEO's of hospitals and health care systems have to measure and quantify everything. The problem is this is not a normal customer-seller relationship....this is more like going to the lawyer for advice (Gawd, did I just compare physicians to lawyers????), you are seeking "expert advice" and when it may not be what you want or expect, a rift develops. The physician (rarely) denies something because they are being a jerk, they are (usually) doing it in the patient's best interest. However, with the need to maximize your PG scores, people are acquiescing. Yes, I know this is not a new problem and pre-dates the PG score, but this is a perfect example of "market forces" in medicine, and why people who think medicine is a business like manufacturing cars are dead wrong....it IS a business, but unlike just about any other out there.