Placebo Effect for Patients

[john5746]

http://www.reuters.com/article/newsOne/idUSN0323176620080103

 

Apparently, Doctors use the placebo with their patients more than I thought. It is common knowledge that it works, so are there any ethical problems with using this method?

[Lilian]

I can't see anything that may be unethical about it...

[iNow]

If the condition will deteriorate with a high confidence if no meds are offered, then exploring the placebo effect is not ethical. It's really a matter of the severity of the condition and the likelihood it will get worse without some specific treatmeant.

 

Exploring the placebo effect is great on headaches or sense of well-being, for example. However, exploring the placebo effect on a victim of a severe plane crash or let's say Stage IV cancer would be viewed as unethical, and such "explorations" should be avoided.

[blike]

Apparently, Doctors use the placebo with their patients more than I thought. It is common knowledge that it works, so are there any ethical problems with using this method?

"45 percent said they had used a placebo during their clinical practice"

 

Not really useful information in the form the news article is presenting it. How often? How much? When? In what setting? What was the "placebo"? Can antibiotics for the common cold be considered placebo?

 

(I haven't read the study, but these are important considerations that the news article does not address)

[SkepticLance]

A couple of years ago, I attended a lecture by a general practitioner (I am not a medical doctor). He claimed that 50% of all the conditions presented to the average GP had no 'organic' cause. In other words, they are psychosomatic. However, they respond well to standard medical treatments.

 

Another doctor who had tried acupuncture and chiropractic reported that patients responded equally well when the needles were inserted in the 'wrong' place, or where the 'wrong' chiropractic treatment was given. In other words, the conditions were psychosomatic and responded to a placebo therapy.

 

Homeopaths have been giving treatments with pure placebo effect for several hundred years, and have a dedicated following of millions of people with psychosomatic ailments, including the British royal family.

 

I would rather see patients with such imaginary ills report to a proper medical doctor, who can also detect any condition that might be real, and require a more potent treatment. If they have to use placebo therapy to keep their patients, it is to everyone's benefit.

[Mr Skeptic]

Placebo effect could be the best (and only) treatment available for some illnesses, so I see no ethical problems with using them in that case. Placebo effect could even be used with some problems that have very little adverse effects.

 

On that note, does that mean that "faith healing" really does cure people?

[DrDNA]

Can antibiotics for the common cold be considered placebo?

 

Unless it was for some secondary bacterial infection, that would probably be quackery.

 

Homeopaths have been giving treatments with pure placebo effect for several hundred years, and have a dedicated following of millions of people with psychosomatic ailments, including the British royal family.

 

 

I often wonder how many people have actually died as a result of being given medications diluted to infinity wehn they have life threatening conditions. Given Homeopathy's popularity, one might speculate that the numbers should be significant. I even hear ads on the radio about Homeopathic Remedies and wonder what the heck the FDA is doing........

[blike]

Unless it was for some secondary bacterial infection, that would probably be quackery.

No physician would suggest they actually fight the cause of the infection -- I'm asking whether or not they would count as placebo.

[SkepticLance]

To DrDNA

 

The homeopathic 'remedies' that really worry me are the vaccines. Imagine going to a malaria prone country, and preparing for it with a homeopathic vaccine. If you contracted malaria (which is probable) and died, who would your family sue?

 

For that matter, what does a homeopathic vaccine protect against? Infinitely diluted germs? After being vaccinated, you could drink sterile water with total confidence.

[john5746]

On that note, does that mean that "faith healing" really does cure people?

 

I think it doesn't hurt, unless it keeps you from trying something else. Dan Dennet has a hypothesis concerning the placebo effect: He thinks that people who responded better to it had an advantage in the days before real medicine. Those that did not respond to the placebo effect would have an evolutionary disadvantage.

[DrDNA]

" Can antibiotics for the common cold be considered placebo?

 

(I haven't read the study, but these are important considerations that the news article does not address)

 

 

Blike,

I just read this and it reminded me you of your question/statement....

 

Quote

"Stop giving antibiotics for colds, doctors told

By Rebecca Smith, Medical Editor

Last Updated: 12:09pm GMT 09/01/2008

Doctors are to be told to stop prescribing antibiotics for coughs, colds and sore throats because over-use of the drugs is fuelling the spread of killer hospital superbugs.

 

Using antibiotics too liberally has led to bugs such as MRSA becoming resistant to treatment with the drugs. Most colds, coughs and flu are caused by viruses, which cannot be treated with antibiotics anyway, Mr Johnson points out.

 

Announcing a £270 million campaign against superbugs, to be launched next month, he says it is vital that doctors adopt "less of a knee-jerk reaction to prescribing".

 

The campaign, called Clean, Safe Care, will also include an extra £45 million for hospitals to spend on infection control nurses or antibiotic specialist pharmacists. All patients going into hospital will be screened for MRSA by 2009.

 

Staff have already been told they must be "bare below the elbows" to help prevent the spread of infection between patients and all hospitals should undergo a "deep clean" by March this year, although experts have dismissed this as a gimmick.

 

advertisementMr Johnson says: "The past 60 years have seen great advances in health care and medicine. For example, the use of antibiotics has saved countless lives, but antibiotics do not work on most coughs, colds and sore throats and their unnecessary use can leave the body susceptible to gut infections like Clostridium difficile."

 

Over-use of antibiotics, which can be used only on bacterial infections, has been blamed for the rise of drug-resistant tuberculosis. The drugs can strip natural bacteria from the gut and allow C.diff to take hold and kill vulnerable elderly people.

 

Too-liberal use of antibiotics, especially when patients do not finish their courses, allows multiplication of bugs that have mutated to become resistant.

 

If antibiotic use is not curbed, doctors could run out of effective treatment as certain bugs become resistant to more and more drugs. Pharmaceutical companies are unwilling to invest the billions of pounds needed to research and develop new antibiotics because they are not very profitable.

 

Dr Mark Enright, professor of molecular epidemiology at Imperial College London, said even common bacterial infections do not really need treating with antibiotics and usually go away on their own.

 

"In the old days, before we had problems with resistance, people thought it really didn't matter - you could throw antibiotics at these cases and you would pick up the odd one that was treatable that way," he said.

 

 

Over-use of antibiotics is blamed for the rise of drug-resistant superbugs

 

 

"I am sure there are still GPs who think they know best and think antibiotics are the global panacea we once thought they were."

 

The most common antibiotic ingredient, amoxicillin - one of the penicillin family - has become less effective because more bugs have become resistant to it. Other common generic antibiotic ingredients that are less effective include cefaclor, used for chest infections, and trimethoprim, used to treat urinary tract infections.

 

Prof Kevin Kerr, consultant microbiologist at Harrogate District Hospital, said the pressure on GPs to prescribe antibiotics can be immense. In some cases patients are told by one doctor in the practice that they do not need antibiotics only for them to book with another partner who is more willing to capitulate.

 

He said: "These campaigns are desperately needed. The focus has been on cleanliness and washing hands but without closing the circle by tackling prescribing it is only half the battle."

 

Norman Lamb, the Liberal Democrat health spokesman, said: "The Government has ignored the link between antibiotics and hospital infections for too long. Over-prescribing of broad-spectrum antibiotics is very dangerous."

End Quote

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=IVLWZ0LAPX2IPQFIQMGCFFOAVCBQUIV0?xml=/news/2008/01/09/nbiotic109.xml

[Royston]

Placebo effect could be the best (and only) treatment available for some illnesses, so I see no ethical problems with using them in that case.

 

The problem with the placebo effect as treatment, is that for it to work, the patient can't know it's a placebo effect. So effectively they're being tricked into believing the treatment disguised as the placebo effect works. This is where it becomes unethical, because what treatment will be more effective over another...well there isn't one treatment more effective than another e.g faith healing over homeopathy.

So it boils down trying to convince the patient this type of treatment is better than another, when they're essentially the same thing, and so conning the patient into some preference, and ultimately parting with their money, and relying on a one-size fits all ailments approach. I wonder how many people that believe in faith healing or homeopathy, have sought the same treatment when proper medication should be used...as was pointed out earlier, this becomes dangerous with more severe conditions. But that aside, the administration of treatments that rely on a placebo effect, is dishonest, even though it needs that requirement to work. As it's only effective for minor ailments, I feel that's unethical...i.e it's unneccesary for the amount of money that's made, and the potential risks.

[SkepticLance]

To snail

 

Yes, placebo treatment is dishonest. However, I think it is needed. Simply put, about half of all ailments are psychosomatic, and those patients will seek treatment somewhere. If they turn up at a professional practitioner of placebo (chiropractor, acupuncturist, homeopath, faith healer etc), they will pay over their money and get what they need. The problem is that the quacks cannot diagnose genuine complaints, and people will die.

 

This industry is massive - quacks make mega billions of dollars as a group. Enormous numbers of people are sucked in to their con jobs. It is much better to have genuine medical practitioners use placebos when needed, so tha the people with neurotic illnesses see them. That way, any genuine organic illness has a much better change of being picked up.

 

The earlier question : antibiotics for colds and flu - are they placebos. If they are, they are ineffective ones. Placebos are very useful, but do not work for all ailments. They have limited value for infectious diseases, and do not work on cancer at all. Essentially, they work best on any condition that mostly affects the mind. They are often effective against distressing symptoms, without actually altering an underlying condition. Treatments like acupuncture often do very well against headaches. Placebos, like other treatments, need to be prescribed for the conditions where they actually work.

[Royston]

It is much better to have genuine medical practitioners use placebos when needed, so tha the people with neurotic illnesses see them. That way, any genuine organic illness has a much better change of being picked up.

 

Considering this already appears to be the case (the OP) it doesn't seem to be working too well. It would be nice to know what's being used as a placebo by practitioners, if it is anti-biotics, then this clearly is a concern. I can sympathize that GP's want to get patients out the door, but are regular, persistent patients being told that their last few ailments were cured via placebo ? That's the only method I can see of the patient waking up and seeing that their condition/s aren't genuine. However that just runs the risk of them seeking alternative medicine...but I guess that's their problem.

 

I still hold, whether the use of placebo works or not, that treating a condition be it genuine or not, with an ineffective drug is still unethical. If a patient is constantly ill due to some psychosomatic induced condition, then they should be treated for a psychosomatic induced condition...not tricked by some fabricated cure...unless as you stated, it can be used to weed out the genuine cases from the hypochondriacs. It just seems that isn't the case.

[SkepticLance]

To snail

 

I really do not have much concern with 'ethics'. They are too often used as excuses for not doing what is right.

 

I am much more concerned with practical matters. In medicine, what matters is making people healthy. If a 'dishonest' use of placebo makes someone healthy, then that is doing what is right.

 

I share your concern about inappropriate use of antibiotics. They should not be used as placebos. I would like to see a doctor getting together with a local pharmacist, and sorting out a code together, with fancy sounding names to be written on a prescription, meaning sugar pill. Of course, the doctor would have to tell the patient that they can only get the treatment from one specific pharmacy.

 

The alternative is to use medicines that are used for specific conditions, selecting those with few side effects. However, nothing beats a good old sugar pill, with a great confidence boosting pep talk from the doctor about what a wonderful miracle drug it is.

 

Sadly, if a proper doctor fails to use placebos, and does what is honest, then that acts to direct patients to consult with quacks.

[Mr Skeptic]

I think it doesn't hurt, unless it keeps you from trying something else. Dan Dennet has a hypothesis concerning the placebo effect: He thinks that people who responded better to it had an advantage in the days before real medicine. Those that did not respond to the placebo effect would have an evolutionary disadvantage.

 

Perhaps the placebo effect is your way of recognizing you are being cared for or will get better soon, and hence can afford to expend more energy fighting the disease, whereas otherwise you would have to conserve some energy if you had to look for food yourself (ie, were on your own). Does anyone know if self-administered medication can be a placebo?

[Psyber]

...Staff have already been told they must be "bare below the elbows" to help prevent the spread of infection between patients and all hospitals should undergo a "deep clean" by March this year, although experts have dismissed this as a gimmick.

I suspect that along with overuse of antibiotics the lapse - at least here in Australia - of the old custom of wiping down all ward surfaces with a mixture of methylated spirit and water daily has been a factor. Hospital linen if of a synthetic mix may also be being washed at a temperature to prevent the fabric cracking up, and thus not killing bugs. Cotton and Linen will cope with 60C plus but common synthetics won't.

 

My old Microbiology Professor used to demonstrate the growth of bacteria in various commercial "antiseptic" solutions at various strengths, and contrast the results with the slower growth in soapy water and a water and ethanol mix.

[DrDNA]

I was not aware of the rampant use of synthetics in hospitals and the issues they bring, but I hear ya. I caught puenomonia in the hospital after a surgery and it wasn't any fun....thank God it wasn't a resistant Staph or worse.

 

To add to that. I have often wondered just what kind of long term problems we might be creating for ourselves with the relatively new "antibacterial" detergents, dishwashing soaps, sponges, hand soaps, etc. It seems like the commericialization of something that perhaps might be left well enough alone.........

[Severian]

It is always unethical to lie to your patients.

[DrDNA]

"Always" is a very strong term.

There may be cases where it is in the patient's best interest to not tell the truth. For example, what if the patient is severely depressed and/or suicidal and telling them that they have terminal, inoperable cancer would send them over the top?

 

http://www.associatedcontent.com/article/474855/medical_ethics_should_doctors_tell.html

[Severian]

Don't you think they would have a right to know that they were going to die?

[john5746]

I could see giving a vitamin to a patient to see if the problem is "in their mind", but then you would be stuck between continuing a lie or possibly making them sick again?

 

If the treatment works, is it really lying to say I think this might help you? Does it really matter if it works because of chemicals that the patient creates themselves? Can an atheist doctor recommend prayer?

[Royston]

If the treatment works, is it really lying to say I think this might help you?

 

Yes, it's still lying, for the reasons I pointed out earlier...it has nothing to do with that particular pill why the patient will feel better, I couldn't convince you my hat will make you feel better, but if something looks like a drug and you're paying for it, the packaging looks legitimate then I'm tricking you into thinking you're receiving treatment. It's a lie, whichever way you look at it, plus it's not tackling the condition directly...the placebo effect is yet to be an exact science. Why not just say, go home, eat some fruit and get some rest, it's the perfect antidote. Why not educate people on conditions such as common colds, flu et.c rather than giving them fake pills...it's bad practice. Remember, trust is paramount when seeing a doctor, and this news just doesn't raise confidence with the trust a patient should have with their GP.

 

There definitely needs to be more information on what type of patients are receiving placebo, and why. I'm slightly baffled by what's being administered as placebo, as things such as packaging, appearance of the drug et.c have to be convincing, surely pharmaceutical companies don't make placebo pills ?

[SkepticLance]

To snail

 

As I pointed out before, the placebo does not work for every condition. In addition, it does not work for every patient. According to a SciAm article I read on the subject, only about 30% of the population is highly open to the placebo effect. For the other 70%, the effect is minimal or absent.

 

Thus, for a doctor to give a placebo and have it work, it must be prescribed for the right condition and to the right person. It will not work for a cold, or other infectious condition, or any condition with a true organic cause, except to mitigate symptoms.

 

However, it might be a reasonable diagnostic tool. If a doctor does not know what a person is suffering from, but gets good therapeutic results from a placebo, that is a damn good indication that the problem is psychosomatic. It the placebo fails, it may be because it is being given to the 'wrong' person. However, the 70% who respond poorly to placebo are the ones least likely to suffer psychosomatic problems anyway.

 

The biggest problem with prescribing placebos is the very practical one that it will not work on genuine organic illness, such as infectious disease or cancer. However, it is not at all unusual for doctors who cannot diagnose an ill to use response to drugs as a means of narrowing down what the problem is. Would you consider that unethical? Since it is being done for the ultimate benefit of a patient, just as the placebo is?

[Royston]

As I pointed out before, the placebo does not work for every condition. In addition, it does not work for every patient.

 

I'm not disputing that.

 

Thus, for a doctor to give a placebo and have it work, it must be prescribed for the right condition and to the right person. It will not work for a cold, or other infectious condition, or any condition with a true organic cause, except to mitigate symptoms.

 

Mitigate symptoms...i.e the placebo effect. But, like I said, *we need more information on what conditions are being treated with placebo...considering the common cold, and flu are so...common, I was guessing that theses are the main contenders that were being treated with a placebo.

 

However, it might be a reasonable diagnostic tool. If a doctor does not know what a person is suffering from, but gets good therapeutic results from a placebo, that is a damn good indication that the problem is psychosomatic. It the placebo fails, it may be because it is being given to the 'wrong' person. However, the 70% who respond poorly to placebo are the ones least likely to suffer psychosomatic problems anyway.

 

But you just said that a placebo could mitigate symptoms...and I agree, if a person is convinced that the condition is lessening, whether the condition is lessening or not, it's the psychological impact on how ill they feel. If that's alleviated they think they're feeling better, and go back to work sooner et.c a cold could be made a lot worse if that person thinks it's worse than it is.

 

The biggest problem with prescribing placebos is the very practical one that it will not work on genuine organic illness, such as infectious disease or cancer. However, it is not at all unusual for doctors who cannot diagnose an ill to use response to drugs as a means of narrowing down what the problem is. Would you consider that unethical? Since it is being done for the ultimate benefit of a patient, just as the placebo is?

 

It's unethical, as I've said before, because it's lying...it's that simple.

 

*Ah, Blike already raised that point.