Placebo Effect for Patients

[JohnB]

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

Agreed 100%.

 

However,

 

The pressure on MDs to "perform" is incredible. A common cold will probably pass in a couple of days but many patients don't want to hear that, they want to be cured now. They are demanding a service from the MD and they don't want to hear "Go home and take it easy for a couple of days and you'll be right."

 

They want a little pill and I dare say that most MDs are aware that some of their patients will go "Doctor shopping" until they get them. The temptation to give these patients a sugar pill and some comforting words must be immense.

 

Please note the above refers to minor ailments that the MD believes will clear up quickly only.

 

Re the superbugs.

 

All that I've read points to two problems. The first, over prescription (which is in the hands of the MDs) has been mentioned however the second hasn't.

 

When prescribed a course of antibiotics, many patients take them until they feel better and then discontinue their use. This increases the probability that a residue of the bacteria will survive after being exposed to the antibiotic and breeds stronger bugs. A Doctor may instruct a patient to take the entire course (and explain why) but it is in the hands of the patient to follow those instructions. Hence educating the MDs is only half an answer, the public needs to be educated too.

 

To use an analogy. While having the City Council kill all the rats in the street is good, it will be ineffective if the householders don't make sure they kill all the rats on their property.

 

It is a twofold problem and requires a twofold solution.

[SkepticLance]

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

 

This statement, like so many others, is only true if your semantics say it is. If you define lying as unethical, then it is unethical.

 

I do not. By my personal definition, lying is neither ethical or unethical. Which category it fits into depends on intent and outcome. If you lie with the intent of saving someone from unnecessary suffering, then by my definition, it is perfectly ethical.

 

Your definition may be more rigid than mine, but that is a matter of semantics.

[iNow]

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

 

This statement, like so many others, is only true if your semantics say it is. If you define lying as unethical, then it is unethical.

 

I do not. By my personal definition, lying is neither ethical or unethical. Which category it fits into depends on intent and outcome. If you lie with the intent of saving someone from unnecessary suffering, then by my definition, it is perfectly ethical.

 

Your definition may be more rigid than mine, but that is a matter of semantics.

 

This post seems to completely ignore the context in which the statement was made... Namely, medicine. General rules like the one you've shared don't necessarily apply in a specialized system.

[DrDNA]

If I (or one of my loved ones) were severely depressed to the point of being suicidal (and I thank God that I am [they are] not) I would certainly appreciate if some doctor did not tell me (them) that I (they) have terminal inoperable cancer (again, thank God I [they] do not). In such a case, please tell me (them) I (they) have the flu or something similar, until such time as I am (they are) able to handle the situation in a rational manner without such severe consequences.......

[SkepticLance]

To iNow

 

Are you suggesting that semantics are not an issue in medicine?

 

If so, it will be the only aspect of human nature for which that is true.

[iNow]

To iNow

 

Are you suggesting that semantics are not an issue in medicine?

No. That is not at all what I was suggesting, so your next statement is irrelevant.

[SkepticLance]

To iNow

 

You have got me confused. I was commenting on the general statement that lying is unethical, and I was pointing out that is true only for one specific definition of the word 'unethical'. Can you please explain your point?

[iNow]

I was commenting on the general statement that lying is unethical, and I was pointing out that is true only for one specific definition of the word 'unethical'.

 

It was not a general statement, it was a statement to be seen in context of the doctor patient relationship. Hence, the definition of "ethical" and "unethical" ... in the medical context... is pretty well defined, and not as subject to widely varying personal interpretations. When you responded, you extended the scope of the concept of "ethical" beyond medicine, and hence your points lost relevance to the discussion in this thread. In other words, in this context, the word "unethical" really does have a specific definition, so your point is moot.

 

Does this help?

[SkepticLance]

To iNow.

Perhaps. I am not a medical doctor and can only go by what I have heard medical doctors discuss. My understanding is that this is not as cut and dried as you make out, and 'lying', in some circumstances, would not be considered unethical. Of course, we need to understand what is meant by 'lying'.

 

My definition is any statement made with the deliberate intent to lead someone into believing something false. Thus, it is possible to lie while never, technically, stating an untruth. I have seen doctor lie to patients, in that they lead them into believing something that is untrue. If this is done for the good of the patient, I cannot believe it is unethical.

[iNow]

My understanding is that this is not as cut and dried as you make out, and 'lying', in some circumstances, would not be considered unethical.

Name ONE.

[JohnB]

If I (or one of my loved ones) were severely depressed to the point of being suicidal (and I thank God that I am [they are] not) I would certainly appreciate if some doctor did not tell me (them) that I (they) have terminal inoperable cancer (again, thank God I [they] do not). In such a case, please tell me (them) I (they) have the flu or something similar, until such time as I am (they are) able to handle the situation in a rational manner without such severe consequences.......

Am I the only one seeing a logical problem with the whole depression/terminal illness concept? If we lie to the patient, we're going to what? Wait until he gets cheerful and starts looking forward to the rest of his life and then tell him he hasn't got one?

 

How many lies are we going to tell to get the patient over his depression? "Things will get better, you'll see." No they won't. I can't think of anything crueller than to raise someones hopes knowing that you are going to smash them to bits. And in doing this to the patient we are going to lie to ourselves that it's "for the good of the patient" to salve our conscience?

 

There ain't no such animal as "one lie", they breed and keep breeding.

[Mr Skeptic]

Name ONE.

 

Using a toy magic wand to cure a child of hiccups?

[iNow]

Not if the patient is suffering from pleurisy of the diaphragm, pneumonia, or uremia.

[John Cuthber]

Interesting question this.

There have been various points put forward along the line that, if it's lying it's unethical.

Personally I think that's debateable (lying about the monster in the lake to stop your kids drowning might be perfectly ethical if that is what keeps them alive, please don't start to debate that here) but I'm not sure it's always relevant.

 

 

Another point made was "The problem with the placebo effect as treatment, is that for it to work, the patient can't know it's a placebo effect. "

 

Again, I'm rather unconvinced.

When I get a sore throat or cough I take cough medications that I know don't work better than a placebo in clinical trials.

 

I'm well enough qualified as a chemist and a pharmacist to fully understand that result, just to make it clear, here's the edited highlights.

 

It means I'm taking a medicine with no real effect, and I know it.

 

However I also know that the placebo effect is much stronger than most people give it credit for, so I believe (and God knows how you would test this) it gives some relief from symptoms.

 

Is it ethical for me to do this?

[Royston]

Interesting question this.

There have been various points put forward along the line that, if it's lying it's unethical.

Personally I think that's debateable (lying about the monster in the lake to stop your kids drowning might be perfectly ethical if that is what keeps them alive, please don't start to debate that here) but I'm not sure it's always relevant.

 

Interesting the two examples of lying involve children...should patients be treated as children i.e take this magical pill, and you'll feel better in a few days. It's not always relevant, but in the context of somebody being aware of their own health (fake pills paint a false picture), and the trust a patient should have with their G.P for the sake of the profession, it's respectively unethical and damaging.

 

Another point made was "The problem with the placebo effect as treatment, is that for it to work, the patient can't know it's a placebo effect. "

 

Again, I'm rather unconvinced.

When I get a sore throat or cough I take cough medications that I know don't work better than a placebo in clinical trials.

 

I'm well enough qualified as a chemist and a pharmacist to fully understand that result, just to make it clear, here's the edited highlights.

 

It means I'm taking a medicine with no real effect, and I know it.

 

So you've just reinforced that a placebo works better than knowing it's possibly a placebo. Also, there must be a reason why you buy cough medicine, over knowing it doesn't do anything e.g 'it's better than nothing'...that's a question by the way.

 

However I also know that the placebo effect is much stronger than most people give it credit for, so I believe (and God knows how you would test this) it gives some relief from symptoms.

 

Is it ethical for me to do this?

 

It's ethical for you to practice the treatment on yourself (cough medicine) but I agree there's no real way of testing whether it's beneficial...it's certainly unethical for the pharmaceutical companies to be selling cough medicine, for obvious reasons. Though I may of misunderstood your point.

[John Cuthber]

The people who take cough medicines "know" that they work- this may be the placebo effect. If the manufacturers were to withdraw the product then all those people would be upset. I'm not sure of the ethics of that one.

[antimatter]

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?

Although this forum isn't much about opinions,

I believe that the ethics of using placebo varies with the condition. If it is something minor, then it's 'okay'.

In general, I don't believe that lying to your patients is all that ethical, but as DrDNA said, there are several exceptions.

[profescher]

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,

 

I would say placebo treatment is unethical, a patient needs to have total trust and confidence in thier doctor and your quote above really captures it for me, the patient has to be tricked and that is wrong, no grey area's.