Survey: Half of US doctors use placebo treatments

Discussion in 'Et Cetera, Et Cetera' started by Big Al, Oct 23, 2008.

  1. Big Al

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    Courtesy of Yahoo News

    By MARIA CHENG, AP Medical Writer

    LONDON – About half of American doctors in a new survey say they regularly give patients placebo treatments — usually drugs or vitamins that won't really help their condition. And many of these doctors are not honest with their patients about what they are doing, the survey found.
    That contradicts advice from the American Medical Association, which recommends doctors use treatments with the full knowledge of their patients.

    "It's a disturbing finding," said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. "There is an element of deception here which is contrary to the principle of informed consent."
    The study was being published online in Friday's issue of BMJ, formerly the British Medical Journal.

    Placebos as defined in the survey went beyond the typical sugar pill commonly used in medical studies. A placebo was any treatment that wouldn't necessarily help the patient.

    Scientists have long known of the "placebo effect," in which patients given a fake or ineffective treatment often improve anyway, simply because they expected to get better.

    "Doctors may be under a lot of pressure to help their patients, but this is not an acceptable shortcut," said Irving Kirsch, a professor of psychology at the University of Hull in Britain who has studied the use of placebos.
    Researchers at the NIH sent surveys to a random sample of 1,200 internists and rheumatologists — doctors who treat arthritis and other joint problems. They received 679 responses. Of those doctors, 62 percent believed that using a placebo treatment was ethically acceptable.
    Half the doctors reported using placebos several times a month, nearly 70 percent of those described the treatment to their patients as "a potentially beneficial medicine not typically used for your condition." Only 5 percent of doctors explicitly called it a placebo treatment.

    Most doctors used actual medicines as a placebo treatment: 41 percent used painkillers, 38 percent used vitamins, 13 percent used antibiotics, 13 percent used sedatives, 3 percent used saline injections, and 2 percent used sugar pills.

    In the survey, doctors were asked if they would recommend a sugar pill for patients with chronic pain if it had been shown to be more effective than no treatment. Nearly 60 percent said they would.
    Smaller studies done elsewhere, including Britain, Denmark and Sweden, have found similar results.

    Jon Tilburt, the lead author of the U.S. study, who is with NIH's bioethics department, said he believes the doctors surveyed were representative of internists and rheumatologists across the U.S. No statistical work was done to establish whether the survey results would apply to other medical specialists, such as pediatricians or surgeons.

    The research was paid for by NIH's bioethics department and the National Center for Complementary and Alternative Medicine.
    The authors said most doctors probably reasoned that doing something was better than doing nothing.

    In some cases, placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also gave antibiotics to patients with viral bronchitis, knowing full well that a virus is impervious to antibiotics, which fight bacteria. Experts believe overuse of antibiotics promotes the development of drug-resistant strains of bacteria.

    Some doctors believe placebos are a good treatment in certain situations, as long as patients are told what they are being given. Dr. Walter Brown, a professor of psychiatry at Brown and Tufts universities, said people with insomnia, depression or high blood pressure often respond well to placebo treatments.

    "You could tell those patients that this is something that doesn't have any medicine in it but has been shown to work in people with your condition," he suggested.

    However, experts don't know if the placebo effect would be undermined if patients were explicitly told they were getting a dummy pill.
    Brown said that while he hasn't prescribed sugar pills, he has given people with anxiety problems pills that had extremely low doses of medication. "The dose was so low that whatever effect the patients were getting was probably a placebo effect," he said.

    Kirsch, the psychologist, said it might be possible to get the psychological impact without using a fake pill. "If doctors just spent more time with their patients so they felt more reassured, that might help," he said.
    Some patients who had just seen their doctors at a clinic in London said the truth was paramount. "I would feel very cheated if I was given a placebo," said Ruth Schachter, an 86-year-old Londoner with skin cancer. "I like to have my eyes wide open, even if it's bad news," she said. "If I'm given something without being warned what it is, I certainly would not trust the doctor again."
     
  2. B_dxjnorto

    B_dxjnorto New Member

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    I think it has to do with doctors being paid so much in the U.S. Many of them are millionaires. Money and ethics seem to be inversely related. Look at our current business climate. I've got mine, so now what if I do take down the whole world financial system?
     
  3. erratic

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    The truth is that for many non-life threatening conditions placebos often work as well or better than actual meds and are usually a lot cheaper.

    Also, many conditions that people see doctors for have no cures. There's nothing you can take but pain relief and sleep aids for a cold. It won't go away any faster. Same thing for a flu.
     
  4. Big Al

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    The placebo effect works to some extent, but it's the patient's belief that something's being done that's curing them, not anything the doctor's pretending to do and charging the patient for. The doctor visits and placebos can be pretty costly, and as stated, the antibiotic placebo can promote development of drug-resistant of bacteria.
     
  5. erratic

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    Selling people hope works, whether it comes in a bottle, a church, or an abstract human construction like "nationality" or "personality".

    As for giving someone an antibiotic just to make them feel better: I'd argue that's not a placebo. Placebos don't do anything. Giving someone penicillin for something like a broken leg is just shitty practice. Buckley's is a placebo. The only thing it does is make people gag.
     
  6. Phil Ayesho

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    First of all- INFORMING a patient they are getting a placebo eliminates the placebo effect. They must BELIEVE the treatment efficacious to get the benefit.


    Second of all, giving painkillers, mood elevators or sedatives can NEVER be considered a placebo treatment because these medications ALWAYS have systemic effects that affect state of mind and sensation of pain.

    Painkillers may not be an effective treatment for the underlying cause of a condition... but it DOES relieve pain related to that condition, ergo- it can not be a placebo. Such treatments are called "Palliatives", not placebos.

    Also- recent experiments suggest that the "pain" suffered by hypocondriacs is REAL pain, in that the pain related nerve centers in their brain ARE firing...
    Therefore, a doctor who suspects the patient's condition is imagined can offer placebo, and pain relief as the ONLY potentially effective treatment.

    Further... the human body is a pretty amazing thing... Most of us will SELF heal from most maladies we can get.
    GPs are trained to understand that 90% of Patient's complaints will resolve ON THEIR OWN within 2 weeks.
    When confronted with ambiguous symptoms... or complaints that seem non-acute... Doctors routinely prescribe some palliative treatment, and tell the Patient to come back in two weeks.

    Because 90% of complaints self-resolve- this approach is actually ALWAYS going to emerge in every medical office in the world... because any other, more aggressive approach is not only NOT going to be more effective... it is going to add considerable cost.

    This approach to healthcare saves billions of dollars.


    That being said... the real crime only occurs when the patient HAS a genuinely treatable condition and the Doctor resorts to placebo rather than discern the actual condition.
    The real horror of Managed care is the idea that Doctor's salaries become tied to REFUSING care.

    It is a short walk from a doctor prudently seeing if a patient's own immune system will handle whatever they have, and a dangerous reticence to test or order treatments that are clearly indicated.
     
  7. SpeedoGuy

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    Salaries, cost savings for the HMO, whatever. All of these create an incentive to deny care.

    I've had to threaten lawsuits to get it.
     
  8. Rikter8

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    Theyre all crooks.

    All children of the drug companies. Right down to their nifty viagra pens and writing tablets.
     
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