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Use of Placebos: Is It Ever Appropriate?
I just read an article that said that nearly half of the doctors in a survey prescribe and give their patients placebos. "About half of the 679 US internists and rheumatologists questioned reported prescribing placebo treatments to their patients on a regular basis."[Tilburt, J.C. BMJ, online first edition, Oct. 24, 2008] And many do not tell heir patients they are doing so. I figured it happens, but I was shocked at the number of doctors who admitted to doing it.
I feel it is unethical for professionals to do this. There is a great focus on pain patients being labeled as seekers when they take meds that provide no relief and continue - in desperation - to try to find someone to help them. Now I am curious - how many of those instances can be tied to a patient being given a placebo? No wonder it wouldn't work! And yet the first to be scrutinized is the patient, not the prescriber. This would make for a very interesting and important research study.
Now these are my own personal comments and opinions on the issues around placebos. If you would like to share your comments, please visit either my pain management and/or migraine message boards and share your thoughts. Put the word "Placebo" in your subject line. Let's hear what people have to say about this controversial topic. Look forward to hearing from you!
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I feel it is unethical for professionals to do this. There is a great focus on pain patients being labeled as seekers when they take meds that provide no relief and continue - in desperation - to try to find someone to help them. Now I am curious - how many of those instances can be tied to a patient being given a placebo? No wonder it wouldn't work! And yet the first to be scrutinized is the patient, not the prescriber. This would make for a very interesting and important research study.
Now these are my own personal comments and opinions on the issues around placebos. If you would like to share your comments, please visit either my pain management and/or migraine message boards and share your thoughts. Put the word "Placebo" in your subject line. Let's hear what people have to say about this controversial topic. Look forward to hearing from you!
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Labels: pain mangement, placebo
16 Comments:
It is so wrong to give someone fake medicine if they don't know it may be real or may be fake. Doctors that do this are the evil twins of the ones who over-prescribe Oxycontin. We should be able to trust our doctor. The fact that so many do this and think it's okay makes me sad.
I don't no if it is right/wrong I do know that there are so many abusers of prescription meds that it is un-real! I am a nurse and I worked in a nursing home taking care of a patient who abused sleeping pills. He would set his alarm clock for 1:45am to call for a sleeping pill ( after 2am we weren't allowed to dispense his sleeping pill) even though he was already asleep. In the mornings he was more accident prone, i.e falls etc. because of his drowsy state (one morning we literally found him face done in his breakfast). But he was insistent on needing/wanting those pills. We finally convinced the Dr. to give him placebos and we eliminated the early morning accidents and he slept like a baby before and after receiving his "sleeping pill".
I studied placebos this summer at Oxford University in a medical science course and I believe that it is ok for doctors to administer placebos. The doctor needs to tell the patient to report and problems with the "medication" though so if it isn't working the doctor can give him real drugs. The doctor shouldn't have to tell the patient it's a placebo otherwise it defeats the purpose and most likely would not work.
Sorry, this is a bit new to me and I didn't realize that "ask Indie a question" would post to the group message board.
I also missed the part about putting "placebo" in the subject line. My questions/comments appear under the title, "Blog: BMJ article"
It is only wrong if the patient has continued to be in pain and it is not working. If the placibo is working than go for it it is obviously working and leaving the patient more comfortable and with less side effects than any actual pain medication would give. You should know what you are getting but you'd be suprised at how much is in your brain:)
I really can't believe many physicians prescribe sugar pills, or medications that have no active ingredients. The study was a survey and only about 1/2 the doctors turned it back in. Only a small percentage of those admitted to doing this.
Most said they had tried things like otc pain meds, antidepressants, etc to treat a pt with a diagnosis where these things are not proven to help. Some treated probable viruses with antibiotics (not good medicine, but not what I usually think of as a placebo). In other words, the researchers had a broad definition of placebo.
I would never give a patient a "sugar pill".
I work in nursing and often find that if you can get around giving medication for something some things get better for you and the patient. Often it doesn't have to be a "sugar pill" but can be a warm cup of tea with honey and lemon or a glass of apple juice. The term placebo is so broad that anything not made by a drug company can be termed a placebo.
Why not? The body heals itself very well in some situations.
WebMD should (when listing drugs) give the standard dose bid, tid, etc. the max daily dose, protein bonding, half life etc.
I feel there is a place for placebos. My son had ADHD growing up. His Dr. said he had outgrown the need for medication. His School however insisted he be on it, and that they give it to him. After much argument that only seemed to caused my son no end of grief at school, I spoke with his Dr. WE decided that if they insisted, they could give him a plabebo. His teacher remarked that my son's behaviour was so much better since I had decided to co-operate with them!! I let the charade go on until the end of the school year, when I asked for a meeting with his teachers. I presented the letter that his Dr. had written, explaining that he'd been on a placebo, that it had had the desired effect, it had placated the teaching staff.
Before thrashing the placebo effect (otherwise known as meaning response), please read Daniel Moermans "Meaning, Medicine and the 'placebo effect'". When forming an opinion about something it is best to do some research. Also performed by surgeons are sham surgeries which also create a placebo effect. Also color and form of treatment have significantly differnt effects on responses by patients. One study for example showed that when taking a blue placebo (for a non-specific sleep problem), more people felt drowsy and were able to achieve sleep than those who took a pink pill. This, and many other statistically significant placebo studies are all referenced by Moerman. I would rather take an inert medication and believe it to be real (and thus have it work) than to take real medication which will truly affect my physiology.
Placebos may have a positive effect on senile or otherwise mentally deficient patients who just need some reassurance, but I think that there is a special place in Hell for doctors and nurses who allow patients to suffer with real pain - so that their own ego's can say, "they are just narcotic addicts - wanting another fix." That is just too easy to do, but shows a lazy, non-caring incompetent health care worker.
I wonder how many placebo-fans who responded here are pain patients... and how many have spent day after day and night after night in unimaginable pain?
I would guess not many have suffered in that way. Until someone does I don't think they've earned the right to have an opinion about what should be done in the specific case of pain. Sure, sometimes a placebo might work, but for the placebo fans, how much more should a patient of true pain suffer if they are not helped with the placebo? For how long? Are they closely watched to be certain they are not suffering needlessly or are they brushed off and not thought of again until the next appointment? And, what would be considered a "success" with a placebo for a pain patient? A possible somewhat reduction of pain? Or what? Because most pain patients do not get full aleviation of the problem with any med. Also, what if the patient is also depressed? Suicide is a true risk with chronic and severe pain patients. Is this a risk worth taking in case the placebo does no good? Listen, it is hard enough to hold on to hope for many pain patients already. If given a placebo, perhaps a pain patient will once again have hope, just to have it dashed. Is it any doctor's right to do that? I say no... never. What if the patient was in a nursing home like a gentleman another poster mentioned and what if pain meds were withheld in order to keep such a man from falling asleep in his breakfast... is the result from not having pain medication that could alleviate some of his suffering ethical. I would have to say you would think not probably if it were your father. I believe even more than you would object to this if it was to you. The placebo-idea, in the case specifically of pain patients because pain causes such great suffering, is simply and in almost all cases wrong.
First of all, Thank You Dr. Hubbard, your a caring,compassionate M.D.! Those of us that have "real"pain,(chronic), and as you have read, tried most of everything out there, we don't need to be fooled by getting "fake" pill's. I, myself have a SCS,(spinal cord stimulator) for three year's now and on a regiment of med's daily for the pain for "FAILED BACK",after three low back/three cervical operations. Suck's to be me, my pain doc is VERY conservitive and has me on the edge of going crazy at times with the pain I have. Sugar is for coffee, not pain! Julianjim.
I just got prescribed Lyrica for my fibromyalgia...and so far its not working much..I SURE HOPE I DID NOT PAY 200 BUCKS FOR PLACEBO....that would be BS.
I am unfortunately one of those people mentioned in your article who suffers from almost daily migraines. Just in past year, I have been fighting to simply feel better and function as with anyone who has dealt with chronic pain (I have 3-4 migraines a week) I would be simply outraged to know that I was given a placebo. It would I feel hinder my progress in finding treatment and finding what works for me and my body. Not tomention the cost of all the medicine we purchase, it gets expensive especially when trying new drugs. I do absolutely trust my doctor and luckily have a very strong relationship with him, so I truly feel he is working with me on getting better. Thank goodness for that!
It is so wrong on many levels. How can you trust any Doctor that thinks it's ok to perscribe placebos. To me is just plain laziness and lack of compassion to do this and think it's ok . Not to mention the money spent on office calls and scripts. If they are going to give you a placebo maybe they should hand you samples. Hope they make sure the patient is'nt diabetic.
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