Placebo effect

[BrainDoctor]

Should doctors prescribe placebos?

[tooty]

Yes

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[Vallinar]

Yes

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no..............

[uwphysmed]

Is grammar no make sense?

[moltenflammingcore]

Should doctors prescribe placebos?

 

Why all the silly replies? (i don't mean arrandil...) I think this is a good question.

 

While placeboes scientifically tend to have a positive effect on the health of individuals and may be significant for the emotional or pyschological state of your patient... I would argue that placeboes are not ethical because it is contrary to the idea of patient autonomy...

 

Basically you are witholding information or even decieving your patients and not allowing them to make a truly informed decision about the pills you prescibe. When you think about it prescribing placebos to decieve your patient is actually a violation of trust and could cause your patient to lose faith in any future treatment you prescribe for more serious or more treatable conditions. In the worse case scenario the patient would lose faith in the medical system as a whole which would be bad bad bad!

[Vallinar]

Why all the silly replies? (i don't mean arrandil...) I think this is a good question.

 

While placeboes scientifically tend to have a positive effect on the health of individuals and may be significant for the emotional or pyschological state of your patient... I would argue that placeboes are not ethical because it is contrary to the idea of patient autonomy...

 

Basically you are witholding information or even decieving your patients and not allowing them to make a truly informed decision about the pills you prescibe. When you think about it prescribing placebos to decieve your patient is actually a violation of trust and could cause your patient to lose faith in any future treatment you prescribe for more serious or more treatable conditions. In the worse case scenario the patient would lose faith in the medical system as a whole which would be bad bad bad!

 

 

i agree i just didn't feel like elaborating.

[uwphysmed]

The question was much funnier before they edited it to something which made sense.

 

Why all the silly replies? (i don't mean arrandil...) I think this is a good question.

 

[lingrad]

I read a news article about doctors handing out placebos for patients recently. It seems like the consensus is that it is OK to suggest a placebo (e.g. homeopathic remedies) granted the patient doesn't need any further treatment, however is requesting/demanding something tangible. That being said, it is NOT OK to suggest or push placebos on patients in order to get them out of your office (obviously, but worth mentioning). A question like this is bound to show up in the MMI's.

[Vallinar]

I read a news article about doctors handing out placebos for patients recently. It seems like the consensus is that it is OK to suggest a placebo (e.g. homeopathic remedies) granted the patient doesn't need any further treatment, however is requesting/demanding something tangible. That being said, it is NOT OK to suggest or push placebos on patients in order to get them out of your office (obviously, but worth mentioning). A question like this is bound to show up in the MMI's.

 

homeopathic remedies are not really placebos by definition. Handing out a sugar pill to a patient when they think it has active ingredients is unethical as it udermines patient autonomy and degrades the doctor patient relationship. As a patient you should be entitled to know everything about your health and treatments.

[Satsuma]

I would probably never trust my doctor (or any other doctor) again for the rest of my life if I thought a treatment was going to help me but turned out to be a sugar pill.

 

 

What if the placebo treatment actually helped you...would you just be happy it helped?

 

I think that some doctors in this era of evidence-based medicine and focus on curing this or that forget that one of the roles of a physician is that of "healer". If a placebo helps a pt to heal, isn`t that the important thing, even if there is no physiologic explanation for how it worked?

[Inspired17]

I think that another issue with prescribing placebos is the fact that they are would presumably be recommended for patients experiencing generic recalcitrant symptoms (like headache, chronic pain, fatigue, etc). Although the physician may think that the symptoms are psychosomatic, one cannot assume so. What if these symptoms are real & are a sign of a serious (but rare/difficult to diagnose) pathology? By prescribing a placebo for generic symptoms, one can be doing harm if there is a real underlying pathology. However, we would hope that a serious pathology would be ruled out prior to prescription of a placebo!

 

The placebo effect is really fascinating. In one of my classes, I learned about a study that found a specific pattern of fMRI BOLD activation for individuals exhibiting a placebo response. I think that rather than prescribing placebos, we should determine more precise mechanisms of how they mediate an improvement & try to work with that info in order to help patients.

[Vallinar]

What if the placebo treatment actually helped you...would you just be happy it helped?

 

I think that some doctors in this era of evidence-based medicine and focus on curing this or that forget that one of the roles of a physician is that of "healer". If a placebo helps a pt to heal, isn`t that the important thing, even if there is no physiologic explanation for how it worked?

 

You're speaking in hindsight tho. When prescrbing a placebo you NEVER know its going to work. But what you do know is that you are deceiting a patient and undermining their autonomy. You then have to consider when it would be appropriate to give a placebo... would it be only for symtoms with no known clinical origin (pyschogically induced?) would it be for symtoms associated with syndromes by which previous treatments have failed? In many of these situations a doc would have likely (or a patient would have likely) tried several treatment routes but to now avail, because you should never prescribe a placebo first ofcourse. Thus in these situations why would a "sugar pill" work when other "real" pils have failed? As you can see this may open up a huge can of worms and start to make physicians stretch the boundaries of justifiable deceit in hopes of maximizing placebo efficacy; they might need to setup false clinical scenarious and then present this placebo as a promising drug for the given false diagnosis.

 

 

In addition to the above, you risk a patient losing trust in medicine, which would have severe effects down the road. IF for whatever reason you decide to use a placebo as a diagnostic tool (ie to determine if the symtom is merely psychologically induced) then in respect of patient autonomy and trust, you would need to reveal that the pill was a placebo and why it was done during the follow up appointment.

[Satsuma]

There are many drugs we prescribe people that we don't know will work.

 

Placebos have been given out by physicians for hundreds of years. And pts have had benefit as a result.

 

Taking away placebos from a physicians arsenal means that some people who may have had relief of symptoms now will continue to suffer. Response to placebo is quite high in some instances.

 

Now, can you inform a pt that you are giving a placebo and still have an effect...yes, but the effect is diminished. Also, most pts don`t actually ask how their meds work.

 

So while some may argue that it is unethical to deceive a pt and give a placebo. .. On the flipside, is it not unethical to withold a placebo if it may provide some relief?

 

And if it is necessary to divulge the fact that the benefit was secondary to administration of a placebo...I think the key is really communication. If you presented it as...u were given a placebo, medicine doesn't fully understand how a placebo works, but there appears to be an interesting connection between mind and body and 30-40% of people in situations such as yours respond positively. Here, you acknowlege that you don`t know how it works and that they are not crazy since many others respond positively too, cause at the end of it, I think that is probably the most offensive thing to a pt...thinking that their doctor just thought it was all in their head. Versus, I gave u a fake pill, there's only sugar in it and since you got better, there is nothing really wrong with you...ie you're crazy. No idea how real patients would actually respond....would be an interesting study to see how receptive pts are.

 

I try to think about how I would feel...and it's one of those things you don`t know 'til it happens to you I suspect....but I think that I would kind of think it was interesting that I was a positive placebo responder and kind of ponder how it all works for a bit (but that is the academic in me). Maybe I would be embarrassed. I don`t think I would be angry with my doctor.

 

Should physicians develop guidelines as to a placebo's appropriate use and how to appropriately communicate its' use to pts...sure, I think that is reasonable. But to take placebos away, I think would be a limiting option.