Nurse, Give This Patient a Placebo.
A new study published in British Medical Journal has shown that almost half of internists have prescribed drugs that were expected to have nothing more than placebo effect. As reported by Bloomberg, these useless prescriptions were handed out as often as 2 or 3 times per month.
Why would docs do this? To increase "positive patient expectations" says Jon Tilbert, author of the study. Among the physicians who participated in the study, 67 percent reported that they believe that this practice is ethical or even morally obligatory.
This is perhaps the best data yet to prove that there is rampant consumerism in healthcare and that physicians are complicit. Prescribing drugs and other unnecessary treatments merely to satisfy the whims of demanding patients who have "expectations" physicians believe must be met, even if this were in the service of maintaining the physician-patient relationship, is not acceptable. This practice, instead of promoting rapport and trust and good communication between doctor and patient, actually erodes it.
That is, if the patient ever knew. But then again, why would a patient ever complain or feel unhappy when they are getting everything they want? Even so, this is unethical, plain and simple. Promoting positive patient experience by prescribing drugs that are no more than placebos is simply unacceptable and unsustainable for the ethical practice of medicine.
Summer Johnson, PhD
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I suspect that with many medications, the effect may or may not be placebo, and it doesn't really matter which as long as it's not hurting the patient and the patient experiences relief.
My kid had "schoolitis" stomach aches in 7th grade, probably related to pre-algebra. They were severe enough that I didn't feel comfortable assuming that's all they were, so I took her to the ped. He checked her out, and then had her take acidophilus tablets, and vitamin C, and drink Celestial Seasoning's Tummy Mint Tea. Her stomach aches eased up. Placebo? Not placebo? Who cares?
If this is the kind of thing they're talking about, I do not see the tragedy.
And as far as informed consent goes - if you know something is a placebo, then it won't have any effect, will it?
- by Laura(southernxyl) on Oct 24, 2008 at 6:50 PM | link
"If this is the kind of thing they're talking about, I do not see the tragedy."
The motivation and results are not always so benign. Sometimes doctors will give placebos to patients with chronic "controversial" illness like ME/CFS or fibromyalgia. Though both diseases are classified as legitimate physiological disorders by the World Health Organization, many doctors simply assume that the symptoms are psychosomatic, and give the patients something like Aleve (which can cause stomach problems).
The result? Patients are less likely to seek real treatment, and they get worse. In the meantime, they continue to pay the doctors who are pretending to attempt to help them.
- by Susan Wenger on Nov 2, 2008 at 2:35 PM | link
I think in this case the distinction needs to be made between the positive effects of a placebo effect and the negative effects of a more or less trusted, licensed professional prescribing placebos.
Regardless of whether the effect is truly a physiological response or a placebo effect--and who can draw that distinction, anyway--if a patient is helped, then it is an effective treatment.
However, if a physician does not think the patient has an actual disease, and is prescribing to put that patient at ease, he is erroding the patient/physician relationship which should be built on trust. Prescribing may take the place of spending time with a patient to listen to his issues, and understand who he is as a complete person, and make him feel that he is being cared for holistically.
Most would scoff at this idea, who has the time for THAT? And that is the point. Medicine has become increasingly consumer driven, just like every other area of American life. We have given up direct patient contact and care, an essential in healthcare, and taken up profit-driven healthcare instead. As a result, I believe in some cases, we continue to treat and prescribe for symptoms instead of the route of the disease.
- by Sylvia Jackson on Dec 10, 2008 at 4:12 PM | link
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