48% Of Doctors Admit To Prescribing Placebos Just To Shut You Up

According to a survey by the University of Chicago, 48% of doctors said “they have given at least one treatment when there was no evidence it would work.”

From the Chicago Sun-Times:

Placebo treatments included vitamins, herbal supplements, saline infusions, dummy pills and doses of medicine too low to be effective.

One of the most common placebo treatments was giving antibiotics for viral infections that don’t respond to antibiotics.

Unneeded antibiotics? Oh, what an awesome idea.

I actually caught a doctor of mine doing this. I was experiencing a crazy type of insomnia where I’d wake up every 45 minutes all night long for like, um, years. I finally decided that this was abnormal and went to the doctor to ask for some help. He said it was probably “stress” and prescribed something to take before bed.

When I went to fill the prescription, the pharmacist goes, “Ok, I could fill this, but its just half of a benadryl. They’re right over there on the shelf, and you can just break them in half.”

Oh boy, was I pissed. Actually, I’m still pissed! Rar!

UPDATE: Judging by the comments, I probably should have mentioned that I specifically told the doctor that I’d tried taking Benedryl (because it made me sleepy) and that it had no effect on how many times I woke up per night.

Meds or sugar? [Chicago Sun-Times]
(Photo:Spidra Webster)

Comments

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  1. bonzombiekitty says:

    Well, what did your doc prescribe? It may have been a legit sleep aid, but overkill, or could have the same effect as an over the counter med. So that wouldn’t be a placebo.

    More and more docs are refusing to prescribe uneeded antibiotics. They used to do it a lot more just to shut patients up that insisted on antibiotics for things like viral infections. Can’t say I really blame the docs for giving in to those types of people.

  2. kimsama says:

    Um, hate to burst your hate bubble, but…

    Benadryl is actually a mild sedative. That’s why its main ingredient (Diphenhydramine) is an active ingredient in a lot of sleep aids.

    Sorry, your doctor was just trying to help you with a non-addictive, well widely used sleep aid.

  3. bonzombiekitty says:

    Forgot to add – I’m surprised the number was ONLY 48%. I’d expect it to be much higher. I’d figure a lot of docs would have to deal with one hypochondriac or another and just get tired of dealing with the person.

  4. winstonthorne says:

    I’m actually with your doc on this one – Benadryl puts me in an outright COMA! Best sleep aid on the market, bar none.

  5. ThunderSaid says:

    Benadryl makes most people sleepy, so I say your doctor wasn’t strictly giving you a placebo. I do think he was counting on the placebo effect from giving you a “prescription strength sleeping pill” to help you get to sleep, though. Also, I’m not sure I disagree with the decision. A lot of sleeping pills are habit forming, so trying this (as a first resort, anyway) was probably healthier in the long run.

    I can’t say the same for using antibiotics to treat viral infections though. I think at this point a doctor has seen enough of the research on resistant bacterial strains to suggest caution when prescribing antibiotics. Flinging them like candy at a parade to every patient with a complaint is asking for trouble.

  6. kimsama says:

    @bonzombiekitty: I’m sure the number of docs who prescribe placebo are higher than 48%, too, so possibly it’s a matter of how the survey asked the question (i.e. some doctors think they “work” and some don’t?).

    Yeah, I don’t know. It seems foolish not to try a placebo when we’re so clearly affected by them (placebo studies, like the much ballyhooed placebo vs. real acupuncture study a couple years ago, as well as psychosomatic illnesses, are very telling in how much our psychology influences our physical health).

  7. surfacenoise76 says:

    I’m sure the actual number of doctors who do this is really much higher. A lot if not most people expect to get something more than just advice if they make a trip to the doctor. This is silly, but it’s the case, especially with the older segment of the population.

  8. 92BuickLeSabre says:

    Obviously there are doctors that are using this as a shortcut to actually doing their job. That is dangerous.

    But insistent folks who there really isn’t an answer for? Sometimes you really just want to give them piece of mind. (Okay, okay, and probably to get them out of your office, it’s true).

    If as a lawyer I could follow-up some consultations with a tiny piece of paper that would magically convince them that their (non-existent) “legal claims” were resolved so that they could just let it go and move on, I would be sorely tempted.

  9. missdona says:

    My husband’s doctor gave him the Z-Pack for the flu.

    Seriously, he had the flu and the quack gave him antibiotics.

  10. ManicPanic says:

    My issue with the docs recently has been that they are all prescribing z-packs instead of a longer course of antibiotics. In my cases, I have found the z-packs to not completely wipe out my problem. And by “problem” I mean persistant sinus infections and bronchitus.

    Also has anyone ever asked for a specific medication (for me it was Zyrtec) and they’ve given you something completely different? In my case I wound up with the supercharged Allegra. Grrrrrrrr

  11. ManicPanic says:

    @missdona: SERIOUSLY! Do they think the Z-Pack is the answer for EVERYTHING????

  12. Cycledoc says:

    This is a fascinating issue since much of what is done by individuals for themselves is, in reality, placebo medicine. For example, Vitamin B12 shots, as taken by Roger Clemens and others, have no proven efficacy for anything but the rarely encountered Vitamin B12 deficiency. Yes there is word of mouth that it will increase your vitality–there are no blinded studies that show this. The same is true for myriad vitamins, supplements, pills, laugh therapy, energy field manipulations magnets, etc. No evidence for efficacy but people think they may help so they take them and many feel better.

    Doctors sometimes encounter patients with problems frequently minor for which there is no known effective treatment. The patient is often not willing to accept the notion that there is not therapy and they will often seek the remedies noted in the above. On occasion some physicians in desperation–patients at their door repeatedly for the same issue for which there is no known treatment–may try a placebo.

    In regard to the Bendryl, as noted it has the side effect of causing drowsiness and is not a bad attempt by the physician to keep a patient off of addicting sleep medication. It is not a placebo.

  13. poodlepoodle says:

    My husband’s doctor gave him the Z-Pack for the flu.

    Seriously, he had the flu and the quack gave him antibiotics.

    Your doctor may have been concerned that your husband’s flu could progress to pneumonia.

    I love medical threads, everyone who has seen an episode of House or Er knows better.

    The typical GP gets 7 min with his or her patient. IN that time he or she is supposed to diagnose, treat and prescribe. If he or she misses something he will be subjected to a lengthy trial where he will be lambasted for not “DOING SOMETHING.” The current attitude in medicine is to over treat, over prescribe and over test because to not do so is financial and career suicide. Look at the CT scan rates and be horrified.

    My issue with the docs recently has been that they are all prescribing z-packs instead of a longer course of antibiotics.

    Your doctors do so because medical studies have shown that you are far more likely to actually complete your course of antibiotics on a short z-pack. Studies have also shown that it is more effective at treating a variety of infections.

  14. nuton2wheels says:

    Benadryl (hydroxyzine) is prescribed as a sleeping aid.

  15. Ghede says:

    I think they should have official placebos for doctors to give out. They should come packaged with a list of possible side effects and such, warnings, and what it is being used to treat, (Preferably printed based on a doctors phone call…)

    As long as they are affordable (Like say, about the same as a bag of M&M’s?), I have no problem with Placebos. Placebos can treat illnesses, so long as the patient doesn’t know it is a placebo. So make a sugar pill flavored with cough-syrup, cover it in the digestible pill cases, and name it Phenopharmoglycine or something.

  16. @kimsama: “It seems foolish not to try a placebo when we’re so clearly affected by them”

    There’s a lot of questions about whether it’s ethical, because patients are supposed to be fully informed of their treatment — but if they’re informed it’s a placebo, it won’t work.

    (It’s acceptable in trials because patients are informed they MIGHT get a placebo.)

  17. 44 in a Row says:

    Also, you shouldn’t assume that just because a drug you’ve been prescribed is also available over-the-counter, your doctor is doing something funny. For example, depending on your insurance, it can be cheaper (in the out-of-pocket sense) to have a prescription version of a drug that’s normally over-the-counter. I was on prescription-strength ibuprofen for a while; sure, I could have bought regular Advil at the drugstore, since the prescription-strength was “just three Advil”, but I would have spent more than my prescription co-pay to do so.

  18. sir_eccles says:

    @ManicPanic: Oddly enough there is an article in the NY Times Science section today that says that antibiotics are no better than a placebo for sinus infections

    [www.nytimes.com]

  19. Rukasu says:

    Actually I kind of applaud doctors for doing this. We live in an age of overmedication and media hype where at the slightest cough or scratch we seek an emergency appointment and Rx or at the News at 11 disease du jour, we all run out to CVS trying to get things filled because we all think we have it because we show 2 of the 8 symptoms. While giving antiobiotics unnecessarily is bad I agree, just giving you a placebo to shut you up isn’t always a bad idea. Sometimes doctors have to put their foot down to your hypochomdria.

  20. kimsama says:

    @Eyebrows McGee: Yeah, sad thing is, placebos don’t really work when you suspect you’re getting a placebo. Catch-22.

    So, ethically, should the doctor be intent on fully informing the patient, or treating the patient? (I agree with you in principle, but considering that most people don’t even bother to become informed about their own health care makes me favor the latter).

  21. kimsama says:

    Is my comment going to show up?

  22. Dervish says:

    As an interesting bit of trivia for the day, did you know that thalidomide was originally marketed without any evidence that it treated the conditions it was supposed to? Too bad it wasn’t as innocuous as a sugar pill. [en.wikipedia.org]

    I’m not trying to imply anything or make a statement here. I just think it’s an interesting and morally reprehensible example of a pharmaceutical company being wrong, wrong, wrong.

  23. missdona says:

    @poodlepoodle: It wasn’t respitory at all. It was all fever, body aches and chills. He was already on the upswing by the time he got to the Doctor.

    And if it’s necessary (which it is often with me, my colds usually turn into bronchitis or some other infection), I love the Z-Pack.

  24. Cerb says:

    Histimine blockers are a legitimate sleep aid. Benedryl is the best known of the H1 antagonists but it’s likely that if he wrote you a prescription, it was probably a different h1 antag (there are quite a few variations).

  25. Skiffer says:

    Don’t pay for name-brand placebos – Make sure to save some money by asking for generic sugar pills

  26. ptrix says:

    now, i’m not a doctor, but i know that antibiotics work by killing/attacking cells in the body, such as bacteria that can make you sick (anti=anti, biotic = living thing), and i believe i’ve heard that they don’t really discriminate between “bad” cells (like bacteria), and “good” cells, (like leukocytes (AKA white blood cells)), so wouldn’t that technically mean that prescribing an antibiotic for a viral infection that won’t respond to it actually make your body MORE SUSCEPTIBLE to the infection and PROLONG IT by attacking the white blood cells that would normally fight off the virus?

    and wouldn’t knowingly doing so be something of a violation of the Hippocratic Oath (“do no harm”) that all doctors swear to practice by, since prescribing such drugs when they (a) won’t treat the illness, and (b) will weaken the cells in the body that would?

    Any doctors out there, please chime in.

  27. Hambriq says:

    @poodlepoodle:

    I love medical threads, everyone who has seen an episode of House or Er knows better.

    Yeah, no shit. Speaking of which:

    @nuton2wheels:

    Benadryl (hydroxyzine) is prescribed as a sleeping aid.

    Hydroxyzine? Really? I really should go back to school….

    Okay, enough smarm. Benadryl (diphenydramine, not hydroxyzine) is commonly prescribed as a sleep aid, because for most people, it makes them extremely drowsy. Personally, I think it was very responsible of the doctor to prescribe you a medication that has no potential for addiction, dependence, or abuse.

  28. Hambriq says:

    Oh, and furthermore, I find it upsetting that not two days ago, Consumerist makes this post: “Billions of marketing dollars go toward television ads that implore us to “ask our doctor” about drugs we don’t need to treat ailments cultured by public relations firms.

    How is Meg’s story any different? This highlights the hypocrisy that runs rampant in criticism of the health care industry. People are so willing to suggest sacrifices and changes, except when it would affect them adversely. According to the last post, we should all be applauding Meg’s doctor from responsibly prescribing her an inexpensive medicine rather than an $100+ sleeping medicine that has addictive potential.

    And yet, instead, we’re vilifying him. Can someone tell me why? The hypocrisy really makes me sick, sometimes.

  29. kromelizard says:

    @ptrix:

    Umm… no, you have been told nonsense. But over-prescribing unneeded antibiotics, is what leeds to drug resistant TB and staph.

    I’m not really surprised by this. Most ailments get better all on their own, but how many people want to be told by their doctor that he carefully examined them and determined that the best course of action was doing nothing? People want to be given little pills to make them feel better and the doctor complies.

  30. missdona says:

    @poodlepoodle: If (by wild chance, IMHO) she was concerned about pnumonia, she could have said so. Instead she said, “You have the flu, here’s a RX for Z-pack.”

  31. Schlarg says:

    I keep reading the two words “prescribing placebos”. Can a doctor actually write a script for a non-drug? I understand the literal definition of placebo, but think there’d be a pretty limited number of drugs that a doctor could use as a placebo. Would it be more likely that the doctor would dig a handful of samples from their office cupboards? Can anyone give me an example of an actual placebo they’ve received? I wouldn’t count Benadryl or antibiotics since they’re actually designed to do something. Not being snarky here, just genuinely want to understand this better.

  32. VitaminH says:

    1) Benadryl is NOT hydroxizine. It’s Diphenhydramine, as already stated.
    It also IS a widely used and effective sleep aid for insomnia from time to time. If you fine you cant sleep every night for weeks to months, there’s probably a deeper problem going on and you need to find the cause.

    2)Antibiotics. As a pharmacist, nothing infuriates me more than the people running around screaming about MRSA and the like, then running to the Dr every time they have a “sinus infection” and demanding antibiotics. Guess what? ITS A COLD. Yup your sinuses are infected alright, WITH THE COLD VIRUS. ANTIBIOTICS WILL DO NOTHING.

    To the Zithromax guy, Z-paks are nice because the med has such a long half life that it’s actually still IN your body working for the full course, even though you’re not taking the tablets. BUT GUESS WHAT! YOUR INFECTIONS ARE VIRAL. Hence ANY antibiotics will do NOTHING. You get better when you take them? Esp the 10 day courses? Thats because the average cold lasts ~7-10, or maybe 14 days. Most people don’t go to the Dr the first few days of symptoms, until they peak and they feel the worst. Then …they go in, get their precious antibiotics for their “sinus infection” and take them for 10 days…WHA LA! They get better somewhere in those 10 days! Here comes the punch: it’s cause YOUR immune system fought it off. All the antibiotics did was give you diarrhea, or a yeast infection if you’re female.

    Sorry for the rant, I guess I’m one angry pharmacist.

  33. Hambriq says:

    @missdona: My husband’s doctor gave him the Z-Pack for the flu. Seriously, he had the flu and the quack gave him antibiotics.

    I don’t think this is as nefarious as you make it out to be. What’s more likely is that when your doctor says, “You have the flu, here’s an RX for Z-Pak,” what he is really saying is,

    “You have symptoms of what could be the flu. I could send you on your way and tell you to tough it out, hoping that in my 7 minutes with you, I have correctly diagnosed you with the flu and that it would not respond to antibiotics. Or, I could give you this prescription for Z-Pak, knowing that these symptoms could easily be indicative of an illness that would respond very well to antibiotics. If that was the case, and I prescribed you nothing, I would be failing as a doctor.”

    But that’s kind of a mouthful. Besides, you still took the Z-Pak, so the end result is the same.

  34. Hambriq says:

    @Schlarg:

    You are correct in that they aren’t actually prescribing placebos, in the strictest sense of the word.

    I would have to read the study itself to see the specific wording of the question, but there’s a lot of wiggle room. If you interpret the question as it was asked, then giving someone cinnamon to help lower their cholesterol, or St. John’s Wort to improve their mood would be considered a “placebo” because there is “no evidence it would work”.

  35. @kimsama: “So, ethically, should the doctor be intent on fully informing the patient, or treating the patient?”

    Fully informing. Not only is it the basis for medical ethics, but informed consent is the law in most (probably all) jurisdictions.

    @Hambriq: “And yet, instead, we’re vilifying him. Can someone tell me why? The hypocrisy really makes me sick, sometimes.”

    My complaint with it is that he didn’t say, “I’m going to try you on bendaryl first. It’s commonly used as a sleep aid and has no addiction potential. If it doesn’t work, we’ll try the bigger guns, but they typically have more side effects. You can buy it OTC and take it in THIS dosage, or I can give you an Rx so you can get it specifically from the pharmacist.” (which many people do prefer, if the cost differential is small, so they don’t mess up the dosage)

    On the sinus infection issue, my understanding is that they can be caused by virus, bacteria, or fungus (and fungus is the hardest to treat). There are supposed to be protocols doctors use to help discern bacterial from viral (culturing is expensive, apparently), so they can attempt to treat appropriately with antibiotics or not. Chronic sufferers are likely to get a benefit from culturing to help with future treatments; if it’s chronic, it’s typically the same infectuous agent repeatedly. (If it’s fungal, it probably never goes away between bouts! Ew!) (Now I’m NOT a doctor, I teach medical ethics, but you pick up a lot of specifics both from the case studies and from students, especially the continuing ed ones. I also suffer from chronic sinus infections so I’ve been through the gauntlet myself.)

    And again, EXPLANATION of this goes a long way towards helping people not be frustrated with their doctor’s perceived lack of diagnostic skill or willingness to treat! And making them partners in their own treatment who actually follow instructions and do a better job reporting symptoms, etc.

  36. @Schlarg: “I keep reading the two words “prescribing placebos”. Can a doctor actually write a script for a non-drug?”

    In theory, yes. (Although a pharmacist could tell you whether a retail pharmacy actually deals with sugar pills or whether you’d have to go to a compounding pharmacy.)

    One very common “placebo” is actually the sugar pills in birth control that you take on the 4th week so that you have a period, but don’t get out of the habit of taking the daily pill.

    Another use of sugar pills is with children learning to swallow pills who are having trouble, and have crossed the age or weight threshhold where most drugs have to be specially compounded to get the correct dosage in chewable or liquid form, or who has to take a drug that only comes in pill form. (Apparently the common teaching method used to be M&Ms, but there’s a larger choking hazard with those than with sugar pills the size of those little bitty sudafeds.) These also come from the pharmacist, although I have no idea if you get a script or just a “note.”

    So they’re at least AVAILABLE.

  37. kimsama says:

    Just to give everyone more fodder, from NPR’s Morning Edition:

    “For the first time ever, the total spent on health care topped $2 trillion…in one area, there was a pretty dramatic increase. Spending on prescription drugs went up 8.5 percent. That’s $16 billion.”

    Yay?

    I agree that to make the argument that we are over-medicated and big pharma is ruining the world, only to turn around a few days later and condemn doctors for prescribing pacebos, is hypocritical (doubly so in the case of condemning a doc for prescribing Benadryl, which actually works for the malady it was prescribed to treat, as many have pointed out).

  38. mattpr says:

    I love The Consumerist, but once again you guys are in way over your head with regards to medical issues.

    Placebo treatment is a widely-used and very effective treatment for many ailments including insomnia. I’m a doctor, and I’ve seen many cases where patients respond quite well to placebo treatment.

    That being said, as others have pointed out, Benadryl is a very powerful sleep aid, NOT a placebo. 5 minutes of research before you had the prescription filled would not only have told what the prescription was, but also its efficacy at treating your insomnia.

  39. csdiego says:

    I can never understand people who rush to the doctor at the first sign of a cold. Somehow they’re convinced that their sniffles, unlike everybody else’s, are probably a sign of a bacterial infection that urgently needs antibiotics. When I start feeling vile, I drink more hot liquids, get more rest, take a day off if possible, and that usually nips it. But certain hypochondriacs I know get mad at me for not going out and getting myself a scrip for antibiotics, as if I’m endangering them by not taking a useless med.

  40. Hambriq says:

    @Eyebrows McGee: My complaint with it is that he didn’t [explain the situation]

    I agree. Granted, I was a little bit glib in my response to MissDona, but I think a response like the one I came up with would be appropriate, and probably result in less anger, accusations of quackery, and whatnot. I think it’s especially important in patients with chronic conditions because oftentimes the biggest detriment to treatment is patient non-compliance.

    Either way though, it has little to do with my main point. The article isn’t about doctors discussing treatment options with their patients. And the Consumerist spin on the article is definitely not about that. As I said before, Meg’s anecdote serves as yet another startling reminder of the hypocrisy that can easily result if you are too quick to jump to conclusions about “what should be done” about the health care industry.

  41. kimsama says:

    @Eyebrows McGee: Again, I agree, but to what extent informed consent? (forgive the poetic phrasing)

    As I understand it, informed consent consists of telling the patient:
    1. the nature of the decision or procedure
    2. reasonable alternatives
    3. risks and benefits

    Wouldn’t saying “I’m going to prescribe you a medicine that will (e.g.) help you to sleep. About half of the people who try this finds it works for them. You might notice some drowsiness if you try to drive or operate machinery, so don’t after you’ve taken the pill. And if this doesn’t work, we can try another sleep aid” qualify?

    Couldn’t it be ethical to treat with placebo without saying “this is a placebo”?

    To me, it is, but then again, I am not an ethicist.

    Always nice talking with you, eyebrows.

  42. missdona says:

    @Hambriq: When I said “Quack,” it was offhanded. I don’t think his Doctor is a quack. And there was no anger in it, I’m not sure where you percieved it.

    Would it not be better to say, “Here’s a prescription for the Z-pack, if you’re not better in three days, fill it and start the pack?”

  43. Hambriq says:

    @Eyebrows McGee: In theory, yes. (Although a pharmacist could tell you whether a retail pharmacy actually deals with sugar pills or whether you’d have to go to a compounding pharmacy.)….These also come from the pharmacist, although I have no idea if you get a script or just a “note.”

    Wal-Greens, CVS, and HEB pharmacies do not carry sugar pills, to my most recent knowledge. However, it’s possible that you could special order them, I would have to check our supplier.

    As for whether or not it would be a prescription, well, a doctor can write a prescription for anything. I’ve seen prescriptions with just the word “cane” written on them. Insurance won’t cover something if a prescription isn’t written for it, but I doubt insurance would cover a sugar pill anyway. I suspect writing it on a prescription pad would be for the “effect” more than anything. But we wouldn’t be able to misinform you about the contents of your medication. If a doctor wrote you a prescription for an actual placebo, we would have to disclose that to you if you asked.

  44. @kimsama: “we are over-medicated and big pharma is ruining the world, only to turn around a few days later and condemn doctors for prescribing pacebos, is hypocritical”

    I don’t think it is; we can object both to being overmedicated and to being lied to or manipulated by medical professionals who, instead of discussing treatment with us, assume they know what’s best for us without our consent.

  45. Hambriq says:

    @missdona:

    That would probably be best. And pretty much anything the doctor said would be better than “You have the flu, here’s a ZPak.” As Eyebrows was stressing, communication really is key.

    Of course, then on the other hand, if the infection WOULD be treated by the ZPak, then the patient has just suffered through three extra days of illness by waiting. It just goes to show that there’s never really a 100% right answer in situations like these. That’s why I tend to bristle at articles which second-guess doctor’s intentions.

  46. @kimsama: “Wouldn’t saying “I’m going to prescribe you a medicine that will (e.g.) help you to sleep. About half of the people who try this finds it works for them. You might notice some drowsiness if you try to drive or operate machinery, so don’t after you’ve taken the pill. And if this doesn’t work, we can try another sleep aid” qualify? Couldn’t it be ethical to treat with placebo without saying “this is a placebo”?”

    LOL, you should come be in my class — you’ve hit the crux of the ethical problem EXACTLY on the head. Some doctors feel that your phrasing is EXACTLY what needs to be done to make placebo prescription ethical. You’ve told a very complete version of the truth, leaving out only that you’re hoping it’s the placebo effect, not the medicine’s efficacy, that turns the trick.

    Other doctors feel that that phrasing is still unethical, because you’re still trying to “trick” the patient, and that it contributes to problems like patients demanding unnecessary medicine, whereas educating them and refusing an unnecessary script would be better.

    I can’t give you a clear answer, because if the only way to treat the patient is to get their head going in the right direction, and the only way to do THAT is by tricking them, then maybe that IS okay. But clearly the second camp who claim it contributes to problems also has a point. (Also, people do have placebo side-effects from taking placebos, so you might make yourself more problems!)

    I think one thing that probably makes a difference is having a long-standing relationship with a doctor you know pretty well and trust. I personally would feel very different about being handed a placebo by some guy I’m seeing for the first time (I’d feel put-off, that my treatment wasn’t thorough, that he didn’t respect me enough to discuss the treatment with me, etc.) than about being handed a placebo by my long-time family doctor who is well-versed in my personal health issues and in the inner workings of my head. :)

  47. @Hambriq: “I suspect writing it on a prescription pad would be for the “effect” more than anything.”

    I think so, too — even OTC instructions are sometimes given to patients on the script pad because it apparently increases compliance.

  48. PS – I love this thread. Coming up with slightly variant situations is an excellent way to explore the ethical boundaries of the point in question. (“Okay, so THAT’s ethical, but what if we did THIS instead.”) You guys can all come be in my class and get As. :) Great fun thread, thanks so much.

  49. Hambriq says:

    @Eyebrows McGee: I don’t think it is; we can object both to being overmedicated and to being lied to or manipulated by medical professionals who, instead of discussing treatment with us, assume they know what’s best for us without our consent.

    I think you’ve got a bit of a straw man going on here.

    There’s a huge difference between “being lied to or manipulated”, and having a doctor not fully discuss our treatment options. But by bundling them together, it’s almost as if we’re expected to view them with the same level of disdain.

    The hypocrisy of Meg’s anecdote comes from simultaneously objecting to being overmedicated and objecting to not being prescribed the medicine she think she should have been prescribed.

    Had it been phrased in such a way that the emphasis was on the fact that the doctor didn’t fully discuss all the available treatment options, that would be one thing. But that is clearly not the focus of the article in the Chicago Sun-Times, nor is it the focus of the Consumerist post.

  50. DrGirlfriend says:

    Bendaryl is indeed a sleep aid, not a placebo. So why would the doctor not simply tell the patient this? “Listen, I’d like you to try Benadryl, as it is an effective sleeping aid that is not habit forming.”

    I get that some people might not understand and insist on something else, but then when they get stubborn like that, you give them a placebo, or just prescribe “diphenydramine”.

  51. @Hambriq: You’re right. But having once been subjected to medical battery, I get a little wound up about non-consent issues in general. :)

    One of the reasons I like my current doctor and ob/gyn is that both explain in excruciating detail what’s going to happen next or why I need to do X or what all the side effects are going to be. If I had a doctor who just handed me a script without telling me why or what for or the full 411 (even after I asked), I honestly probably wouldn’t take it. I certainly wouldn’t go back to that doctor.

  52. Monkey4Sale says:

    Honestly, knowing quite a few doctors personally, I’m going to pull the B.S. card. Perhaps 48% of crappy doctors prescribe placebos, but you shouldn’t go to a crappy doctor anyway (there are lists that show good doctors, use them). If a doctor does prescribe a placebo your pharmacist will point this out, as it is a looked down on practice, with no insentive from any party. No one makes money dishing out placebos.

  53. ShadowFalls says:

    If you want a sleep aid, take some Excedrin PM, should do the trick :)

  54. Monkey4Sale says:

    Also, depending on what state you live in, you can’t buy anything with psuedoephedrine in it over-the-counter. Like here in Oregon for example, you need a Rx.

  55. AtOurGates says:

    I think the more remarkable study would be how many “placebo” surgeries. I’m married to a medical student, and related to a few surgeons, and I frequently hear them discussing “open ‘em up and see what you can find” surgeries, performed when the patient keeps complaining about something that might be possible to cure surgically.

    I would guess they’re most frequently done by Orthopedic surgeons for patients who complain about chronic back pain. Here’s the thing, almost everybody has chronic back pain. Unless you have something that’s obviously visible on an x-ray, (a cracked vertebrae, etc..) you’re probably better off getting a massage then trying to get an Orthopedic surgeon to open you up.

  56. tinmanx says:

    I know someone who takes antibiotics for the common cold even thought he knows he’s not supposed to because he said it makes him feel better. If a doctor won’t prescribe it then he just gets ‘em without a prescription. It’s the power of placebo at work.

  57. kimsama says:

    @Eyebrows McGee: Cool, you teach an ethics class (or somesuch)? You would be the coolest person to have at a dinner party.

  58. Kevin Cotter says:

    When I lived in AZ I knew people who would go to Mexico and buy antibiotics OTC. They’d pop them at the first sign of illness. Those people had it rough when they actually had something.

    This area is a big double-edged sword – placebo to shut people up that won’t listen to logic, yet at the same time they are deceiving the patient.

    My wife is an MD; her big drug problem is drug seekers, usually narcotics. People doctor shop to see who will prescribe the most or strongest. Sometimes they have elaborate setups with multiple doctors and pharmacies. She’s called insurance companies to have them only allow one pharmacy for scripts for abusers.

    Wait’ll Hillary is in charge of our health making all of our decisions for us. She’ll fix everything!


    [krcotter.home.mchsi.com]

  59. SexierThanJesus says:

    I nip this issue in the bud before it happens, by not having health insurance. You’ll never get to me with your silly placebos, you quacks!!!

    /kidding

  60. LionelEHutz says:

    I have told doctors to not waste their time prescribing z-pack s to me since they never work. I’d rather be miserable for a few extra days if they are going to go that route.

  61. SexierThanJesus says:

    @Kevin Cotter: “Wait’ll Hillary is in charge of our health making all of our decisions for us. She’ll fix everything!”

    What’s your solution?

  62. poodlepoodle says:

    It wasn’t respitory at all. It was all fever, body aches and chills. He was already on the upswing by the time he got to the Doctor.

    Not to be a bitch but why the hell did your husband waste the doctor’s time then? “I have a sniffle, please give me something.” Want doctors to stop prescribing so much? Stop going to the freaking doctor for every hang nail.

    My husband’s doctor gave him the Z-Pack for the flu. Seriously, he had the flu and the quack gave him antibiotics.

    actually I take that back. I’ll be a bitch. You weren’t there, you don’t know what the doctor actually said, your husband wasted the doctor’s time by going to the doctor’s office when by your own admission your husband was “on the upswing” and now you call your husband’s doctor’s perfectly reasonable actions “quackery.” Screw you lady.

    Super infection after influenza is a very real, very deadly condition. Maybe your doctor thought you’re just the whiny types to sue.

    In medicine you can ALWAYS justify over treating. In a court of law when they start trotting out the pictures of how happy you were when he was alive there is no defense of “well he seemed fine.” And now you know why. Whiny bitches like yourself.

  63. csdiego says:

    @AtOurGates: Re: placebo surgeries, yeah. A friend of mine (mid-30′s) was having terrible foot pain, to the point of being in a wheelchair for a while. She went from orthopedic surgeon to orthopedic surgeon and none of them could figure out the problem, but more than one had no problem suggesting they open her up just to see what they could find. They also had all kinds of scary ideas about breaking bones here and cutting tendons there to force her feet to heal healthier than they’d started.

    Then she went to an osteopath, who put her on a regimen of what sounded to me like physical therapy. Now she’s all better, back on her feet, just had a kid. No scalpel needed. And yet, how many thousands could have been wasted if she hadn’t been willing to stick it out and had instead succumbed to placebo surgery?

  64. csdiego says:

    @AtOurGates: I meant to add, my dad was in a similar position, except that he was lucky enough to have a doctor who didn’t try to sell him on surgery. He was having a lot of hip pain and walking was getting to be a problem, so he went and asked a highly-rated orthopedic surgeon about a hip replacement. The surgeon didn’t give him a yes-or-no answer, instead asking “What do YOU want to do?” In other words, if Dad demanded a hip replacement, the doc would do it, but he wasn’t going to push it on him.

    When Dad balked at the idea of unnecessary surgery, the doctor prescribed physical therapy, plus some cortisone shots to get him started. Again, it worked like a charm, with no need for cutting.

  65. faust1200 says:

    @mattpr: I hope you don’t mind if I pay you with placebo money then.

  66. missdona says:

    @poodlepoodle:
    Whatever. You weren’t there either, and you’re not married to my husband. So, you are welcome to stop with your assumptions about about how we live our lives.

    People like you think “Screw you lady” and “whiny types/ whiny bitches like yourself” are perfectly appropriate to ways to discuss an issue.

  67. Mauvaise says:

    @missdona:

    This isn’t so much directed at you (or your husband, as the case may be), but to anyone reading this:

    Does no one think to actually talk to their doctor at the time of the visit and ask why they are being given a particular course of treatment? I know for damn sure if I went to the doctor because I was sick and wasn’t sure if it was just the flu or something else and was told, “it’s the flu, here’s some antibiotics”, I would immediately ask if it’s just the flu (i.e. a virus), why am I being given antibiotics?

    Maybe people are too afraid or intimidated or whatever by the fact that they don’t have a medical degree that they just accept whatever their doctor tells them. I learned from my mother to always question – side effects, generics, why X instead of Y, contradictions, etc. I don’t do it in a confrontational way, but because if I’m putting something in my body, I want to be fully informed.

    I’ve never had a doctor refuse to take the time to answer my questions, but I would change doctors if they did. Seriously people, you owe it to yourself to make sure you’re informed about..well, yourself.

  68. UpsetPanda says:

    I really think most people who go to the doctors are really freaking out about their condition. Our culture (and I don’t mean just America) is one of caution…be careful to prevent X disease. Why are people all of a sudden drinking tea? I’ve been drinking tea since I was 4, I didn’t do it because I felt like I needed to prevent something. Sometimes, the sniffles is just the sniffles. And yet, if you know your body well, you know your limitations, and you know the limitations of the human body, you better get yourself checked out when you do encounter something entirely unusual.

  69. trollkiller says:

    The majority of ailments will “cure” themselves with time. A doctor’s job is to make you feel better while you are being cured. If handing you a placebo makes you feel better the doctor has done his job. Of course this is assuming the doctor has not “caused harm” by not treating the cause.

  70. kimsama says:

    @Mauvaise: I used to teach health literacy to low-literacy adults, and this was actually a big problem for them, for the reasons you stated. They felt that they didn’t know enough to question the doctor, or they were too intimidated to ask questions when they didn’t understand.

    Health literacy issues actually lead to billions of dollars in costs every year. I wish there were more programs like the one I worked for that taught people how to ask questions, get information, keep health info organized, etc (and how to feel comfortable when doing so).

  71. Mauvaise says:

    @kimsama: It’s good that there are programs like that, but yes, I’d agree that there should be more, and I don’t think the problem is only with “low-literacy” people. My grandfather was a blindingly intelligent man and just accepted anything a doctor would tell him to do/take. My mother would be the one that would go to the doctor with him and question the doctors.

    Granted one anecdote does not a trend make, but I would bet that he’s not the only literate person that just accepts whatever a doctor tells them unquestioningly because it’s a doctor that tells them.

  72. AD8BC says:

    I wish I could get a doctor to prescribe me M&Ms, boy howdy!

  73. shortergirl06 says:

    For about 10 years my mom has had persistent joint and muscle pain. Finally after being tired of hearing that “It’s nothing, it’s all in your head”, she went to a rheumatologist. He started giving her prednizone, a steroid. She’s been on it for two years now.

    Finally her doctor retired, or died, either way he’s not practicing. My mom got shifted off to another doctor in a different practice. The new doctor is taking her off the prednizone, a 2 month procedure because of the high dose she was taking. All she needed, really, was some Alieve. And no. The prednizone didn’t work all that well.

    What I can’t understand, is why the first doctor told her that she needed a potentially dangerous medicine, one that caused massive weight gain, when a simple pain releaver/anti-inflammatory would work.

    I think it’s just another case of the pharma companies pressuring the doctors to prescribe something more expensive rather than something that works.

  74. UpsetPanda says:

    I like that House has prescribed mints before…I medicine were minty.

  75. calpchen says:

    However, waking up every 45 minutes will make it harder for the ninja assassins to get to you.

  76. @kimsama: Yep. :) Technically I’m an “Adjunct Professor of Philosophy” but they brought me on to cover the professional ethics classes (lawyer background is good for that), so mostly I get to teach ethics, medical ethics, business ethics … it’s great fun.

    (And I’m only fun at a dinner party if you like disagreements with your salad. :D )

    @Mauvaise: “My grandfather was a blindingly intelligent man and just accepted anything a doctor would tell him to do/take.”

    I think a lot of people just don’t like to ask questions generally, afraid to appear ignorant or afraid to waste someone’s time. Luckily for me and my socially-inappropriate level of curiosity, I’ve discovered most people are absolutely DELIGHTED to get to talk about themselves, or their jobs, or their hobbies.

  77. newspapersaredead says:

    The big problem here is both the Doctor and the patient think the problem can be fixed by taking a pill. How about trying to get at the root of the problem and see what is causing you to wake up every 45 minutes in the first place? I would start with examining diet and exercise (crazy thought I know). It could be something more complicated, but a deficiency in some sort of medication is not what caused the ailment, so why would you think it will provide the solution? You might get relief by taking a pill, but what happens when you start waking up again? Take a stronger medication? Why not just fix the original problem so you don’t have to take any pills??? I’m all about advancements in medical technology, but I think we are taking a step backwards with our over reliance on medications.

  78. asscore says:

    yes, benadryl is technically not a placebo.
    But when you go to the doctor expecting a Valium or Klonopin and he gives you benadryl it may as well be a placebo.

    Same with pain meds. I go to the doctor with extreme back pain, no I do not fucking want your 800mg ibuprofens. I want oxy’s or sublingual morphine tabs! I wouldn’t have gone to the damn doctor if ibuprofen would cure my pain!

  79. Dawnrazor says:

    As a doctor, I can offer a few comments about this. It is unethical for us to prescribe a placebo pill in such a manner as to “trick” patients into thinking they are taking a legitamate medication; modern medicine is based upon the “informed consent” model (with a few exceptions, primarily involving acute psychiatric emergencies) in which patients must be informed of the suspected condition/disease, prognosis, treatment options, and likely outcome if recommended treatment is declined-this precludes placebo use in an “under-handed” manner. One way we DO attempt to exploit the “placebo effect” is nicely illustrated by the insomnia treatment. The patient complained of insomnia and the doctor (realizing that almost all cases of insomnia are secondary to some other problem) prescribed conservative treatment; the goal was to give this patient some immediate relief while minimizing the risk of adverse effects. Low-dose Benadryl accomplishes this: the “real” effect is mild sedation physiologically/pharmacologically insufficient alone to maintain sleep, but when augmented by the patient’s expectation of improved symptoms (due to a positive, hopeful attitude toward the treatment) the desired effect is achieved. I could cite many examples of similar patient approaches working well for a variety of complaints (headaches are also very responsive to placebo effects). IMO, this is a doctor that understands the “art” of Medicine as well as the concept of “first, do no harm” and formulates creative solutions for patients (we are careful to say that we “practice” Medicine)-exactly the type of doc I would refer my wife or mother to. The motivation is simply to help people feel better while minimizing the probability of adverse effects. Many sleep medications have significant risks of adverse effects: very dangerous in overdose (with some of the older drugs, simply taking two or three instead of one pill could lead to ICU hospitalization), very dangerous when combined with other sedating drugs and especially alcohol (as many dead Rock stars know), significant risk with some agents for bizarre and potentially dangerous behavors such as sleepwalking, and many agents have significant risk of dependence. The doctor prescribed Benadryl because it does not really have any of these problems to a significant degree; if something “stronger” had been prescribed and an adverse event occurred, the doctor would be the first blamed (and sued), reagrdless of whether or not the patient was irresponsible or noncompliant with the instructions for use. This scenario often leads us toward more conservative prescribing styles, and the majority of the time this works just as well as prescribing the “newest and strongest” (and most expensive).

  80. CumaeanSibyl says:

    @asscore: Especially if the prescribed dose is half of an OTC Benadryl tablet. Who even does that?

    And if I want 800mg of ibuprofen, I can take four Advil.

    It’s not so much that Advils and Benadryl are totally useless, it’s that if I’m at the doctor’s office, I’ve probably tried all of the non-prescription remedies. I’m not there to get the same damn thing I could buy OTC at Walgreen’s.

  81. poodlepoodle says:

    People like you think “Screw you lady” and “whiny types/ whiny bitches like yourself” are perfectly appropriate to ways to discuss an issue.

    Typical “I can dish it out but can’t take it behavior.” You called a professional a quack and were told “no that isn’t quackery.” Now you’re whining about it.

    Yea, the shoe fits.

    People you’re in charge of your own heath, you can’t tell a doctor part of the story and expect he/she is going to magically guess what is wrong with you. Your doctor is not House. House does not actually exist he is a TV character and he gets to spend all day on one person, even your “quack” doctors could figure out all your ailments given a day to work you up.

  82. ManicPanic says:

    @sir_eccles: Thanks for pointing that out–I get ragers and have had them for a couple of weeks in the past before going to see the doc hoping they would get better. I have tried two out of the three suggestions (ibprofin, Neti Pot) and the saline almost seems to make it worse. The longer course of antibiotics has proved to be more effective than a z-pack for me in completely getting rid of it.

  83. Hambriq says:

    @asscore:

    Same with pain meds. I go to the doctor with extreme back pain, no I do not fucking want your 800mg ibuprofens. I want oxy’s or sublingual morphine tabs! I wouldn’t have gone to the damn doctor if ibuprofen would cure my pain!

    Drug seeking behavior anyone?

    I kid, I kid.

  84. missdona says:

    @poodlepoodle: I will not indulge your name-calling.

    I can dish it with the best of them, but if you are going to resort to language like “Screw you lady,” I’m not interested in what you have to say.

  85. forgottenpassword says:

    So…. I could be WASTING money on placebos????? WTF???

    How about doctors just grow a pair, assert their medical authority & say something like “I am the doctor, I dont think you need (insert drug of choice)…. of course you can always get a second opinion.”

    Its bad enought that I have to blow money/time on a 30 minute wait & then a 5 minute “look-see” session with a doctor but to waste even MORE money on medicine that has no medicinal effect?

  86. Buran says:

    @tinmanx: You can thank him for MRSA. Seriously. You need to get him to stop. Even if it takes turning him in.

  87. overbysara says:

    GOOD. if it keeps them from over-prescribing antibiotics. some people get sick and just COMPLETELY demand a prescription. it’s in everyone’s best interest not to have antibiotic-resistant super bacteria roaming around.

  88. spunky_redhead15 says:

    i am prone to getting at least two sinus infections a year. i have had so many of them in the past few years, i know when i have one opposed to the common cold. i am also allergic to basically all your common antibiotics (sulfas and cillins, all the cheap stuff!) and zpacks are what has worked the best for me.

    the week of my wedding, i came down with one hell of a sinus infection, complete with a pretty good fever and everything. i had a doctor argue with me, tell me she was pretty sure i only had a cold, but she was going to prescribe me antibiotics anyway. her reasoning being “you’re getting married on friday, i can’t have you be potentially miserable. but i’m sure time will get you better as opposed to the meds”. then she asked me what i normally took and what worked. i told her the zpack. she goes and prescribes me something completely different, that had nasty side effects (heartburn and a metallic taste in your mouth), and cost about five times more than a zpack, and that was with my insurance.

    as much as i hated to say “i told you so”, within 24 hours of being on the antibiotics, i was doing much better, but i unfortunately got stuck with both of the aforementioned side effects. when most brides are wanting to pop zanax on their wedding day, i was wanting to eat an entire container of rolaids, but i couldn’t, due to drug interactions with the antibiotic. i took the antibiotic, only because i know my body and i know how it acts when i have a cold versus a sinus infection.

    sometimes, i swear doctors are so full of themselves, they forget that sometimes their patient, who knows their body better than anyone else, is sometimes their best diagnostic tool.

  89. aaydemi says:

    @Skiffer:
    3rd year medical student chiming in.

    Antibiotics work in many different ways, but in their simplest form, they work by inhibiting bacterial replication. They don’t blindly “attack” random cells, they stop bacteria from reproducing. Most bacteria have crucial proteins/enzymes that are used during replication (and that are different from anything in your body), and antibiotics basically bind to and inhibit them. While the bacteria can’t reproduce, your own body’s immune system is busy pumping out white blood cells to fight off what bacteria is left. Eventually, your body wins out (most of the time).

    Back on topic…what I think a lot of people don’t realize is that doctors run a business. If your patients aren’t happy, they won’t come back (as many above have attested). And while it’s not the main factor why most doctors practice, it is a reality in today’s world. When a crazy mom comes in with a sick kid who’s got nothing more than a simple viral infection but is demanding antibiotics because she thinks her kid has necrotizing fasciitis after reading WebMD for 3.5 minutes, what is the doctor going to do? Give antibiotics, waste 15 minutes trying to explain to a stubborn mom that this will go away on its own, waste another 15 minutes trying to explain to a now even more stubborn mom that overuse of antibiotics has led to drug-resistant infections like MRSA, or risk losing the entire family’s business because her neighbor’s doctor gave her neighbor’s kid antibiotics when he had a cold.

  90. Firstborn Dragon says:

    Hey, I go to the doctors with some issues, NOT expecting them to give me anything. In fact, I’m happier when they don’t. Reason? Aside from being on so many meds at the moment I would rather NOT be on, I don’t want to be drugging myself unless absolute necessary.

    I’m even this way with pain killers like tylanol. And in fact, I’ve had doctors who said outright they could do nothing for me.

    For example when I went in with an issues of sleeping over 20 hours a day, and unable to stay awake. I knew SOMETHING was wrong. No it wasn’t an issue of getting enough sleep. It was an issue of me not being able to stay awake. My main reason for going was to get a note for work, as I knew if I waited a week, I would get over it on my own.

    Doctor actually agreed that she thought it was a viral infection, and that there was nothing she could do. Then told me about the viral issue and not being able to give me anything. I was happy, I got my note for work WITH orders to stay home till it worked itself out, and I didn’t need to add another drug to my regiment at the time.

    At the same time, there are issues I admit I don’t even bring up with a doctor. Supposedly they gave me the strongest medication for it, and it did nothing, but make me feel worse. (Admittedly this doctor was a total idiot I found out latter, but I digress)

  91. RvLeshrac says:

    @spunky_redhead15:

    STOP

    OVERMEDICATING

    WITH

    ANTIBIOTICS

    NOW

    You think you have sinus problems? Wait a few more years until you’ve generated some new hideous disease using your amazing medical skills, one that CAN’T be treated with ANYTHING. You’ll then be sitting around complaining about how the doctors overmedicated you and didn’t give you anything different.

    Then, of course, the homeopaths will use your story as anecdotal evidence of the “evils” of medicine.

  92. whoda says:

    This isn’t even a story. 98% of people have invented an illness to call sick into work. Apparently half of them go get treated for it.

  93. whoda says:

    I guess I’m lucky. I have medical insurance and go to the Doctor regularly, yet I have NO IDEA what a z-pack is. It’s great to be from the end of the gene-pool that doesn’t get sick but once every 3-4 years.

  94. MrEvil says:

    @ptrix: I’m not 100% certain about these newer Antibiotics, but older ones like Penicillin target cell walls of a cell. Since Human beings are of the animal variety of life-forms. None of our cells have cell walls, only membranes. Bacteria however do have cell walls. Which is why most antibiotics have side-effects in your GI tract as they not only kill the infection, but the good bacteria that live in your gut.

  95. clipper says:

    You just can’t please everyone. If people get prescriptions they bitch about being over medicated. If they don’t, they feel they are not getting treated.

    It never ends.

  96. banmojo says:

    The placebo effect is well researched and documented. If I can treat your pain with a non harmful placebo pill that has no known side effects (aside from placebo caused AEs) then isn’t it to your benefit, and then haven’t I fulfilled my oath as an MD???

    The problem is, drug companies are allowed to advertise to lay people, which results in said lay people coming into a professional’s office and requesting drugs by name, based on what they read in some stupid ad in Vanity Fair last week. Drugs should not be advertised to the lay public (they prevented cigs from being advertised on the TV, (kinda), so I’m sure they could make a ruling on this as well.)

  97. parnote says:

    Thanks, all you doctors out there who do this! You are only helping Big PharmA snag even higher profits and, at the same time, helping to keep drug costs and health care costs at all-time record high levels in the US. We, who cannot afford legitimate health care, applaud your work!!!

  98. Hambriq says:

    @parnote:

    …That doesn’t even make sense. Wouldn’t prescribing a placebo keep profits OUT of “Big Pharma”‘s hands?

    I guess logic has no place in the New World Order.