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)
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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.
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.
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.
I’m actually with your doc on this one – Benadryl puts me in an outright COMA! Best sleep aid on the market, bar none.
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.
@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).
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.
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.
My husband’s doctor gave him the Z-Pack for the flu.
Seriously, he had the flu and the quack gave him antibiotics.
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
@missdona: SERIOUSLY! Do they think the Z-Pack is the answer for EVERYTHING????
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.
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.
Benadryl (hydroxyzine) is prescribed as a sleeping aid.
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.
@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.)
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.
@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]
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.
@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).
Is my comment going to show up?
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.
@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.
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).
Don’t pay for name-brand placebos – Make sure to save some money by asking for generic sugar pills
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.
@poodlepoodle:
Yeah, no shit. Speaking of which:
@nuton2wheels:
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.
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.
@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.
@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.”
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.
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.
@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.
@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”.
@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.
@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.
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).
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.
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.
@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.
@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.
@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?”
@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.
@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.
@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.
@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.
@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.
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.
@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.
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”.