Half Of Doctors Routinely Prescribe Placebos
The New York Times says that half of doctors responding to a nationwide survey admitted to routinely prescribing placebos.
Most of the doctors in question said that they used vitamins and headache pills, but some also prescribed antibiotics and sedatives. The study says that in most cases the doctors described these prescriptions to patients as “a medicine not typically used for your condition but might benefit you."
From the NYT:
Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.
But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. “Is that a placebo treatment? Depending on how you define it, I guess it is.”
But antibiotics and sedatives are not placebos, he said.
Of course, placebos have shown to be effective. The NYT says that 30 percent to 40 percent of depressed patients who are given placebos get better, which is almost as good as the results from real anti-depressants.
Half of Doctors Routinely Prescribe Placebos [NYT]
(Photo: Getty)
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Comments:
I'd prescribe placebos too if my patients were a bunch of self-diagnosing idiots.
I don't have any problem with placebos in theory. It's problematic that some of the medications given with the hope of placebo effect have effects of their own that shouldn't be taken lightly, and the placebo effect also increases the more a medication costs, which is its own can of worms.
Pretty interesting. I'm surprised that doctor admitted to it and used his real name. Doesn't seem right though that they can decide if you're really sick or not and just give you placebos. Nobody knows how you feel but you.
Is there a 12-step program for placebo addiction? Not for me.... For a, uh, friend.
This has been on the news repeatedly, but I think it's overblown. Some people go to the doctor because they think they are sick, and finding out that it's all in their heads won't help them much. For the most part, this is no big deal. The only thing I might consider an issue is how much the placebos cost. Some costs might be justified, since a psychological cure is still a cure, but it is definitely an abuse of the doctor/patient relationship if this is being used as an opportunity to make a serious profit.
This is one of the reasons why I ALWAYS do research on anything my doctor prescribes (another is to check for side effects, as my doctors usually just mention the serious "call me if you experience this" ones).
If it is something I have an issue with, I'll call the doctor or go back in for another prescription. Luckily, I don't have any major health problems, so I haven't really had to deal with this particular problem.
Just to be clear: none of the study's questions used the word "placebo." From what I can tell, I consider some of the questions to be leading. But I can't say for certain, because the original paper doesn't include the actual wording of the scenarios and questions.
so you're telling me that epsom salts won't cure this rash?
they forgot to mention the success rates.
This is the equivalent of tech support sending away the problem client with "here, try this {random item which hopefully takes several hours}" -- which I'm sure many here can relate to...
@Keen314:
"Self diagnosing idiots"? Wow, that has a lot of presumption loaded on top.
I have a lot of presumptions as well. For instance, every time I have to see a doctor (which I only do as a last straw) I ASSUME the Dr. has been bribed, bought and payed for by "Big Pharma" companies to HO their overpriced and potentially dangerous drugs.
I'm really glad to see some Dr's are using placebos. That shows some serious thought is going into the "legal" drug pushing arena.
Uh, isn't using antibiotics as a 'placebo' (whether you want to call it that or not) part of the reason that their effectiveness has become limited in recent years?
I would love to take placebo but the side effects are horrendous.
As long as I don't pay for it, and I feel better, then fine.
@j-o-h-n: Not really. Those random things usually have no chance at all of working, and are only to get the annoying customer off the phone rep's back. At least a doctor prescribing a placebo has a chance of actually working and making the person feel better.
What i fail to understand is how someone can be duped into actually taking a placebo thinking it's the real deal. If the doc gives you a bunch of 'samples' then i guess I could understand it. But, if I take a Rx for something like Prozac to the pharmacy, and get my Rx filled, wouldn't I know it's a fake?
I guess I just don't understand how that works.
@Keen314:
I'll go to a doctor every time I have a sniffle. Wouldn't want to presume I know what it is, I mean it might be something fatal.
@toddkravos: I suspect it's not for big name medications, but for other problems.
i.e. "I have mood swings, I'm depressed", "Ok, here's a prescription, take these, they always work" when the prescription is for ibuprofen.
I'd love to market placebo.
"The most studied medication in history -- Placebo!"
"20% to 30% effective for every ailment or disorder -- Placebo!"
"The industry, academia, and government all agree: Placebo sets the standard for safety and effectiveness!"
"Now available without a prescription!"
coming soon -- placebo XR!
I have nothing against placebos, but I don't like the idea of doctors having to prescribe pills to patients because the patients are demanding a prescription (even if medically they don't need one (ex: have a virus)) or because doctor's ASSUME patients are going to want a prescription.
There's been an important shift in the relationship between doctors and patients in the last 20 years or so with the advent of medical information readily available online. Only a few doctors have been able to actually cope with it. Most doctors simply long for the old days, when patients blindly believed whatever you told them, and moan endlessly about the patients that now come in with stacks of self-researched information.
The problem is, this is not something that's suddenly going to change back. The internet is here now. Medical information is available now. It's not going away. Rather than trick patents into taking placebos, doctors need to be learning to communicate more effectively with their patients, and explain why they don't need medication and why they don't have disease X in terms they can understand. For doctor's that learned and practised for years to just tell patients anything and be believed, this is a big change.
But it's one that must come. Because unless you can think of a way to stop everyone in America from Googling their symptoms, this is the new doctor-patient relationship.
This information is common knowledge.
What needs to be understood from it - is the equally
common knowledge that easily 70-80% of the contents of the average pharmacy, are also nothing more than placebo's - and often deeply stupid and damaging placebo's, designed for the ignorant and desperate.
(Like almost all 'cold' medicines which contain sweet or sugary substances. If your body's producing excess mucus - causing everything from sinus issues to headaches - the only way to stop it, is to avoid mucus-producers. Period. So eating anything with sugar or sweeteners, or incipient sugars,just keeps it going.)
um... their job IS to decide if you are sick or not. People ask, for example, for antibiotics when they have a viral cold. Antibiotics don't work, but most people don't want to hear that, so the doctor gives them pills that won't do anything (because there's nothing they can give that will) to make the patient go about their business.
@tande04:
Antiobiotics aren't a placebo. Placebo's are used probably most frequently in place of antio-biotics because people think its a cure all that it is not.
Unfortunately the insurance system is making sure that Doctor's never have the time to explain all that to the patients. Primary care docs need to see multiple patients per hour just to keep up and get compensated enough... and most primary care docs earn under 100k per year, not counting in cost of insurance. Your new doctor-patient relationship won't get any better until doctors can actually take time with each patient.
I don't like that the "placebo" is an actual medication. Can't that cause some harm? in actual testing situations where placebos are used, it's not a real medicine right? Just sugar pills or whatever.
So the study IMHO shows that doctors are giving people random medicine (not placebos) for random conditions.
Thats sounds good but then people would just doctor shop. The tv tells us we need these drugs to feel better
or to just feel. We are a over medicated society and the corps love it unless you self medicate. Smoke a joint you grew in your back yard and your a drug addict go to jail do not pass go we take your house etc. But here take this prozac or zanex or ambian to cope with the depresion of getting f-ed by the legal system.
The problem comes when a patient comes into the office insisting that they have some major illness when they just don't. The patient also has to be receptive to the idea of not being all that sick, or the idea that there is no reasonable treatment, and most just aren't. We despise patients who come in toting 400 pages printed off WebMD because they'll be reading about a disease, without adequate knowledge of what they're reading, and come in and refuse to believe that they're wrong.
If you feel that your doctor is wrong in expecting you to "blindly believe" what he's telling you, you should probably find a doctor you actually trust. The internet is a great resource for researching a diagnosis once you have one--but arriving at the office convinced you have Rocky Mountain Spotted Fever helps no one and it certainly doesn't help you get better or help your doctor treat you.
@Goodnightbabytron: "If you have an erection lasting more than four hours with Placebo, please contact your physician."
@ilves: I took it right from the article and consumerist's write up.
"The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives."
From a strictly definitional stand point, a placebo is an inert medication like a sugar pill. Thats why I quoted the word 'cause the way they're using it wouldn't strictly be a placebo (at least not the way I think of it). A "big dose of aleve" wouldn't fit what I'd conisder a placebo but its example they used. Which is part of the point I think since some of these (even the "big dose of aleve") could have unintended side effects.
I was just pointing out that I was surprised to see any doctor prescribing an antibiotic as a "placebo" when the over prescribing of them has been pointed to the decline in their effectiveness recently.
@mwshook: That's my question - I can just picture someone asking "Have you ever prescribed placebos for any patient" rather than, say, "Do you prescribe placebos to multiple patients on a regular basis, more than, perhaps, once a week?"
@ilves: So the doctor explains it, and the patience gets all stupid and irate and goes to another doctor, where he or she gets the scrip.
When my doctor told me that antibiotics wouldn't help my upper respiratory infection, I shook his hand and thanked him for doing the right thing, isntead of assuming that I wouldn't be satisfied with an honest answer. But I don't know if all of his patients are like that.
I actually knew someone once who said he took antibiotics whenever he got a migraine, just to make sure it didn't get really bad. Cue me ahem, gently, explaining to him how antibiotics work and why they would have no effect on his migraine...
Ever been prescribed "Obecalp" or "Cebocap"? Probably not, but those are placebo "brands" (The first being the generic! LOL!)
Of course, being lactose intolerant, I expect I'd be prescribed lactase rather than lactose as a placebo. :D
Some pharmacies have special code names for their placebos that (I'm assuming) would be shared with local doctors upon request. I'm sure a doctor/nurse could tell you more, but then they'd have to kill you.
Another one from googling: Normazaline.
@frodo_35: Come on, how is anyone supposed to make any money if you do your FREE drugs instead of buying ours??
I read a similar article a few days ago and I'm sort of torn. While I agree with the informed consent angle as a problem in theory, I know that most people go to a doctor because they aren't doctors and they need a doctor to nudge them into the right conformed consent in the first place. If a doctor is sure something is psychosomatic, then why not make the patient happy with a sugar pill, right?
The most obvious ethical trap here is the doctor making money by taking advantage of hypochondriacs. If Joe keeps imagining problems and keeps paying his doctor $140 a visit to get a packet of 10 white pills the doctor just hands him after a cursory examination and quick 'research' withdrawal, then we have a pretty serious problem.
@FrankenPC: Most clinics have pretty strict rules about how Pharm reps can contact physicians nowadays. Most of that is in-house regulation. The AMA has rules about compensation (for example, Pharm corps can't even give free office supplies anymore). The Pharm companies can offer free samples of their product, which most doctors hand out to their needier patients. Still, this kind of generosity can sway a physician to prescribe one particular drug over another.
But, the days of free trips to Hawaii are long gone.
@InThrees: I don't think they can prescribe a sugar pill. As in, there is no 'brand' of placebo pills that a person can just go pick up.
"I'm here to pick up my prescription of Sucrosia RX, thanks!"
@Keen314: Doctors and health insurance companies advise patients to do the research and know as much as they possibly can before seeing the doctor. We've all been coached to be "that" patient. So WTF? Now we're going to be given bullshit meds because it's assumed we're "difficult?"
Give me a break. This is crap.
@tande04: Only if they don't take the full course of antibiotics. Antibiotic resistance is caused when bacteria are exposed to an antibiotic, but it doesn't kill them. The best way to prevent selecting for bugs that are resistant is to take your full course of pills. Whether it's 3, 7 or 10 days, make sure that you take them or, or use that cream, or whatever. Or else the bug might come back, and be resistant the next time.
One prophylactic use of antibiotics that might be a source for resistant bugs is the meat industry. Many cows/pigs/chickens are on antibiotics for most of their lives. It's one thing for a person to take an unneeded 10 day course of Keflex. It's another thing for a cow to spend 5 years on cow antibiotics. That's asking for selection of a resistant bug.
@ilves: Right... except this guy admits to giving out antibiotics as placebos. It would be one thing if they gave out sugar pills. It's quite another to prescribe actual drugs that the doctors know or think will not have any effect on the condition in question.
So is there some sort of super-secret doctor/pharmacy shorthand for placebos (e.g. Dupahexopharmaleve PLCBO, 20mg), or do doctors only do what's described in the article and prescribe pain relievers, vitamins, etc. and try to convince the patient that's what they need?
and if there is a super-secret shorthand, does it cost the same as the real drug?
I am as annoyed as anyone by hypochondriacs and attention seekers, but as a middle aged woman, I now realize that this is all too often the default diagnosis for those of us in the demographic. Twice so far I've been diagnosed with vague and completely irrelevant 'syndromes' and only later discovered that I was actually sick and getting worse.
Last year, I saw a doctor for a series of admittedly odd, diffuse symptoms, and was twice sent home with diagnoses that amounted to telling me I had Hysterical Lady Syndrome; before the third visit when they finally did a blood test and discovered that I was so anemic I was almost to the point that I would have needed blood transfusions.
So while I don't doubt that there really are a lot of hypochondriacs and drama junkies out there, I also know, based just on personal experience, that at least some of these bullshit diagnoses are actual sick people who've been blown off by stupid, lazy doctors.
@floraposte: Probably the biggest problem is that use of placebos when NOT part of a clinical trial is generally iffy or outright forbidden under the ethical rules doctors agree to abide by when admitted to practice in whatever state.
If you've got half of all doctors blithely ignoring an ethical rule, that's a serious problem. If the ethical rule is that bad, it should be rewritten. But if half of doctors are totally comfortable ignoring the ethics rules, rather than confronting a problem with them, we should probably worry.
@soloudinhere: That's part of the problem, but part is also some doctors' unwillingness to admit that they (or medical science in general) don't know how to adequately treat someone's condition. A placebo - or some medication the doctor doesn't think will actually work but might placate the patient - might given so the patient feels less anxiety than hearing 'we don't know what to do to help you.'
Some/most of the problem is patient insistence, but I think that a big chunk of the placebo-prescribing originates on the doctors' end.
I can see why some doctors might want to prescribe placebos. For example, I know that frantic parents with kids who are sick with a cold or something insist on the doctor giving them something. Since it would be irresponsible to prescribe antibiotics (which is what doctors used to do before realizing that doing so built up antibiotic immunity), a doctor might prescribe a placebo instead.