According to the scientific journal Ed (8 pm Tuesdays, NBC-TV), there was a patient who sued his doctor when he learned that the “medicine” he had been prescribed for his arthritis – and which had worked – was just a placebo. It stopped working after he learned it was a sugar pill.
The doctor argued that the patient had come to him for a cure, and that he had provided one. The patient countered that he didn’t expect his doctor to deceive him, even if the deception eased his pain.
Okay, so this is not exactly what the OP was asking for, but I will mention that shows like Ed often seem to base episodes on actual incidents, so it might be worth checking a legal database for similar cases. (I just did a quick Google and didn’t come up with anything.)
That’s one problem with the system. Another is “Why the hell should I have to pay for phony medicine that doesn’t really do anything when I want real help?”
Even if you think a pill works, it won’t cure everything. I don’t think you’d cure blindness my telling a blind man “hey, this pill’ll fix ya.” Or “screw AZT, try this!”
Prescribing a placebo you know will provide no medicinal benefit is unethical. But it is also true that giving anything often helps anxious patients, etc. I do not normally prescribe any pill for the sake of prescribing it, certainly not what the pill salesmen recommend. On the rare occasion I give placebos, I phrase things along the lines of “this is a pill with few side effects that I have found to be effective in people with similar conditions, but for many people it has no medicinal benefit”. But I would never give a sugar pill, probably a mild anxiolytic, antibiotic, etc. I’d still prescribe a real medicine.
I rarely prescribe expensive medicines, having found cheap ones are generally as effective. Many good medicines are about as cheap as sugar pills, at pennies a dose.
To get approval for a drug, the company does controls to show it is better than placebo. There is no guarantee any individual drug will work for an individual person. Also, many drugs commonly used are not much better than placebo - including muscle relaxants, cold medicines, some antihistamines, etc.
I tend to prescribe low dose amitryptilline for mild anxiety, sleeping difficulties and unusual pains (in young folks). It does have a psychological effect I have found helpful. It often works, and presumably not solely due to a placebo effect. It is also cheap. It is proven to help with neuropathic pain in many people.
What I would do in real life would depend a lot on the specific case; I’m talking generalities here. Many conditions get better on their own: flu, mild respiratory infections, colds, low back pain. I don’t push medicine on patients if I think it is not needed and can persuade the patient it is not needed.
Would you ever consider suggesting that a patient see an herbalist or some other “alternative” practictioner? Even if you as a physician might think that such treatments would do little good, it might have an enhanced placebo effect because (hopefully) both the practitioner and the patient would believe in itl.
Wow, I am stunned by this. I just tried it at a very low dose (25mg) for migraine prevention and the side effects were anything but minor. I discontinued it after a month. If my doc was going for the placebo effect, I have no problem with that (whatever works, and all). I understand the ethical problem with giving something with no actual effect, but I still would have much preferred a sugar pill.
Dont laugh. You can have different strength placebo’s.
Different colour pills can have dirrerent placebo effects eg blue and green are better for tranquilizers and pink is better as a stimulant than white.
How would the legal position of homeopathist compare to a doctor prescribing a placebo? Would the former not fall into the category of breaching informed consent because they themselves are deluded?
This is from what I can recall from a show like 20/20 - about 2 months ago - sorry no more info then that:
There is a condition that there are only 2 drugs that can treat it - but only for so long. The common practice was/is to tell the patient that they will be perscribed one drug till it wears off, switched to a 2nd then a 3rd - but one will be a placebo. The patient would know that one of the meds would be a placebo but
wouldn’t know which one. From the story it seemed to work at extending the useful time of drug treatment.
I’m pretty sure I was given a placebo when I was having anxiety attacks at the age of 13. For a while, whenever I was leaving on a trip or was goigng to be in a new situation (like starting a new school year), I would get so nervous that I would throw up and have to stay home. I went to my pediatrician about it, and he prescribed a small, flat, blue pill that he told me to dissolve on my tongue whenever I felt an attack coming on.
They didn’t really help me to begin with, but when I figured out that they were just sugar pills (they tasted sweet on my tongue, and why wouldn’t he prescribe something that I had to swallow to help with an upset stomach?), I stopped taking them and was very angry I had been lied to.
Strangely enough, the only thing that worked and helped me to get over my attacks were another sugar pill, Altoids! They had the right amount of sugar and peppermint that settled my stomach - I had to take them with me every day for a few years, but now I’m fine.
The antibiotics prescribed for viral infections are anything but harmless; in my opinion prescribing them is malpractice and sugar pills are better. First, they have side-effects. My bowels usually go wonky after I have had antibiotics. Second, they induce resistance in your gut bugs at least. Then if one of them wanders off to the kidneys and causes a urinary tract infection, it will be harder to treat. Third, it might lead to immune repsonses so that the antibiotic cannot be used when it is really needed.
When I was growing up in the forties and fifties, it seemed to me that (nearly) all presciptions cost 85c and took a half hour to compound. This 85c/half hour was so common, it became a cliche. In retrospect, I suspect they were all sugar pills. My mother was a hypochondriac and agoraphobic (interestingly, both later disappeared) and if they weren’t sugar pills I cannot imagine what they might have been.
Amitryptilline does indeed have side effects, in these can be very severe in elderly patients. Many folks get dry mouth and drowsiness. Elderly can lose their balance and fall as a result of amitryptilline. I keep the dose small. But I don’t prescribe this for the sake of prescribing something; more when I think the problem is minor and there are correlating problems of anxiety, sleep deficit and pain not responsive to usual medicines.
I occasionally recommend patients see herbalists, try chamomile tea, etc. in cases where things I would have thought to be more effective don’t work. Sometimes herbs and chamomile tea does the trick when pain medicines and physiotherapy do not. My interest is doing what works for the patient.
I think providing a sugar pill is unethical. Prescribing amitryptilline if I genuinely think it will have no benefit is also unethical. The difference is clinical experience, and realizing that not every medicine is much better than placebo anyway. I should emphasize that I do stress non-medicinal treatments for many conditions and find these fairly effective. I do not start out by pushing pills at the depressed, those who cannot sleep and people with colds or heartburn. I would not give these placebos/medicines as a first line treatment, but I do give them when other things have failed.
Really? I would have thought that a therapist’s beliefs about a treatment could have an impact on a patient’s trust in that therapy.
I was under the impression that it was those sorts of concerns that led to the use of “double-blind” trials. When doctors knew which patients were receiving the placebo and which were receiving the drug under investigation, patients were picking up on it and didn’t expect the placebo to do them any good (and conversely, had heightened expectations for the drug being tested).
Aren’t placebos all about faith? If you think it works, it does. If a therapist told me something would work, and I trusted him, I think the placebo effect would be enhanced. On the other hand, if I got a speech like Dr_Paprika gives in which I was told that “for many people it has no medicinal benefit”, I’d think any placebo effect might be diminished.
Hmm… If doctors WERE prescribing placebo’s, wouldn’t it be in your best interests to remain ignorant about the practise? By coming on this message board, your only harming yourself and those who read your thread.
Many medicines don’t benefit one person taking them. Ask anyone you know who has migraines. That doesn’t mean there isn’t a medicine that will work, just that it is a trial and error process sometimes. People respond well to statements like “One in two people who take this drug report a greater than 50% decrease in their pain”. I would not lie to a patient, though, and think informed consent is pretty important. The point is, by saying that up front, you may not decide to take the medicine in the first place, which also may be the best thing.
After giving it some thought I guess I should admit that in my case, the counter-placebo effect was probably a factor. After 30 years of trying everything but faith healing, blood-letting and leeches, I was pretty convinced it wasn’t going to work. And it didn’t.
