Ethicality and practicality of therapeutic placebos

Great Debates
1

I recently read a good book on complimentary and alternative medicine(CAM). The point of the book is to try and show whether or not CAM is distinguishable form placebo. Some of the things in the book got me thinking about the place of placebos in medicine. I don’t want this to be a debate about CAM treatments, or placebos in clinical trials. Rather I want to debate whether doctors should prescribe placebos to treat patients when there is no good pharmaceutical options. In the past U.S. pharmacies stocked a wide range of placebo pills, syrups, and solutions with different code names that doctors could prescribe. That has fallen out of practice in the U.S., but still happens in other places.

Here are some of the things we currently know about placebos:
From the book:
[ol]
[li]placebos have a statistically significant effect on short term pain[/li][li]a placebo causes activity in reward centers of the brain[/li][li]opioid blockers prevent the effect from occurring[/li][li]the placebo effect is correlated with the patients belief that they are getting real medicine[/li][/ol]
From a more recent source: The more expensive the patient believes the placebo to be, the more effective it is.

So placebos have real, observable effects that can be documented and explained, but they require deception to function. If patients knew what they were getting was inert, the effect would not occur and the higher the price they pay for it the better it works.

Up for debate, should doctors prescribe placebos? Is it ethical to do so? In today’s world with malpractice lawsuits, media everywhere, and consumer testing organizations is it practical?

Jonathan

2

No. I pay $110 dollars for just one of my medications a month. If I learned that I blew $110 dollars on a sugar pill, regardless of whether it worked or not, I’d want a refund of all of my money. If doctors want to prescribe placebos, the best way is to give patients a free samples of it.

3

The problem is we also have to deal with things like nocebo effects, ie an expectation that a medication will have a negative effect means its more likely the person will perceive a negative effect with the medication.

A loss of faith in a medication can there mean its less effective too, due to overfocussing on side effects and the like, resulting in the person not persisting with the treatment.

So by using placebo, as people find out its occurring you’d be reducing faith in doctors generally and increasing those kinds of issues as a result. Trust is an important part of the therapeutic relationship in medicine it shouldn’t be messed around with lightly.

Otara