General Question

Lightlyseared's avatar

Should doctors be allowed to prescribe placebos for their patients?

Asked by Lightlyseared (30635points) September 15th, 2008

There seems to be a lot of evidence suggesting that placebos do actually work. For example 2 sugar pils are better than 1 for healing stomach ulcers Blue sugar pills are better than pink ones for treating anxiety. Putting a brand name on the packet of sugar pills improves their ability to treat pain.

Ethically there is a bit of a problem because you cant actually tell the patient you’re giving them sugar pills else they wont believe they’ll have an effect.

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14 Answers

poofandmook's avatar

I can’t wait to read what Shilolo says… I was just going to when I noticed him “crafting.” :)

JackAdams's avatar

Most definitely, because psychologically, I have seen them WORK!

shilolo's avatar

I’ve always been in favor of placebos for situations where people demand treatment where none is needed. However, for real diseases (such as stomach ulcers), I doubt very highly that your comment is true. Placebos can work for some diseases, but true treatments are only approved if, in placebo-controlled trials, the treatment is significantly better than placebo. If you could provide a citation for the improved efficacy of placebo over defined ulcer treatment, I would love to see it.

Mr_M's avatar

Placebos do work in certain circumstances. However, today there’s no need to prescribe a “placebo” per se; there are many drugs that can be prescribed at doses so small as to have no physiological effect on the patient at all; the only effect is in their minds.

shilolo's avatar

Mr. M. That isn’t ethical, and could get you in a lot of trouble (assuming you aren’t the fictional Dr. House).

wundayatta's avatar

I don’t know. You could prescribe pills that will help the patient harness the power of their own body to fight off the disease, or to make them feel better.

It works for me. I merely need to go to the doctor, and have them tell me I’ll be ok, and I get better within a week. I am a great believer in the power of the placebo effect.

When you think about it, a placebo pill is like a fetish object. It has the power of concentrating belief, and belief can make you get better. It doesn’t matter what the object of the belief is; it’s simply the fact of concentrating or focussing on health; a kind of self-hypnosis; that works. A doctor can give a placebo pill without calling it that, and with directions necessary to make it work better.

Mr_M's avatar

@shilolo, example, a vitamin supplement. Medically justifiable and not unethical at all if the doctor knows there is nothing physically wrong with the patient and it makes the patient feel better. Done in this way, there’s no placebo to hide.

shilolo's avatar

You can’t say, here’s an antibiotic for your “cold” (which is a virus and shouldn’t be treated with antibiotics) only to give someone a vitamin. That is unethical, even though I think it wouldn’t hurt. In our litigious society, you can guarantee yourself a lawsuit that way, too.

poofandmook's avatar

Wait, now I’m confused. How do you prescribe a placebo then? You can’t say “here’s a placebo” because then it wouldn’t work.

wundayatta's avatar

Actually, it might still work, even calling it a placebo. It would be interesting to have some research done on that.

Lightlyseared's avatar

@shilolo Still can’t find the reference for ulcer healing sugar pills but in the mean time

Here’s a reference for the placebo effect for treating obstructive hypertrophic cardiomyopathy. They insert a pacemaker but don’t switch it on and still see an improvement in the patients condition both in the patients perceived quality of life and more interestingly in measurable physiological changes to cardiac function (not entirely sure of the ethics of putting a pacemaker in someone for no reason and not telling them but there we go). If the pacemaker was actually switched on the changes were more pronounced but even so…

Linde C, Gadler F, Kappenberger L, Ryden L. Placebo effect of pacemaker implantation in obstructive hypertrophic cardiomyopathyPIC Study Group. Pacing in Cardiomyopathy. Am J Cardiol 1999;83:903–907

shilolo's avatar

@Lightly. Interesting study. I’ll have to look at it but you should know that there is good precedent for these types of sham procedures in many studies (and it is clearly ethical).

I never argued that there isn’t a placebo affect (though I think it is smaller than people think). What I said was “true treatments are only approved if, in placebo-controlled trials, the treatment is significantly better than placebo.” Thus, the need for sham procedures, though in extreme cases such as in transplant surgery, or coronary artery bypass surgery, it would be hard to do a sham procedure. Convincing someone to be put a heart-lung bypass machine (for sham), or even to have their chest cracked open would be very difficult. Thus, we don’t really know if CABG (bypass surgery) really works.

Mr_M's avatar

@shil, here’s the problem. You DON“T prescribe a placebo for a REAL physical problem instead of the appropriate medication. The placebo is prescribed when the physician KNOWS there is nothing physically wrong with the patient and it’s all in the patient’s head. The placebo makes the patient’s “illness” go away. The physician tries it and, if it works, might conclude it’s a psychological thing.

In your example, if you gave a vitamin, you wouldn’t say “here’s an antibiotic for your cold” but you might say “Here is a prescription for a Vitamin C supplement”.

The alternative, remember, is to tell the patient that there is nothing wrong with him and they spend the rest of their life, “suffering”, going from doctor to doctor who all say the same thing.

shilolo's avatar

@Mr. M. If only patients were so compliant as to accept a vitamin supplement in place of an antibiotic. Besides, most people agree that the placebo affect mainly works when the patient believes they are getting a real medicine. I’m not sure a vitamin (or sugar pill) would work, especially if the patient knows that it is only a sugar pill.

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