Survey: Doctors Give Placebos, Don't Tell

[OhioChick]

Source: AP

Half Of US Doctors Not Honest With Patients, Say Survey

POSTED: 5:13 am EDT October 24, 2008
UPDATED: 5:24 am EDT October 24, 2008

About half of American doctors in a new survey say they regularly give patients placebo treatments -- usually drugs or vitamins that won't really help their condition.

And many of these doctors are not honest with their patients about what they are doing, the survey found.

That contradicts advice from the American Medical Association, which recommends doctors use treatments with the full knowledge of their patients.

"It's a disturbing finding," said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. "There is an element of deception here which is contrary to the principle of informed consent."

The study was being published online in Friday's issue of BMJ, formerly the British Medical Journal.

Read more: http://www.newsnet5.com/health/17793094/detail.html

[angstlessk]

1. yeah, but what do they bill the insurance companies for?

[knitter4democracy]

12. Doctors don't bill for meds. They bill by the level of care.

It's roughly by how much time they spend, what procedures they do, stuff like that, but doctors are prohibited by law to sell medicine out of their office, so they're not billing for the meds.

[Realityhack]

2. It's not a placebo if you tell the patient n/t

[Azlady]

3. DOes this surprise any of us anymore?

I had a Dr give me a supplement for an issue, when I googled it... it had NOTHING to do with the issue I had at all. Sad, very sad. I trust a Doc about as far as I can throw them!

[newtothegame]

4. Disturbing n/t

[Indenturedebtor]

5. Half of US patients insist that they need antibiotics

and will go around asking doctor after doctor to give them the drugs they want until they find someone who does.

Seriously it might not be half, but I've read that this is a huge problem and has only gotten worse with the prominence of the internet.

I'm sure 99.9% of them aren't doing this to be diabolical... they're actually trying to help their crazy patients.

[OhioChick]

7. I agree with you on the antibiotic issue...

However, if you read the entire article, doctors are practicing this (without patient consent) on people with arthritis, joint problems, depression, etc.

Not good.

[LisaLynne]

9. Depression in particular disturbs me ...

It smacks of going back to the "it's all in your head" thing with mental illness. Just does not make me comfortable.

[OhioChick]

34. Now hypothetically speaking....

Let's say that someone goes in to see their doctor (for depression) who believes it "is" in the patient's head and prescribes some placebo. It's common knowledge that an anti-depressant takes 4-6+ weeks to begin working.

Having said that....the patient becomes more and more depressed as the days pass and doesn't call the doctor as the doctor told the said patient that they'd begin noticing a difference in X/amount of weeks and the patient commits suicide.

What happens to that doctor?
A patient paid the physician for his/her services and ended up dead due to the physician's belief in the use of placebos. (in which the patient was not aware)

Sounds like that type of situation has "Medical Malpractice" written all over it.

[orleans]

6. i pay cash for my drugs. i'd lose my fucking mind if i found out i was

paying for a crock of shit.

[strategery blunder]

8. If a doctor is going to willingly prescribe placebos,

then the doctor should pay for it.

Now I guess I'm going to have to bluntly ask that question whenever I am prescribed medicine...because I will not pay for shit that will not work. Doctors may not think they're breaking the "Do no harm" bit of the Hippocratic Oath, but every time they prescribe something they believe will have no effect other than the "placebo" effect, they are doing harm to the patient's wallet.

If they want to prescribe placebos, they should have "free drug samples" of sugar pills to hand out for that purpose.

[madmax]

10. I don't understand

The pharmacist would know - how do they counsel someone asking about drug reactions or allergies? These placebos are hand outs at the dr's office?

[knitter4democracy]

11. Now, wait a minute. Placebos work.

My husband often recommends supplements and even homeopathy (saying that he's had patients have good results from it, which is true) that he knows won't interfere with their other meds. When he has a patient who just isn't getting better, who cannot handle the medicine for his condition, or who's a hypochondriac (he has several--they're in every week and try to get our home number all the time from everyone so they can call him at any time of the day or night), he suggests something he knows will be safe for them that just might work.

Viagra and the other pills are only marginally better than the placebo in the studies, and they have worse side effects. Many meds are in the same boat, and that's because placebos actually work. My husband talked my ob/gyn into trying a placebo on me during labor, and it worked better than anything else we'd tried. Considering my bad reactions to so darn many drugs, I take supplements, and I feel better. I don't care if it's the placebo effect of if it's real: I feel better.

Now, doctors who prescribe expensive meds that do have side effects and such for the wrong conditions, that I'm not okay with. That's not as safe, and it's too expensive.

[pitohui]

16. can you point to any study showing a placebo worked for more than 3 weeks?

i would like to see it, not being sarcastic but this was contrary to what i've been told

think of the billions in medical research that would not be necessary if placebos worked

[knitter4democracy]

21. I'll have to look into it.

I'll ask Hubby, too. I know that placebos always do well in the random drug trials, though, and some of those are longer than a few weeks. Drugs don't get the okay unless they beat the placebo, but I've always found it funny how well the placebo does sometimes.

[knitter4democracy]

24. Found some studies:

http://content.nejm.org/cgi/content/short/344/21/1594 (you have to have a subscription, but maybe you can get it at your library or hospital's library)

From May 24, 2001:
Is the Placebo Powerless?— An Analysis of Clinical Trials Comparing Placebo with No Treatment

Asbjorn Hrobjartsson, M.D., and Peter C. Gotzsche, M.D.

Conclusions: We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.

This seems to justify your position that they really don't work or that the effect isn't lasting.

There was a book review in NEJM in 2006 of this book that sounds like it might have the info in it that you're looking for:
The Placebo Effect and Health: Combining Science and Compassionate Care
By W. Grant Thompson. 350 pp. Amherst, N.Y., Prometheus Books, 2005. $18. ISBN 1-59102-275-4

http://jama.ama-assn.org/cgi/content/abstract/271/20/16...

From May 25, 1994:
The importance of placebo effects in pain treatment and research
J. A. Turner, R. A. Deyo, J. D. Loeser, M. Von Korff and W. E. Fordyce
Department of Psychiatry, University of Washington, Seattle 98195.

OBJECTIVE. To estimate the importance and implications of placebo effects in pain treatment and research from the existing literature, with emphasis on their magnitude and duration, the conditions influencing them, and proposed explanations. DATA SOURCES. English-language articles and books identified through MEDLINE (1980 through 1993) and PsycLIT (1967 through 1993) database searching, bibliography review, and expert consultation. STUDY SELECTION. Articles were included if they pertained to the review objectives. RESULTS. Placebo response rates vary greatly and are frequently much higher than the often-cited one third. Placebos have time-effect curves, and peak, cumulative, and carryover effects similar to those of active medications. As with medication, surgery can produce substantial placebo effects, and this possibility is commonly overlooked in case series reports on back surgery. Individuals are not consistent in their placebo responses, and a placebo-responder personality has not been identified. Models advanced to explain placebo effects emphasize the role of anxiety, expectations, and learning. CONCLUSIONS. Placebo effects influence patient outcomes after any treatment, including surgery, that the clinician and patient believe is effective. Placebo effects plus disease natural history and regression to the mean can result in high rates of good outcomes, which may be misattributed to specific treatment effects. The true causes of improvements in pain after treatment remain unknown in the absence of independently evaluated randomized controlled trials.

This study seems to suggest that some people are more likely to benefit from placebo than others and for longer times. Interesting.

[pitohui]

27. "little evidence that placebos had powerful clinical effects"

that's what i've always heard


i have myself been helped in a clinical setting (i was hypnotized prior to oral surgery) but the effect lasted for under 2 hours -- a better argument for hypnosis in the doctor or dentist's office than an argument for the placebo effect itself if you ask me

the second study, which claims that there is also a placebo effect from some back surgeries, is something i've heard before -- but again it is not an argument that giving a placebo DRUG, as opposed to a one time dramatic intervention like surgery -- would be effective

[knitter4democracy]

29. Interesting about pain, though.

That's what it worked on for me, but it didn't last long enough for the hour of suturing afterwards.

I'm having trouble wading through pages of studies that list placebo somewhere in the title. When I find more recent stuff, I'll post it, too.

[bananas]

38. How about 8 studies where placebos worked for at least 12 weeks?

http://www.ncbi.nlm.nih.gov/pubmed/18036616?ordinalpos=...

1: J Psychiatr Res. 2008 Aug;42(10) 91-6. Epub 2007 Nov 26.

The persistence of the placebo response in antidepressant clinical trials.
Khan A, Redding N, Brown WA.

Northwest Clinical Research Center, Bellevue, WA 98004, USA. [e-mail]

Our objective was to assess the persistence of the placebo response during at least 12 weeks of continued placebo administration in depressed patients who have responded to 6-8 weeks of acute placebo treatment. We identified 8 placebo-controlled antidepressant trials with a total of 3,063 depressed patients in which, after acute phase placebo treatment, placebo was continued for more than 12 weeks. The number of patients entering the continuation phase and percentages relapsing during this phase were determined. Based on the total number of patients entering the continuation phase 79% of placebo responders remained well (did not meet relapse criteria) during this phase compared to 93% of antidepressant responders. Although significantly more patients on placebo than on antidepressants relapsed in the continuation phase, 4 out of 5 placebo responders stayed well. The widely held belief that the placebo response in depression is short-lived appears to be based largely on intuition and perhaps wishful thinking.

PMID: 18036616

[Fire_Medic_Dave]

18. Does he lie to his patients and tell them the supplements are some other drug?

[knitter4democracy]

22. No. He's a doctor, so he's not selling or giving the drugs.

He's not allowed to prescribe a placebo or to give one unless it's in a randomized controlled trial (which he doesn't do). All he does is offer supplement ideas or homeopathy so the patient can go to the store and get it for him/herself. He's had many patients who've done really well with homeopathic treatments, and all those are are sugar water or pills. He doesn't argue with the results, though.

[pitohui]

13. that's sort of what "placebo" means

when my doc pulled this crap on me (recommended calcium) i spoke up and pointed out the decades of calcium had not helped my mom because it is so poorly absorbed

at that point he smiled, admitted to the "gotcha" and said, "well it does no harm"

true, it does no harm for most of his patients (our area is well to do and i'm prob. the poorest patient he sees) but i personally don't need to spend money on supplements that don't work

i think a lot of times when docs recommend vitamins/minerals, that's what it's about -- they're giving you a relatively safe, cheap pill to humor you

a placebo generally only works for 3 weeks when it works at all, was my understanding of the science, so it's pointless for a chronic situation

[Fire_Medic_Dave]

14. Bad poll, off label use is not a placebo.

Neurontin comes to mind as a drug prescribed more often off label than what it was initially approved for. My wife takes it for restless leg syndrome according to this poll it's a placebo. Not only is the prescribing of true placebos sugar pills contrary to the principle of informed consent, if the doctor or pharmacist is mislabeling drugs and charging for them, then it's probably medicare fraud, possibly mail fraud.

David

[Mojorabbit]

19. I agree

and the wording in the article is very strange. Off label use is not placebo.

[BearSquirrel2]

15. I find the rate of antibiotic treatment disturbing ...

I find the rate at which doctors are undermining the effectiveness of antibiotic treatements disturbing. If someone patient with the flu comes in and demands anti-biotics, I think giving them "samples" is an ideal solution. It gets them out of the office and they get a placebo effect from watching their flu run it's normal course.

[Fire_Medic_Dave]

17. How about the docs just be honest and tell them no?

What if someone comes in demanding huge doses of Oxycontin? I'm pretty sure they have the ability to tell people no.

David

[customerserviceguy]

26. Then the patient will keep shopping

until they finally find Rush Limpball's doctor, or someone like that.

[Fire_Medic_Dave]

32. Maybe so, is it more ethical to lie to them and give them a placebo?

[customerserviceguy]

45. If the patient really has a problem in their head, rather than their body

and the placebo is for their head, sounds like accurate treatment to me.

[Fire_Medic_Dave]

51. Actually a referral to a psychiatrist would be appropriate.

Lying to patients with mental problems will only worsen their problem if they find out they've been lied to. These docs were treating arthritis so I don't see how your argument applies.

David

[customerserviceguy]

53. In many cases, yes, it would be appropriate

but most psychiatric benefits included with health insurance plans just are inadequate to cover it. With arthritis, there's really nothing you can do, so treating a patient with a placebo is about all a doctor can do, maybe we really don't need to pay a specialist to do that, if it 'works'.

Fifty years ago, before HMOs, PPOs, and micro-managed care, doctors spent time with their patients. The feeling that one was being cared for and treated is something we just don't have as much of today. Is it any less ethical that this "I care about you" feeling is administered through placebo to a drug-believing society? Several decades ago, we weren't bombarded with TV commercials about how the solutions to life's problems came out of a pill bottle, we weren't stuffing Ritalin down the throats of little kids who are just being kids, and we had more of an attitude that you had to "tough it out" when you're sick, we even let people stay awhile longer in hospitals to get better before dumping them back into their everyday lives.

I guess I can't blame a doctor for using whatever he/she can find to help patients, we just don't have the tools that were used some time ago.

[Fire_Medic_Dave]

57. There are lots of treatments for arthritis and they don't involve placebos.

Again true placebos have never been shown to help patients. Painkillers, sedatives and antibiotics have, which is what 67% of the "placebos" that the doctors used. So just to be clear you think it's ethical for doctors to lie to patients if they can't come up with a diagnoses or don't believe in that particular illness?

David

[Fire_Medic_Dave]

20. Is there some big anti-pain medication bias in the UK?

The article seems to imply that painkillers are a placebo and not an actual treatment for rhuematoid arthritis related pain, that just strikes me as utter nonsense. But hey I'm no medical ethicist.

David

[knitter4democracy]

23. Painkillers are a placebo?

RA is horribly painful. Why wouldn't you treat that pain? *shudder* What kind of bias does the author have?

[Fire_Medic_Dave]

33. That's what the article said 41% of the doctors said painkillers were the most common placebo used.

That doesn't sound like a placebo to me.

David

[knitter4democracy]

41. Ummm. What? That makes no sense.

Painkillers aren't placebos. They're backed up by all sorts of studies and years of evidence that they work. I find it scary that there are doctors who think that painkillers are placebos.

[Fire_Medic_Dave]

42. We agree.

[EFerrari]

44. Are you kidding? Where do you think all of our Puritans came from?

lol

[customerserviceguy]

25. Faith healing was about all medicine was 150 years ago

why are we surprised to find doctors are still using it today? The biggest problem that I have is they charge way more for it than the other faith healers, like acupuncturists, chiropractors, naturopaths, and aromatherapists.

[knitter4democracy]

30. Acupuncture's been proved to work, though.

Lots of studies have shown it to be as effective as meds or better for a host of issues, usually pain related. I just started with an acupuncture doctor (my doctor wanted me to try it, since I can't take prednisone and my asthma's bad), and I've been able to go down in my asthma meds.

[customerserviceguy]

46. Glad it worked for you

but then, so do placebos. I don't believe in alternative medicine, so it wouldn't work for me.

[knitter4democracy]

47. Interesting. Does that mean that Hubby's med school profs were wrong?

They covered acupuncture in a couple of his classes at Case Western. One of his profs said that acupuncture's two thousand year old history was a case of classic empirical science. The New England Journal must be wrong, too, as I've seen several studies in there that show that acupuncture works, especially for migraines and other pain issues. All those MDs must be lying in order to do a massive placebo effect, then.

I wasn't sure about it when I went. It was really weird and not like anything I'd ever been through. Then, after the needles were in and I was lying there, my ears started burning, and then my face got flushed, and I got really cold. Weird. This last session, when he put a needle in a spot on my face, it hurt like the dickens, and when he pulled it out, everything started spinning and I got really sick to my stomach. The needles do something, since I hadn't had vertigo that bad in weeks. I'm not sure that it's the cure-all so many think it is, but my asthma's better on lower doses of medicine, and something's happening.

[Missy Vixen]

49. knitter4democracy, I wish I could send you to my acupuncturist

She's the fifth generation in her family that does acupuncture, and she made back pain of fifteen years' duration vanish after two treatments. She's amazing.

What did the acupuncturist say after you talked with him about the sensations you had when he removed the needles? She put one in the meridian between my thumb and my index finger on my left hand about a month ago that hurt, but other than that, nothing else has hurt.

The first time I went, I felt a surging sensation throughout my body. It wasn't unpleasant, but it wasn't what I was expecting. It seems like every person that tries acupuncture has a different result. (The person that referred me warned me that I might cry during treatment; he evidently does. So far, no tears.) I'm getting relief from her I never got with painkillers or other MD-recommended prescriptions, so I'm going to keep doing this.

I hope it goes better, and I'm glad to read that you're seeing an improvement in your asthma as a result.

Julie

[knitter4democracy]

50. He completely freaked out.

He pulled it out when he saw how much pain I was in (almost made me cry, and I didn't cry when I broke my elbow this summer) and watched me, asking me to describe exactly how I felt. Then, he found another point on my arm on the same meridian and pressed on it, wondering if there was just a lot of blocked energy or whatever, and that hurt. The needle that he put in there didn't hurt, though. He checked on me a few times while I laid there, and the weirdest thing was that I felt this white-hot sensation going in waves from my head to my feet where every needle was, including the spot on my face where he'd taken it out. I've had vertigo all week since then with pain in that spot. I'm going to ask him to put a needle in there on Tuesday to release the rest of whatever that was. Maybe that'll make it better. We'll see what he says.

Dardest thing I've ever been through.

[customerserviceguy]

54. Again, I'm glad it has an effect on a lot of people

but so would being treated by a witch doctor with a voodoo doll. The mind has incredible power over the body, but you have to be susceptible to this sort of thing. Every hypnotist knows that human beings are arranged on a continuum as to how easily they can be hypnotized, some people are strong-minded enough for it not to be possible.

On the other hand, chemistry uses known laws of physics, and produces reactions that are uniform across a wide spectrum of humanity. Truly, some medicines work better or worse depending on gender, age, and race, but that's just a matter of discovering the reasons why body chemistry is different in different individuals and the groups they belong to.

I'm also aware that there is a lot of bad science out there, and a profit-driven motive has turned the Louis Pasteurs and Jonas Salks of the world into people who are more concerned about their stock options than winning Nobel Prizes for truly advancing knowledge and alleviating human suffering.

[knitter4democracy]

56. That's true about the continuum, but I'm not sure about the meds.

I'm one of those who can't take many meds. Heck, my doctor's getting to the point that she's scared to prescribe anything new, what with all the really bad reactions I've had in the last couple of years. Thank goodness stuff like acupuncture and massage are still around for those of us they don't formulate those meds for who just plain can't go the allopathic medication route.

[Fire_Medic_Dave]

52. Placebos haven't been shown to be effective long term.

[customerserviceguy]

55. That's why they have to keep switching them around

The placebo effect is caused by the person getting the placebo internalizing the "I'm being treated" into viewing their symptoms differently. I would even say in some cases that stimulates enough of the body's own defenses into finishing the job of treating the patient.

Have you ever seen a toddler fall flat on their face? If Mom or Dad comes up and just picks the kid up, they often go on as if nothing much had happened. But if the parent rushes over with a look of abject fear on their face, the child reads that as "Something's very wrong, I must be hurt!!!" and the tears begin to flow.

As the practice of medicine has turned from art to science, we have minimized the art of making people feel cared for during a physician visit. We've been substituting with drugs, which continue a portion of the "caring" for the length of the prescription. We've also developed a feeling of need for drugs, when people go into a doctor's demanding antibiotics for things that those drugs will not treat, they feel shorted when they go out with nothing.

Big pharma loves it, they've been nurturing us this way for a long time now. When you cannot watch a half-hour of commercial TV without seeing an ad for some prescription drug, that should tell you how pervasive they have become. The effect of the barrage of advertising actually exacerbates the placebo effect.

[Fire_Medic_Dave]

58. Please stick with repairing laptops.

You really have no idea what you are talking about. Do you actually think that painkillers used for arthritis related pain are a placebo? Doctors have no business giving any drug because a patient demands it. Plain and simple doctors should be honest with their patients. For the 1 in 1,000 that actually is a hypochondriac lying to them only fuels their delusion, which would cause harm and therefore is against the hippocratic oath.

David

[caitlincsnms]

28. I hope my pills aren't placebos

[onecent]

31. How is the prescriptin written to tell the pharmacist that it is not

the real drug, but a placebo?

I don't understand that?????

[smurfysmurf]

35. They should be sued

Placebos don't cure diseases.

[LisaL]

36. But placebo effect is a real effect.

The patient might feel better because of the placeebo.
And if the doctors were to tell the patient it's a placeebo, it won't work.

[OhioChick]

37. But....

If a person is paying for a service, shouldn't they be entitled to the "real" service? The key phrase that you used was "might feel better." If not....then I assume they have to cough up even more $$$$. I just don't feel that a patient should be treated (without consent with a placebo) behind their back.

A good example would be post #34.

[LisaL]

39. You can't treat someone with placebo

if you get their consent. The whole concept behind placebo is that patient thinks he/she is getting real meds, and that's what gets the patient better.

[OhioChick]

43. I think that can be a very dangerous practice. n/t

[Poseidan]

40. by doctors they mean pastors

or priests

[Haole Girl]

48. It doesn't surprise me.

Not one bit.