Prescriptions for placebos
Anna Kushnir
Friday, 24 October 2008 15:54 UTC
There was a one-sentence blurb in the Wall Street Journal this morning, which I found very intriguing.
“About half of U.S. doctors surveyed by NIH researchers say they regularly give patients placebo treatments.”
Unfortunately, I could not find any elaboration on this statement. Is the practice of prescribing placebos really this widespread? How does this work? Does the physician write out a script such that the patient cannot decode it’s a placebo and the insurance company pays? Or is this something that the doctor hands out in the office? I also wonder which conditions this treatment is most common for.
Any clarification of this practice would be greatly appreciated. Opinion would be nice as well – the word regularly in the sentence from the WSJ makes me a little nervous, for some reason.
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“Does the physician write out a script such that the patient cannot decode it’s a placebo”
That would explain the handwriting…
But pharmacists don’t have placebos lying around, do they? So it would be something they got from a trial? I am so confused. Maybe it was in the context of trials? -
Anna, is treatment = prescription? Or does the doctor say ‘you need to go for more walks’, or ‘take cold showers’, or ‘eat more garlic’? I think that might explain it (somewhat..)?
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I had that question as well, Steffi! “Treatment” to me implies more than medication. However, I think this may be a disconnect between clinical jargon and newspaper language. I couldn’t come up with an example of a placebo procedure or non-medication treatment. I am not sure that a walk fits in the category of placebo, as I understand placebo to mean a medication that the patient thinks is real. It’s tricking the patient, in a way, into believing they should be better, so they feel better. Does that make sense?
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Poking around more, the original Reuters news item talks about actually ‘giving patients harmless drugs, such as painkillers’ – which the physicians would just have in their office, so they’d just send the patient home with it, right?
Walks and cold showers and garlic will help with many things too, though :)
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Oops, posts crossed – I was interpreting ‘placebo’ more widely, to try and make it fit around ‘treatment’ – anyway, riddle solved, I think! But not the end of the discussion, I am sure.
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On the physician actually prescribing something.. watch out for ‘Obecalp’, according to wikipedia (check under etymology)..
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There is some blog chatter this week about a paper in BMJ (currently free to read) that sounds like it was the source of the ‘about half’ statistic.
About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period.
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Fascinating! I wonder if they tell the patients or (as they seem to be in the USA) bill them for some drug they are not taking. (I presume they have to write something on the bill.)
It seems bizarre to me – either the patient needs a drug in the opinion of the doctor, or he/she doesn’t. There only seems to be one case in which the prescription of a placebo is justified ethically, and that’s in a clinical trial.
Am I missing something?
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It almost seems like many patients are considered hypochondriacs by the doctors. Why else would the administration of any form of “medicine” be considered sufficient? Fake antibiotics? Why is saying “You don’t have an infection” enough of a treatment?
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But of course! For example, isn’t the entire system of homeopathy (so popular in India and the UK) standing upon placebo effect?
On one hand, The Lancet of August 27, 2005 featured articles highly critical of homeopathy centered around a meta-analysis of clinical trials of homeopathy compared with clinical trials of conventional medicine, concluding that homeopathic treatment was no better than placebo.
On the other hand, thousands of people (including, regrettably, my own parents) swear by it (so much so that my father, after a recent accident, took three homeopathic medicines – while being unable to take a common NSAID because of gastric irritation – and apparently got better). Since, for the life of me, I cannot understand the highly implausible homeopathic principle of mega-dilutions, what can I say here other than placebo effect, or other than that his injury was not that perhaps that serious, there was no infection (thankfully!), and the body took care of itself aided by complete bed-rest, my mother’s fussing, and their staunch faith that the homeopathic medicines were indeed working?
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