19 replies to this topic

[Still Waters]

Most family doctors have given a placebo to at least one of their patients, survey findings suggest.

In a poll, 97% of 783 GPs admitted that they had recommended a sugar pill or a treatment with no established efficacy for the ailment their patient came in with.

The PLOS One study authors say this may not be a bad thing - doctors are doing it to help, not to deceive patients.

The Royal College of GPs says there is a place for placebos in medicine.

http://www.bbc.co.uk...health-21834440

[Frank Merton]

Placebos work.  They work on a biochemical level, not just a psychiatric level.  The doctor should always downplay doubts about even the real drugs he provides.  (By the way, this effect also produces a lot of side effects too).

[Queen in the North]

They ain't in the BNF!

Sugar pill is different to treatment with no established efficacy.

Will post properly later, busy learning about Rxs actually!

[pallidin]

That's a bothersome article.

In the US, placebos are used in clinical trials to help determine the actual efficacy of a new drug(a very well recognized and respected procedure), but never as an actual course of treatment, even temporary. To my knowledge anyway.

Another aspect is abuse of authority. That is, what if the doctor(or nurse) said he was giving you a painkiller, but in fact it's a sugar pill, and he pockets the real drug for his own use or profit?

Edited by pallidin, 21 March 2013 - 04:11 PM.

[Mikko-kun]

pallidin, that can happen too, but it's better to not give a painkiller than to give one in general, if the outcome is patient still being healthy after the procedure or ailment, because of the side-effects. My nation (Finland) has half it's population using lighter painkiller on a regular basis, Burana is the most common I think. It can make your stomach more vulnerable at least, and can create new sources of pain that accumulate the more constant and on-going your usage is. Not worrying too much because of the negative placebo that worrying brings is good, but you shouldn't use them when you can go on fine without them. I've had a bone fracture, deadly hangovers, my back and other places killing me at work sometimes, but no painkillers ever. You can summon your own placebo with a force of will, concentration and meditation. It's not the pain we should fear anyhow, but the thing it warns us from.

[pallidin]

Mikko-kun, on 21 March 2013 - 04:49 PM, said:

It's not the pain we should fear anyhow, but the thing it warns us from.

I like that perspective.  

[Queen in the North]

pallidin, on 21 March 2013 - 04:09 PM, said:

That's a bothersome article.

In the US, placebos are used in clinical trials to help determine the actual efficacy of a new drug(a very well recognized and respected procedure), but never as an actual course of treatment, even temporary. To my knowledge anyway.

Another aspect is abuse of authority. That is, what if the doctor(or nurse) said he was giving you a painkiller, but in fact it's a sugar pill, and he pockets the real drug for his own use or profit?

They aren't supposed to be used in treatment here, either. Though a quick google concerning prescribing placebos did come up with some American articles you may want to check

Saying that, worldwide these days I do believe many drugs aren't only tested against the placebo, but against the current gold standard treatment (especially when studying a disease area in which it may be considered unethical to give one group of patients no medication at all). It's easier to show efficacy against the placebo effect, but the drug might actually be good if it is shown to be more efficacious than the current gold standard treatment.

Anyway, I'm not sure how these GPs are giving their patients sugar pills, because I'm fairly certain they can't prescribe them. I even checked through the bloody BNF (commitment right there).
And it's just downright irresponsible to treat viral infections with antibiotics, hoping for the placebo. Resistance, allergies anyone?

Edited by Queen in the North, 21 March 2013 - 05:33 PM.

[Render]

Of course they have , it's called homeopathy.

[Frank Merton]

Placebo works, that's the thing to remember, and there are physical bases for it -- not just psychology.  Otherwise how would homeopathy ever manage?  The idea of drugs is to find those that work better than placebo.  It is also important when hearing about reported side-effects of drugs to see them compared to the same side-effects of placebo.

The doctor has several mandates, but the first is to do no harm.  Failure to treat with a known effective drug might be deemed doing harm, but treating with an inappropriate drug with known side effects would be far worse than treating with placebo.  Not treating is even worse than that.

Some people don't think a drug is effective unless it is expensive.  Now that does create an ethical problem, but most doctors can find an excuse to give the pills away, or offset it otherwise.  When you have to use prescriptions and doctors can't give the stuff out themselves, as is getting to be more and more the case in over-regulated societies, the sensible benefits of giving a placebo are lost.

[bmk1245]

Render, on 22 March 2013 - 02:06 PM, said:

Of course they have , it's called homeopathy.

...or acupuncture, which is not better than sham (random punctures), or placebo (fake punctures).

[Frank Merton]

I dunno; I think acupuncture has some creditable support, and have had personal and good experience with it.  Who knows?  My experience could be placebo, but I would like to see.

[Queen in the North]

Frank Merton, on 22 March 2013 - 02:42 PM, said:

I dunno; I think acupuncture has some creditable support, and have had personal and good experience with it.  Who knows?  My experience could be placebo, but I would like to see.

I haven't studied the literature myself, but my notes on complementary and alternative medicine indicate there's very little evidence to support acupuncture.

[bmk1245]

Frank Merton, on 22 March 2013 - 02:42 PM, said:

I dunno; I think acupuncture has some creditable support, and have had personal and good experience with it.  Who knows?  My experience could be placebo, but I would like to see.

To see what exactly? E.Ernst paper (J Inter Med. 2006: 259(2):125–137)? Or short review by Steven Novella of A.Vickers et al Arch Intern Med. 2012;172(19):1444-1453 paper?

[Queen in the North]

Ummm... this study was funded by a CAM group.

Interesting what their definition of 'PLACEBO' is though.

Quote

Positive suggestions
Nutritional supplements for conditions unlikely to benefit from this therapy (such as vitamin C for cancer)
Probiotics for diarrhea
Peppermint pills for pharyngitis
Antibiotics for suspected viral infectionsSub-clinical doses of otherwise effective therapies
Off-label uses of potentially effective therapies
Complementary and Alternative medicine (CAM) whose effectiveness is not evidence-based
Conventional medicine whose effectiveness is not evidence-based
Diagnostic practices based on the patient’s request or to calm the patient such as
Non-essential physical examinations
Non-essential technical examinations of the patient (blood tests, X-rays)

Off label use is not a placebo. Many drugs are useful for treating ailments other than listed in the marketing authorisation, they just haven't put the money into more clinical trials to prove it yet. Example in link.

Also, MOST of conventional medicine is not evidence based.

[ouija ouija]

Queen in the North, on 21 March 2013 - 05:32 PM, said:

Anyway, I'm not sure how these GPs are giving their patients sugar pills, because I'm fairly certain they can't prescribe them. I even checked through the bloody BNF (commitment right there).

This was what leapt off the page at me too! How are doctors in the UK writing out prescriptions for 'sugar pills'? Unless they're private doctors maybe?