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Still Waters

Placebo drugs given by 'most family doctors'

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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

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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).

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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!

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Posted (edited)

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

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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.

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

I like that perspective. :tu:

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Posted (edited)

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

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Of course they have , it's called homeopathy.

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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.

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Of course they have , it's called homeopathy.

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

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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.

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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.

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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?

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

Interesting what their definition of 'PLACEBO' is though.

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.

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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?

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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?

They aren't. See my above post :)

The actual figure quoted for doctors giving 'real placebos', either a sugar pill or saline injection, was 12%. About 90 from the sample of 783. Which leads me to believe there's a possibility a very few number of GPs have given patients saline injections or possibly Tic Tacs* right there in the surgery when they present with their symptoms, and basically saying "This'll sort your right out! On yer way, now."

*only kidding ;)

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It's okay to inject salt into people willy-nilly? :o

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I have noticed one thing -- doctors here in VN always give you an injection no matter what ails you. I've always wondered and so always asked for a prescription instead, and hip-ho no problem. Where's my pen? I figure they give you something good if there's something good to give you, otherwise they give you some vitamins or tonic or something like that.

Normally if you are sick here you go to a pharmacist (although small clinics are everywhere too and easy to walk into without an appointment -- they deal mostly with pregnancy issues and routine injuries). The pharmacist asks you a bunch of questions and then gives you a few packets of pills, each packet containing three or four of something. They are labeled so I can check the internet and see what they are, and they seem to be sensible enough -- mostly symptom relief but sometimes something more potent. All quite cheap. They seem to have a formulary that they have memorized.

There are also the Chinese pharmacies, where something similar happens except you don't know what you get. Still, for things like my hay fever, it works. Nowadays with my diabetes and my blood pressure and my liver and whatnot, I have about a dozen pills I have to take probably for the rest of my life. The only one that I am nervous about is an anti-viral against the hepatitis, but I take it and the others as ordered. I don't need prescriptions for any of these but of course monitoring blood glucose and blood pressure takes special equipment -- things I get for free (I'm not sure why).

They are really gung-ho now about sonograms, and lately every three months they've been sonogramming almost all of me. They are concerned about some blockage or something going to my brain and of course they watch my liver. If you are gonna have a cluster of chronic problems like me, I think Vietnam is a good place to live. The most a whole day at one of the larger clinic/hospitals, going through the whole routine, has ever cost me was 800,000 vnd -- $40 US, and truth to tell I think they are far more thorough and just as competent as in the States.

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Ouija, no its not okay. Its better than giving people antibiotics for a viral infection though. It is a small number of GPs admitting to saline injections or sugar pills that at least, not what the article would have us believe. But whenever you break the skin there is always a chance of introducing pathogens.

Frank, in Vietnam can you buy antibiotics without a prescription? Just interested :)

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I suspect probably so, although you would no doubt get a lecture and a bunch of questions as to why you want it. You would have to ask for it by name, and few Vietnamese ask for specific drugs -- as I said they just answer questions and are given something. I think there are a few that are not available through pharmacies except pharmacies in hospitals.

They are very slow to give out Cipro to Westerners who ask for it (this seems to be the thing westerners automatically want when they have travel-trouble, and I strongly doubt a Vietnamese could get it without going to a clinic, but it would be available there if the doctor thought it needed (westerners get away with a lot of things).

One friend of mine who had a tooth abscess got an antibiotic (I don't remember which one) for that from his dentist after the abscess was removed, but a dentist is not much different from a doctor.

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