plcaebos

Verbal · Post by **Verbal** » 15 Jul 2010, 00:30

what yer thoughts on doctors intentionally prescribing placebo pills to patients for certain things?

Meat Engine · Post by **Meat Engine** » 15 Jul 2010, 00:35

If the patient is a hypochondriac, by all means. Or let's say a person has mild anxiety, but enough to complain. A placebo might work.

Verbal · Post by **Verbal** » 15 Jul 2010, 00:40

you dont think it's better to reason/explain the situation to a patient?

that if people start deceitfully prescribing placebos for things it will/would undermine the doctor/patient relationship? that patients would (rightly) lose any trust in what doctors tell them?

Abzu · Post by **Abzu** » 15 Jul 2010, 02:20

[quote name="The Fu Monster"]If the patient is a hypochondriac, by all means. Or let's say a person has mild anxiety, but enough to complain. A placebo might work.[/quote]

I think this is fine.

Meat Engine · Post by **Meat Engine** » 15 Jul 2010, 02:54

[quote name="Verbal"]you dont think it's better to reason/explain the situation to a patient?

that if people start deceitfully prescribing placebos for things it will/would undermine the doctor/patient relationship? that patients would (rightly) lose any trust in what doctors tell them?[/quote]

When stubborn patients meet impatient doctors, shit happens. What about parents and pediatricians? I imagine it to be far worse. I think that placebos can have a place in prescriptive medicine, though justifiably limited. What if a parent demands an antibiotic for the child, "or else"? Many people do not understand the limited use of antibiotics, and the importance of reserving their use. They want to feel as if they're being proactive. Let them have that feeling. Prescribe the placebo.

If all people were reasonable, we wouldn't be having this conversation. Doctors would explain the necessity or lack thereof in prescribing medicines. The patient would defer to the higher authority, and that would be it.

Mr. P · Post by **Mr. P** » 15 Jul 2010, 03:00

:plcaebos:

Verbal · Post by **Verbal** » 15 Jul 2010, 03:14

if the doctor doesnt think antibiotics are appropriate....but the patient "demands" them, the doctor should explain why the are not needed. and if that doesnt satisfy the patient, they are free to go see someone else. imo its extremely important that patients can go to doctors and trust the doctor is being frank and honest with them. that they are treating them as an adult (what about retarded people? - i dont know). just because some people are unreasonable, shouldnt mean we compromise the doctor/patient relationship for everyone.

im fairly sure i think it would be better if placebo prescribing was not allowed - i just wanted to have the discussion - i may change my mind

open to arguments for and against

Meat Engine · Post by **Meat Engine** » 15 Jul 2010, 03:25

I understand the desire for an honest, transparent relationship between patients and doctors. Let me ask this, are there currently any situations where obfuscation or omission are ethically acceptable practices?

jawn galliano · Post by **jawn galliano** » 15 Jul 2010, 05:02

[quote name="Verbal"]if the doctor doesnt think antibiotics are appropriate....but the patient "demands" them, the doctor should explain why the are not needed. and if that doesnt satisfy the patient, they are free to go see someone else. imo its extremely important that patients can go to doctors and trust the doctor is being frank and honest with them. that they are treating them as an adult (what about retarded people? - i dont know). just because some people are unreasonable, shouldnt mean we compromise the doctor/patient relationship for everyone.

im fairly sure i think it would be better if placebo prescribing was not allowed - i just wanted to have the discussion - i may change my mind

open to arguments for and against[/quote]

well, what if referring the stubborn patient elsewhere results in another doctor prescribing antibiotics unnecessarily? a placebo would eliminate that risk and its associated public health risks, as well as getting the patient to shut up.

Lavabug · Post by **Lavabug** » 15 Jul 2010, 05:06

Is it a common or institutionalized practice?

If it is, bad idea imo, but that's just me. I think the integrity of the health service should remain intact for everyone. Tricking a willfully ignorant patient into doing the right thing for his health is a noble deed at heart but if a doc is going to do it, it should be done under his own responsibility to safeguard the integrity of others in the field if he ever gets caught doing that by an authority or something.

Placebos should not be an institutionalized practice, blinding patients with science & cold hard FACTS should be. :pelvicthrust:

Verbal · Post by **Verbal** » 15 Jul 2010, 05:09

[quote name="The Fu Monster"]I understand the desire for an honest, transparent relationship between patients and doctors. Let me ask this, are there currently any situations where obfuscation or omission are ethically acceptable practices?[/quote]

no.... i cant think of one anyway.

two that i suppose may be claimed as being such (but are not really) would be:

1 before someone goes for an operation (or starts a medication), doctors dont list every potential sideeffect that ever has ever been suggested as maybe being possible. the major ones are supposed to be disclosed (common ones, and rare serious ones). and if patients ask - you are supposed to be completely honest. maybe give them some more info if they want it. but thats not really in the same league as deceitfully precribing placebos. this situation, particularly for operations, is probably quite well covered because of the fear of being sued as well as the ethical issues.

2 gray areas like..... when a lousy diagnosis is suspected. again, people arent supposed to lie, but if someone comes in with anaemia, generally the doctor shouldnt go "could be colon cancer". The degree to which different conditions are suspected at different times, and how serious they are, and how much one holds back on mentioning things like cancer as being possibilities, is obviously a gray area. Again, not really in the same league as the placebo thing.

i think it would undermine the entire field of medicine. i cant see how it would be a good thing. i think it would make medicine almost equivalent to homeopathic-type charlatans. you may as well refer patients to homeopathists.

also - im not sure how it would ever be appropriate for a hypochondriac. they are people who worry they might have something serious wrong. they arent generally looking for treatments...theyre looking for tests. i suppose you could do a sham test - but that seems like a terrible idea.

Verbal · Post by **Verbal** » 15 Jul 2010, 05:23

[quote name="hard-on bearer Incognito"]
[quote name="Verbal"]if the doctor doesnt think antibiotics are appropriate....but the patient "demands" them, the doctor should explain why the are not needed. and if that doesnt satisfy the patient, they are free to go see someone else. imo its extremely important that patients can go to doctors and trust the doctor is being frank and honest with them. that they are treating them as an adult (what about retarded people? - i dont know). just because some people are unreasonable, shouldnt mean we compromise the doctor/patient relationship for everyone.

im fairly sure i think it would be better if placebo prescribing was not allowed - i just wanted to have the discussion - i may change my mind

open to arguments for and against[/quote]

well, what if referring the stubborn patient elsewhere results in another doctor prescribing antibiotics unnecessarily? a placebo would eliminate that risk and its associated public health risks, as well as getting the patient to shut up.[/quote]

in a tutorial once i remember this antibiotic issue coming up. the situation was something like "patient comes in with a cold and wants abx. would you give them?" some people said that they would.(these people would have probably failed micro for saying this the year previously) one of the reasons was that "well they would just go to someone else and get the abx". that is completely fucking negligent, reckless and retarded. imo. surely we all agree on that..? (

)

i dont know how to deal with that problem. apart from more quality control on gp practices or something. i definitely dont think them giving in and prescribing unecessary abx, or pretending to give in, and prescribing a placebo are good ideas.

while it may satisfy the patient with a cold looking for abx to give them a placebo "on the qt", such behaviour is surely just going to make such demanding worse (whether you give abx or placebo). and, although giving the placebo doesnt obviously carry the problems associated with unecessary precription of abx, it is again, just completely ruining any hope of establishing trust between doctors and patients.

Verbal · Post by **Verbal** » 15 Jul 2010, 05:53

[quote name="Lavabug"]Is it a common or institutionalized practice?

If it is, bad idea imo, but that's just me. I think the integrity of the health service should remain intact for everyone. Tricking a willfully ignorant patient into doing the right thing for his health is a noble deed at heart but if a doc is going to do it, it should be done under his own responsibility to safeguard the integrity of others in the field if he ever gets caught doing that by an authority or something. [/quote]

even if someone did it under their own responsibility, and was found out, and admitted they were wrong, and lost their licence or something....the fact that it happened at all would be a pain in the ass for the other doctors. but yea, if youre going to do it, that is the way to do it

(assuming there is a situation where it is a noble deed).

im not aware of it being common or institutionalised practice. although some doctors are big into alternative medicine, so it would surprise me if it doesnt happen somewhere. id say things that they can claim actually are treatments (like alt med things) are more common than sugar pills though. or prescribing actual meds in a situation with very little reason to think they will work (but enough of a reason that you cant get called on it). im speculating though. and some of these people may think they are actually helping (ie doing more than a placebo), which makes it different to the question at hand.

[quote name="Lavabug"]Placebos should not be an institutionalized practice, blinding patients with science & cold hard FACTS should be. :pelvicthrust:[/quote]

Hugo. · Post by **Hugo.** » 15 Jul 2010, 18:58

I truly believe that when Johnny Gleeso becomes Dr. Johnny Gleeso....... EVERYONE WILL GET BETTER.

Verbal · Post by **Verbal** » 15 Jul 2010, 19:13

shadowalk · Post by **shadowalk** » 15 Jul 2010, 20:47

[youtube]a4JhtoR39M0[/youtube]

Lavabug · Post by **Lavabug** » 15 Jul 2010, 21:12

:plcaenta:

Verbal · Post by **Verbal** » 15 Jul 2010, 21:29

childbirth and placenta are both proof that satan is real

vomit, vomit, vomit, cringe, vomit, cringe, vomit, an hero

Lavabug · Post by **Lavabug** » 15 Jul 2010, 21:49

I was going to ask what that meant, but then I remembered sense-making is not a requirement.

Abzu · Post by **Abzu** » 16 Jul 2010, 03:45

I thought my son's placenta looked cool.

Meat Engine · Post by **Meat Engine** » 16 Jul 2010, 04:44

Meat Engine · Post by **Meat Engine** » 16 Jul 2010, 07:52

The point of a placebo is to serve as a baseline for late stage clinical drug trials. Efficacy over placebo is an important benchmark for potential drugs.

Meat Engine · Post by **Meat Engine** » 16 Jul 2010, 10:17

To play devil's advocate to my position, the argument is that it undermines trust between patient and doctor. There is an implied contract between the two. Doctors will, to the best of their abilities, diagnose any malady and explain any treatment options in a way that allows a patient to give informed consent. If doctors prescribe placebos hoping that the perception of treatment will be enough, then the implied contract can be seen as invalid. The doctor is no longer acting in good faith, and the patient cannot give fully informed consent. The placebo effect works so long as the person taking the placebo is unaware, necessitating the lie by omission on the part of the doctor.

Hugo. · Post by **Hugo.** » 16 Jul 2010, 18:36

I'm study homoapathy.

Meat Engine · Post by **Meat Engine** » 16 Jul 2010, 18:55

[quote name="nell's tits"]So, even if the placebo could be used effectively in clinical treatment, it would still violate doctor and patient trust. This would certainly be a problem. If the patient were told beforehand that they might be taking a placebo, and that clinical trials show that it is equally effective at treating their symptoms as the real drug, then this would be a good use of the placebo. I doubt such a thing exists though.

If it did happen though, it might be a good idea to recommend to the patient that they go on a raw and balanced diet and start facing all of their mental conflictions.

btw...I do realize that was terrible english. ***edit (the first paragraph)[/quote]

The placebo effect only works if the patient thinks they are taking real medicine. That's why in double blind clinical trials, the doctor and the patient have no idea if the patient is getting the placebo.

Meat Engine · Post by **Meat Engine** » 17 Jul 2010, 04:33

A patient in a trial will know that there is an even chance of getting the placebo or the real deal. They don't know for sure though.

Verbal · Post by **Verbal** » 17 Jul 2010, 04:36

been meaning to check out evidence for electric shock therapy

i would be completely astounded if i dont end up pissed off

Meat Engine · Post by **Meat Engine** » 17 Jul 2010, 04:52

[quote name="nell's tits"]
[quote name="The Fu Monster"]A patient in a trial will know that there is an even chance of getting the placebo or the real deal. They don't know for sure though.[/quote]

They don't know for sure that there is an even chance of getting the placebo or the real deal?[/quote]

They know it's an even chance. They don't know for sure what they're getting.

Meat Engine · Post by **Meat Engine** » 17 Jul 2010, 04:59

Then what the hell are we talking about?!

Verbal · Post by **Verbal** » 19 Sep 2020, 17:59

there must be posts deleted from this thread

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