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Gorgo
SFN Die Hard

USA
5310 Posts

Posted - 10/24/2008 :  07:01:26  Show Profile Send Gorgo a Private Message  Reply with Quote
Half of US doctors use placebo treatments, survey shows; many aren't honest with patients
By MARIA CHENG | AP Medical Writer

6:01 PM CDT, October 24, 2008
LONDON (AP) _ 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.


I wonder how many people die because doctors have misdiagnosed an illness, and given placebos when there really is treatment that works.

Still not a perfect science, I guess.

I know the rent is in arrears
The dog has not been fed in years
It's even worse than it appears
But it's alright-
Jerry Garcia
Robert Hunter




Edited by - Gorgo on 10/24/2008 07:04:34

tomk80
SFN Regular

Netherlands
1278 Posts

Posted - 10/24/2008 :  07:24:04   [Permalink]  Show Profile  Visit tomk80's Homepage Send tomk80 a Private Message  Reply with Quote
Originally posted by GorgoI wonder how many people die because doctors have misdiagnosed an illness, and given placebos when there really is treatment that works.

Still not a perfect science, I guess.

I doubt that subscribing a placebo or not would automatically raise the number of deaths due to misdiagnosis. Many symptoms treated by general practitioners are of the kind "medically unexplained physical symptoms" (MUPS). If the GP won't prescribe a placebo, he'll prescribe a drug that won't have that much effect in the first place. In those cases the difference will mostly be in pricing. Now the patient gets a sugar tablet, otherwise he'd get an advil against the headache.

Ethically questionable perhaps, as a doctor should be honest with his patients. But I doubt it does serious harm outside of increasing patient/physicians distrust after an article like this comes out.

Tom

`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll-
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Gorgo
SFN Die Hard

USA
5310 Posts

Posted - 10/24/2008 :  07:35:07   [Permalink]  Show Profile Send Gorgo a Private Message  Reply with Quote
Originally posted by tomk80



I knew a woman that had cancer. Since her sister had a mental problem, the doctor assumed that her problem was mental.

They sent her to a psychologist or psychiatrist, delaying her diagnosis of cancer, and I wonder if that delayed her diagnosis enough to kill her. I do know she did die of cancer, but I don't know if she would have died anyway.

My point is in situations where misdiagnosis leads a doctor to prescribing placebo rather than to requesting help from other doctors, this might delay treatment enough to kill people.

I know the rent is in arrears
The dog has not been fed in years
It's even worse than it appears
But it's alright-
Jerry Garcia
Robert Hunter



Edited by - Gorgo on 10/24/2008 07:38:20
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chefcrsh
Skeptic Friend

Hong Kong
380 Posts

Posted - 10/24/2008 :  07:39:45   [Permalink]  Show Profile Send chefcrsh a Private Message  Reply with Quote
Gorgo's anecdote aside, prescribing placebo as treatment (except in trials) is dishonest and should be totally against ethics/ license to do so.


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tomk80
SFN Regular

Netherlands
1278 Posts

Posted - 10/24/2008 :  07:43:29   [Permalink]  Show Profile  Visit tomk80's Homepage Send tomk80 a Private Message  Reply with Quote
Originally posted by Gorgo

Originally posted by tomk80



I knew a woman that had cancer. Since her sister had a mental problem, the doctor assumed that her problem was mental.

They sent her to a psychologist or psychiatrist, delaying her diagnosis of cancer, and I wonder if that delayed her diagnosis enough to kill her. I do know she did die of cancer, but I don't know if she would have died anyway.

My point is in situations where misdiagnosis leads a doctor to prescribing placebo rather than to requesting help from other doctors, this might delay treatment enough to kill people.

And my point is that in the cases where a doctor prescribes a placebo, he wouldn't be sending them to a specialist in the first place. He would be prescribing a different medicine. So prescribing a placebo or the real thing won't matter here.


Tom

`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll-
Edited by - tomk80 on 10/24/2008 07:48:10
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Gorgo
SFN Die Hard

USA
5310 Posts

Posted - 10/24/2008 :  07:44:10   [Permalink]  Show Profile Send Gorgo a Private Message  Reply with Quote
Originally posted by chefcrsh

Gorgo's anecdote aside, prescribing placebo as treatment (except in trials) is dishonest and should be totally against ethics/ license to do so.

I understand the motiviation, but it's just fraud. There has to be a compromise between being cold and rude, and serving up sugar pills.

I know the rent is in arrears
The dog has not been fed in years
It's even worse than it appears
But it's alright-
Jerry Garcia
Robert Hunter



Edited by - Gorgo on 10/24/2008 07:51:04
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Gorgo
SFN Die Hard

USA
5310 Posts

Posted - 10/24/2008 :  07:47:21   [Permalink]  Show Profile Send Gorgo a Private Message  Reply with Quote
Originally posted by tomk80

And my point is that in the cases where a doctor prescribes a placebo, he wouldn't be sending them to a specialist in the first place. So prescribing a placebo or the real thing won't matter here.


Prescribing a placebo might convince the patient that the doctor knows what he's doing long enough to avoid getting a second opinion. If a doctor just says that he doesn't know what's wrong, then the patient might seek some other doctor.

I know the rent is in arrears
The dog has not been fed in years
It's even worse than it appears
But it's alright-
Jerry Garcia
Robert Hunter



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tomk80
SFN Regular

Netherlands
1278 Posts

Posted - 10/24/2008 :  07:55:10   [Permalink]  Show Profile  Visit tomk80's Homepage Send tomk80 a Private Message  Reply with Quote
Originally posted by Gorgo

Originally posted by tomk80

And my point is that in the cases where a doctor prescribes a placebo, he wouldn't be sending them to a specialist in the first place. So prescribing a placebo or the real thing won't matter here.


Prescribing a placebo might convince the patient that the doctor knows what he's doing long enough to avoid getting a second opinion.

And otherwise the doctor would be prescribing something else, giving the patient the same idea. If a patient has brain cancer, it won't matter if the doctor prescribes advil or a placebo, the idea the patient has will be the same.

If a doctor just says that he doesn't know what's wrong, then the patient might seek some other doctor.

A doctor will give a placebo if he has an idea what is wrong and that what is wrong is not fatal but has a large psychological component. The point being that the reason the doctor proscribes a placebo is because he thinks he knows what is wrong and that what is wrong does not require intensive medication or further medical treatment.

Tom

`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll-
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Gorgo
SFN Die Hard

USA
5310 Posts

Posted - 10/24/2008 :  08:01:13   [Permalink]  Show Profile Send Gorgo a Private Message  Reply with Quote
Originally posted by tomk80

[quote] The point being that the reason the doctor proscribes a placebo is because he thinks he knows what is wrong and that what is wrong does not require intensive medication or further medical treatment.


So, the problem isn't placebo, it's misdiagnosis, and there is a certain amount of placebo in any treatment.

Advil, however, isn't prescribed as a placebo, it is prescribed as a treatment for something. The reason placebo would be used would be to defraud. If a doctor were not committing the fraud, then other treatment might be sought.

I know the rent is in arrears
The dog has not been fed in years
It's even worse than it appears
But it's alright-
Jerry Garcia
Robert Hunter



Edited by - Gorgo on 10/24/2008 08:02:00
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tomk80
SFN Regular

Netherlands
1278 Posts

Posted - 10/24/2008 :  08:05:09   [Permalink]  Show Profile  Visit tomk80's Homepage Send tomk80 a Private Message  Reply with Quote
Originally posted by Gorgo
So, the problem isn't placebo, it's misdiagnosis, and there is a certain amount of placebo in any treatment.

Right.

Advil, however, isn't prescribed as a placebo, it is prescribed as a treatment for something.

But Advil is not really a treatment anymore than a placebo is. Or better maybe, advil is not a cure. It is treating the symptoms of pain, but not curing the illness. And this holds for quite a few medicines. This is also where placebos enter in. They are used to treat symptoms.

The reason placebo would be used would be to defraud. If a doctor were not committing the fraud, then other treatment might be sought.

I'm not following you here. What do you mean? Do you mean misdiagnosis? Because that is not the same as fraud. Doctors are human just as anyone else and will make mistakes. Especially in a field like medicine, where a lot of diseases do not present themselves immediately with clear symptoms.

Tom

`Contrariwise,' continued Tweedledee, `if it was so, it might be; and if it were so, it would be; but as it isn't, it ain't. That's logic.'
-Through the Looking Glass by Lewis Caroll-
Edited by - tomk80 on 10/24/2008 08:07:15
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Gorgo
SFN Die Hard

USA
5310 Posts

Posted - 10/24/2008 :  08:11:23   [Permalink]  Show Profile Send Gorgo a Private Message  Reply with Quote
Misdiagnosis is not the same as fraud. Treatment is not the same as cure. The rest just isn't that important.

I know the rent is in arrears
The dog has not been fed in years
It's even worse than it appears
But it's alright-
Jerry Garcia
Robert Hunter



Edited by - Gorgo on 10/24/2008 08:11:45
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Kil
Evil Skeptic

USA
13458 Posts

Posted - 10/24/2008 :  08:15:35   [Permalink]  Show Profile  Visit Kil's Homepage  Send Kil an AOL message  Send Kil a Yahoo! Message Send Kil a Private Message  Reply with Quote
I'm not sure they do it so much anymore, but for many years it was common practice for doctors to prescribe an antibiotic to a patient with a virus, like a flu or a cold. For one thing, the patents made demands on the doctor expecting to come away from the office with some kind of treatment. And, until resistant strains of bacterial infections started showing up, the doctor probably saw no harm in making the patient happy.

I suppose the doctor could rationalize prescribing an antibiotic for a virus infection as a preventative against a secondary infection. But really, it was a placebo.

The idea of prescribing a placebo was not to get out of an actual diagnosis. In most cases, there was a diagnosis, probably a good one, and the doctor did what he/she thought was best.

Anyhow, I agree with chef on this. Doctors should not give in to demanding patients and should tell them the truth. In the case of over prescribing antibiotics, the ultimate result of that practice hasn't been a good one.

Uncertainty may make you uncomfortable. Certainty makes you ridiculous.

Why not question something for a change?

Genetic Literacy Project
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Simon
SFN Regular

USA
1992 Posts

Posted - 10/24/2008 :  09:02:13   [Permalink]  Show Profile Send Simon a Private Message  Reply with Quote
Originally posted by Kil

I'm not sure they do it so much anymore, but for many years it was common practice for doctors to prescribe an antibiotic to a patient with a virus, like a flu or a cold. For one thing, the patents made demands on the doctor expecting to come away from the office with some kind of treatment. And, until resistant strains of bacterial infections started showing up, the doctor probably saw no harm in making the patient happy.
I suppose the doctor could rationalize prescribing an antibiotic for a virus infection as a preventative against a secondary infection. But really, it was a placebo.
The idea of prescribing a placebo was not to get out of an actual diagnosis. In most cases, there was a diagnosis, probably a good one, and the doctor did what he/she thought was best.
Anyhow, I agree with chef on this. Doctors should not give in to demanding patients and should tell them the truth. In the case of over prescribing antibiotics, the ultimate result of that practice hasn't been a good one.



Indeed. People were not happy with 'it's a virus; you'll get over it' and expected a prescription.
If the first doc did not give it to them, they would go to a second one until they got what they wanted...

In this case, prescribing a placebo is a good thing, as it prevents the patients from ending up using an antibiotic it does not really need and rising the risk of developing antibiotic resistant bacteria.

Furthermore, if you don't have a treatment, if such a treatment does not exist or the patient's condition is imaginary (it happens, I guess), a placebo might help the patients and will have a lower risk of side-effects.

And, of course, you can't be 'honest' with somebody you are prescribing a placebo to. It would not 'work' if you did...

Look again at that dot. That's here. That's home. That's us. On it everyone you love, everyone you know, everyone you ever heard of, every human being who ever was, lived out their lives. The aggregate of our joy and suffering, thousands of confident religions, ideologies, and economic doctrines, every hunter and forager, every hero and coward, every creator and destroyer of civilization, every king and peasant, every young couple in love, every mother and father, hopeful child, inventor and explorer, every teacher of morals, every corrupt politician, every "superstar," every "supreme leader," every saint and sinner in the history of our species lived there on a mote of dust suspended in a sunbeam.
Carl Sagan - 1996
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Ricky
SFN Die Hard

USA
4907 Posts

Posted - 10/24/2008 :  09:17:37   [Permalink]  Show Profile  Send Ricky an AOL message Send Ricky a Private Message  Reply with Quote
Placebos have effects on nonpsychological illnesses as well. If you were to get a disease which the doctor knew was not serious and had no treatment but would just run it's course, then telling you the truth or not will not change anything. Giving a placebo on the other hand may reduce the symptoms. In this case, the truth actually hurts the patient. And they could tell the patient that they may take the placebo along with other OTC symptom reliving meds.

I would imagine placebos are also a good method of testing whether an illness is psychological or not. The doctor should always make followup calls in such cases.

Why continue? Because we must. Because we have the call. Because it is nobler to fight for rationality without winning than to give up in the face of continued defeats. Because whatever true progress humanity makes is through the rationality of the occasional individual and because any one individual we may win for the cause may do more for humanity than a hundred thousand who hug their superstitions to their breast.
- Isaac Asimov
Edited by - Ricky on 10/24/2008 09:18:29
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Gorgo
SFN Die Hard

USA
5310 Posts

Posted - 10/24/2008 :  12:40:22   [Permalink]  Show Profile Send Gorgo a Private Message  Reply with Quote
Evidently this article reads a little different from the BMJ study. I'm reading about this on the Healthfraud list, and one of the participants shared this online response he found:

Tilbert et al report a startlingly high rate of "placebo"
prescription among physicians. However, their findings are
perhaps not so surprising given that virtually any medication
with little or no efficacy was considered a placebo. I would
define a placebo as an inert substance deliberately administered
to a patient who believes he or she is receiving an active
pharmaceutical agent. By the authors' looser standard, however,
even an over-the-counter cold medicine would count as a placebo,
given that this class of medications has no proven efficacy.
Physicians often relent to the wishes of their patients,
explaining that perhaps some individuals do benefit from such
medicines, and that it's OK to take it. That's hardly the same as
prescribing a sugar pill to dupe a patient into feeling well.

- Thomas M Morgan, Assistant Professor of Pediatrics
Vanderbilt University, Nashville, TN:

I know the rent is in arrears
The dog has not been fed in years
It's even worse than it appears
But it's alright-
Jerry Garcia
Robert Hunter



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chefcrsh
Skeptic Friend

Hong Kong
380 Posts

Posted - 10/24/2008 :  16:46:25   [Permalink]  Show Profile Send chefcrsh a Private Message  Reply with Quote
So if I think I notice a tugging in the front end of my car, and I bring it to the shop,and the mechanic finds nothing amiss, is it OK for the mechanic to just slap some lube in it, but tell me he rebuilt the steering box and charge me for a full front end job?

I mean if I believe it has had a full work up, maybe I'll stop complaining right?

As a Chef is it OK for me to tell people they are eating a prime grade steak but only selling them a choice steak? Or Selling them fried chicken but actually using squirrel or rat? Serving Rat will be more humane (chickens live a brutal life) and more environmentally friendly. So if I can fool them with my placebo food the amount of good in the world is increased.

Edited by - chefcrsh on 10/24/2008 16:49:06
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