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Simon
SFN Regular
USA
1992 Posts |
Posted - 10/24/2008 : 18:08:30 [Permalink]
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But, in this case; your car is not benefiting from the lie. As for the rat example... I'd think that some people would argue that it is indeed the ethical thing to do...
I'd say that the advantage in term of environmental gain is too weak and flimsy to justify the lie. In the case of placebo... who knows? |
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 |
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HalfMooner
Dingaling
Philippines
15831 Posts |
Posted - 10/25/2008 : 00:09:50 [Permalink]
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The placebo effect itself is real. Sometimes. In fact, placebo may, in individual cases, be one of the most "powerful drugs" in the pharmacopoeia. If the placebo effect weren't so effective, many quacks would never even get started.
So placebos may be given for a spectrum of reasons, from well-intended help from physicians who are out of other ideas, to high-priced "treatments" by conniving quacks. From arguably good use, through questionable deceit, to outright bilking of suckers.
There's a lot of room for abuse of patients, but also there is that real, demonstrable effect that placebos often give to patients. And that effect would disappear if the patients knew they were getting sugar pills. It seems clear to me that placebos work through some effect begun in the brain. (I suspect that placebo, as a matter of suggestion, is related to hypnotism.)
Maybe research needs to be done to create a real drug that triggers whatever happens in the brain to create the placebo effect.
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“Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive. |
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HalfMooner
Dingaling
Philippines
15831 Posts |
 Posted - 10/25/2008 : 00:18:04 [Permalink]
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Originally posted by Ricky
Originally posted by chefcrsh
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.
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Your analogy would only be proper if doctors were increasing their profit by giving placebos.
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It's the placebo industry's dead hand in this that bugs me. "Big Plas" has used its riches to corrupt drug studies for ages, even getting its product established as the standard "control."
Yeah, "control" is right! 
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“Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive. |
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bngbuck
SFN Addict
USA
2437 Posts |
Posted - 10/25/2008 : 00:55:45 [Permalink]
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Regardless of controversy, placebos work! My daughter has had some form of illness, malaise, disease, injury, pain, or whatever for the past twenty-five years!
She has had her share of disease, injury and medical problems; but she is also a world-class hypochondriac!
I conspire with her doctor, who was on the verge of denying her as a patient, to prescribe for her various forms of placebos for much of her imaginary illnesses. It works most of the time. Takes a sugar pill of some sort or another, gets well soon! Occasionally needs real treatment or medication. Like breaking both hips, twice. Or RA. Very real and demanding very real surgery or treatment.
But for much of her almost daily parade of medical problems, a pill, often prescribed just over the phone, solves the problem for a few days. Has terminal flu, (a cold), takes an mild antibiotic, and all is well within hours!
I know, I know - she is in need of serious psychiatric attention. After years of effort, I just got her to accept treatment from a bona-fide shrink recently. Too early to tell, hope it works to a perceptable degree!
god or dog or ra bless the placebo! It has saved me a ton of money and made caring for this poor creature a great deal easier! |
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chefcrsh
Skeptic Friend
Hong Kong
380 Posts |
Posted - 10/25/2008 : 03:48:26 [Permalink]
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Originally posted by Ricky
Your analogy would only be proper if doctors were increasing their profit by giving placebos.
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Oh, I didn't see the part of the story where it said all the doctors who do this only do pro bono work...can you point out where it says that?
By charging their patients for a fake pill over doing nothing and sending them on their way, they are increasing their profit. Further it has already been stipulated that they do this in part because otherwise the patient will just get treated from another doctor.
Hmmm qui bono? And more importantly who benefits through fraudulent treatment? |
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chefcrsh
Skeptic Friend
Hong Kong
380 Posts |
Posted - 10/25/2008 : 03:54:21 [Permalink]
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Yes placebos work and so do nocebos. See: http://skepdic.com/nocebo.html and http://skepdic.com/placebo.html
But we have to admit that if it is OK for a doc to pass off a placebo med as treatment then they are also fine laying of hands, praying for the patient, prescribing homeopathy, and even auditing thetans if they think those would be suitable alternatives to real treatment.
Somehow I can't believe these other alternatives would be deemed acceptable by the majority of this board, so why the support for sugar pill fraud?
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chefcrsh
Skeptic Friend
Hong Kong
380 Posts |
Posted - 10/25/2008 : 07:43:24 [Permalink]
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| Bye the way, while placebo does sometimes work, it is the standard benchmark for efficacy of real treatment. We do not consider a treatment suitable (efficacious) unless it performs several times better than placebo. So given that logic all placebo treatment fails the basic benchmark for efficacy, just one more reason it should not be allowed. |
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Ricky
SFN Die Hard
USA
4907 Posts |
Posted - 10/25/2008 : 09:04:37 [Permalink]
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Originally posted by chefcrsh
Oh, I didn't see the part of the story where it said all the doctors who do this only do pro bono work...can you point out where it says that?
By charging their patients for a fake pill over doing nothing and sending them on their way, they are increasing their profit. Further it has already been stipulated that they do this in part because otherwise the patient will just get treated from another doctor.
Hmmm qui bono? And more importantly who benefits through fraudulent treatment?
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If a doctor prescribes a placebo before running all the proper tests to make sure that the patient is not in any danger, then yes, they are of course a fraud and deserved to get bitch-slapped along with their medical license revoked. The same is the case where a doctor prescribes a placebo even though they suspect another doctor may be able to help the patient.
But a doctor does not make more money for prescribing a pill rather than not doing so. Furthermore, the pill has a very real chance at having a positive effect whereas in your example, the mechanic has done nothing to help the car.
Also, for your chef example, that would be like selling a patient a placebo for the cost of a brand name prescription drug, which is not the case.
| So given that logic all placebo treatment fails the basic benchmark for efficacy, just one more reason it should not be allowed. |
More effective than doing nothing. Of course if there is a drug that will actually help the patient, the doctor would prescribe this instead. But in the case we're dealing with, there isn't. You must compare a placebo to the alternative: doing nothing. |
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 10/25/2008 09:09:02 |
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Dave W.
Info Junkie
USA
26020 Posts |
Posted - 10/25/2008 : 09:08:33 [Permalink]
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Originally posted by chefcrsh
Your analogy would only be proper if doctors were increasing their profit by giving placebos. |
How many other countries have something like the pharmacy system we've got in the U.S.?
Doctors might find a monetary incentive to prescribe the latest, newest, fanciest placebos here (because the drug companies give them ski vacations beforehand), but they're not making money by prescribing actual sugar pills or even generic antibacterials, because they cannot actually dispense such things themselves, and kickbacks aren't going to be financially feasible unless the costs have a high cost.
Sure, the patient might come back for more with a successful placebo prescription, but that's awfully iffy, don't you think? Either that, or the doctor is servicing a small community in which people don't have much of a choice, in which case they'll come back no matter what the doctor prescribes or doesn't prescribe.
Now, some doctors do sell supplements and other alt-med placebos directly from their offices, but that's frowned on by medical boards (though not, unfortunately, illegal - yet). But those aren't the sort of placebo being discussed, are they? |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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Gorgo
SFN Die Hard
USA
5310 Posts |
Posted - 10/25/2008 : 10:10:10 [Permalink]
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| So, it might actually be ethical for competent doctors to dispense inert placebos? Hadn't thought so before, but I wonder. |
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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Kil
Evil Skeptic
USA
13476 Posts |
Posted - 10/25/2008 : 10:37:00 [Permalink]
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Originally posted by chefcrsh
Bye the way, while placebo does sometimes work, it is the standard benchmark for efficacy of real treatment. We do not consider a treatment suitable (efficacious) unless it performs several times better than placebo. So given that logic all placebo treatment fails the basic benchmark for efficacy, just one more reason it should not be allowed.
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What is interesting is that in the control group, some percentage of people will benefit from the placebo.
For those that do, there is a much lower possibility of harmful side effects.
The problem is, how would an MD know which person is likely to benefit from a placebo when efficacy is important to recovery?
And what happens if the placebo patient discovers the doctors ruse? How would that patient ever trust the "evidence based" physician again to tell them the truth?
I'm sure that there are times when prescribing a placebo just might be the best action taken. But as a rule, I think the truth is more important than the risk of unnecessary side effects. A person needs to be able to trust their doctor, which may have a placebo effect of its own, though not one that brings questionable ethics into play. |
Uncertainty may make you uncomfortable. Certainty makes you ridiculous.
Why not question something for a change?
Genetic Literacy Project |
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Ricky
SFN Die Hard
USA
4907 Posts |
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chefcrsh
Skeptic Friend
Hong Kong
380 Posts |
Posted - 10/25/2008 : 19:02:40 [Permalink]
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I think Dave has a wrong view of doctors and clinics. I am certain that when I lived state side many doctors and clinics also dispensed medicines. It would seem that is the case with the placebos as well. Internationally it is also common that doctors have a small dispensary in their office, and only write scripts for larger quantity or things they do not have in stock. In any case they do not need a pharmacist license to give a sugar pill or over the counter med. And if the placebo is to work they will need to charge as if the med is real in order to fool the patient.
Regarding Ricky in the cases mentioned the doctor is using a placebo as a wild guess. Given that placebo only works on roughly 1/3 of patients it is a real stab in the dark, plus as stated above if the rouse is to work the patient must be charged for real medicine. Placebo is all about the art of the illusion.
Yep Fraud. Informed consent is still a legal right, and it is not up to the doctor (in deed it takes a judge) to decide when the patient is not fit to know or make decisions on full disclosure.
And the whole argument for this fraud seem to be that the doctor is somehow placed at the level of inerrant holy shaman, who knows there is nothing wrong with the patient. In any case where a doc can not find a usual cause it only means the doc does not know the cause, it is a twist of illogic to assume that means there is no cause. So given that and the poor odds of placebo how can he be reasonably certain of the treatment? Can't be done.
Again if this is OK then so must be homeopathy, or laying of hands, for the same reasons, hey some people respond well. I call BS.
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| Edited by - chefcrsh on 10/25/2008 19:08:49 |
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Ricky
SFN Die Hard
USA
4907 Posts |
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Half of U.S. doctors use placebo
