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chefcrsh
Skeptic Friend
Hong Kong
380 Posts |
Posted - 10/25/2008 : 21:44:25 [Permalink]
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I am cock sure that a doctor, charging a patient, to surreptitiously, and unilaterally, supersede the patients natural rights in order to perpetrate a sham treatment OF ANY KIND is unethical...yes.
I think the wild logical acrobatics is required to argue the contrary. |
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chefcrsh
Skeptic Friend
Hong Kong
380 Posts |
 Posted - 10/25/2008 : 21:56:24 [Permalink]
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Originally posted by Ricky
| And if the placebo is to work they will need to charge as if the med is real in order to fool the patient. |
You have a rather uncreative mind, chef. "The government offers a subsidy reducing the price of this drug," would suffice.
| in the cases mentioned the doctor is using a placebo as a wild guess |
Where do you get this from?
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The adhom is irrelevant, plus do you always equate creativity with ability to add one lie to another?
As to where I get this: QED. If there is only a 1 in 3 chance that a placebo will have any effect at all. Ordering placebo in the cases regarding arthritis and other joint problems, pain treatment and such, is at best a stab in the dark. Especially when actual pain medicine is proven to be significantly more efficacious for the management of pain.
Which again is why we skeptics rail against such things as acupuncture or Reiki. Because they show no more benefit than placebo. i/e random shot-in-the-dark roll-of-the-dice chance.
And even when I go to a casino, to play a game of chance, I want to know the rules first, I want to be fully informed. If the Casino is rigging the game and hiding the real odds from me, we call it fraud. Same so with a doctor, a butcher, a baker or a brewer. |
| Edited by - chefcrsh on 10/25/2008 21:59:32 |
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Dave W.
Info Junkie
USA
26020 Posts |
Posted - 10/25/2008 : 23:41:13 [Permalink]
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Originally posted by chefcrsh
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. |
Well, I don't know where you were, but the only time I've been handed drugs at a doctor's office they've been sample packs provided - for free - by the pharmaceutical companies, and so not charged. If the doctor is charging my insurance for them, I don't know about it (never shows up on the bill), and that would be insurance fraud.
Clinics here may have a pharmacy within them, yes, but they still have a pharmacist who is dispensing the drugs, and the doctors still write a prescription (and don't get paid for the drugs themselves).
Again: in small towns things may work differently, but most of the population here lives outside of small towns. Of course, even "small town" America is plagued with Wal-marts and other giant chain pharmacies. Doctors in such towns, if they're interested in profit, would take advantage of such pharmacies instead of buying and storing drugs themselves and eventually writing off inevitably expired medications.
And in the ER and surgeries, things work differently again. Crash carts are loaded with drugs for emergency situations. But if they're giving me placebos when I'm hemorraging, I'll be unlikely to know it or be able to do anything about it, and I've got a large chance of dying anyway.
The bottom line is that the vast majority of doctors practicing in the U.S. would not have a monetary incentive to prescribe placebos, simply because they don't dispense drugs other than free sample packs (if that).
Even over-the-counter stuff (I've had doctors tell me to keep a fever down with Tylenol, but they didn't dispense the Tylenol, I went to the grocery store for it). With space for storage of drugs at a premium (square footage costs a lot) and perhaps a dozen customers a day per medication, they'd have a lot of patients complaining about massive overcharges for over-the-counter meds when compared to big chain pharmacies that buy in large lots and with the financial muscle to negotiate lower rents.
Actually, I take back part of the above. The kind of drugs that doctors keep in their office are those that require injection. Except for insulin. Vaccines and injectable steroids would probably be the most-common drugs in a doctor's office. And yes, they will charge for those - obviously. Of course, the reason for them keeping those around is that most patients don't inject themselves on a regular basis, and it is possible to screw it up badly, so a professional hand is often required.
But speaking of insurance, holy cow! My HMO pays my primary-care physician for 15 minutes, period. My doctor tries to take less time than that because if he only needs five to look me over and toss a 'script my way, he still gets paid for 15 minutes, and could potentially see two more patients in that same 15 minutes. This is why my "three o'clock appointment" is almost always 15 or 20 minutes late: because the doctor purposefully overbooks his time, but sometimes can't get rid of patients quickly enough to meet the overbooked schedule. (If you want to be seen right on time, get the first appointment in the day to get the best odds.)
Now, in order to cram so many patients into a day, and thus defraud the insurance companies of as much money as possible, my doctor actually has a prescription printer hooked up to a computer. Keying in my patient ID, the name of the drug and the dosage, and then waiting for the prescription to be printed takes only a minute or so. Compare that to what he would have to go through to actually create a fake bottle of sugar pills for me that looks professional (so as to fool me better), and then add in the extra cost of storage space for bottles, pills and labels, and the extra time it would take the doctor's staff to bill my insurance company for the fake pills. No, if he's intent of giving me a placebo, his best use of his time and space is to print a 'script for a placebo and make me go wait for it at the supermarket. The doctor makes no extra money off that.
And then consider this from the doctor's point of view. If he's trying to provide the best medicine he can, then sugar pills are going to be the best medicine only rarely. Are all the extra effort and resources really worth a few extra dollars per day, at most? (If he's intent on defrauding people, of course, then he optimizes the sugar-pill dispensing but quickly goes out of business anyway because 2/3rds of his patients find better doctors.)
There are much better ways for today's urban and suburban doctors to commit fraud or otherwise increase their bottom line. Keeping and using all the fixings for placebos in their offices ain't one of them. Better to use the time to see more insurance-carrying patients. Better to use the space to store samples of the most-popular drugs, for which kickbacks might be reasonable. Better to save the money to blow on a hooker in Tahoe after the drug rep comes around again next month.
Actually, here is a scenario in which giving a placebo would have a monetary incentive: patient goes to an orthopedist complaining of a muscle strain or "bone bruise" which the doctor knows (after examining the patient) will resolve itself after a few days, but the patient is stubbornly demanding treatment and thus threatening the doctor's 15 minute HMO payment (or however long they give specialists). Doctor injects saline, but tells the patient it is cortisol and charges accordingly. Doctor saves his HMO limitation and his stockpile of injectable steroids (although cortisol has got to be pretty cheap already). |
- 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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Hawks
SFN Regular
Canada
1383 Posts |
Posted - 10/26/2008 : 07:05:53 [Permalink]
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Originally posted by chefcrsh
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. |
Your 1/3 figure seems a bit low, but that is not really that important. What is important is that a lot of medicines for various conditions don't work on every patient either, so doctors prescribing these are also stabbing in the dark. I don't mean to imply that that means that medicines and placebos are on equal footing, but rather that using less-than-100%-patient-efficacy does not make a treatment useless.
| 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. |
I don't know about the legal right part (it is probably different in different countries) but I would probably agree that informed consent is important in most cases.
| 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. |
I'm not sure why this situation specifically keeps on being brought up (where a doctor administers a placebo because he/she does not know the cause). What about administering a placebo if the doctor is fairly certain of the cause but knows that there is no proper medicine for the condition - or that said medicine has too many side-effects? What about the doctor that takes an extra five minutes talking to the patient (and charging more) rather than prescribe an anti-depressant in order to, for example, reduce anxiety in the patient.
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METHINKS IT IS LIKE A WEASEL
It's a small, off-duty czechoslovakian traffic warden! |
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Gorgo
SFN Die Hard
USA
5310 Posts |
Posted - 10/26/2008 : 08:19:20 [Permalink]
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| Are you sure placebos have no side effects? |
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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Ricky
SFN Die Hard
USA
4907 Posts |
Posted - 10/26/2008 : 09:21:43 [Permalink]
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| I am cock sure that a doctor, charging a patient, to surreptitiously, and unilaterally, supersede the patients natural rights in order to perpetrate a sham treatment OF ANY KIND is unethical...yes. |
This kind of rhetoric sounds like a political speech. You sound like you're trying to make your case through the use of a thesaurus and not arguments. A simple "yes" would suffice, and I don't fault you at all for that. It is a reasonable position and you can ensure that you won't get any fake meds by stating this to your doctor beforehand. But have you really considered all the cases?
The adhom is irrelevant, plus do you always equate creativity with ability to add one lie to another? |
When I said you were uncreative, it was merely in passing. Don't take it personally. Above, you also use the word "lie" as if lies are always bad things. But yes, coming up with a compelling reason why the patient can buy the placebo at a reduced price whilst convincing him he's getting the real thing goes under creativity in my book.
As to where I get this: QED. If there is only a 1 in 3 chance that a placebo will have any effect at all. Ordering placebo in the cases regarding arthritis and other joint problems, pain treatment and such, is at best a stab in the dark. Especially when actual pain medicine is proven to be significantly more efficacious for the management of pain. |
Ah, when you said "wild guess" before, I thought you were referring to the diagnosis, not the efficiency of the treatment. But again, you're not making a comparison, placebo versus giving them nothing. One third chance of working (which like Hawks I don't accept) versus absolutely zero chance of working. QED.
Which again is why we skeptics rail against such things as acupuncture or Reiki. Because they show no more benefit than placebo. i/e random shot-in-the-dark roll-of-the-dice chance. |
We rail against them because they are often used as treatments that we have effective drugs for. They are also commonly used on things that can't be cured by the placebo effect, and won't just go away on their own. We are not talking about either of those cases when a doctor prescribes a placebo.
And even when I go to a casino, to play a game of chance, I want to know the rules first, I want to be fully informed. If the Casino is rigging the game and hiding the real odds from me, we call it fraud. Same so with a doctor, a butcher, a baker or a brewer. |
The casino is working to take your money. As is any salesman who sells you lower quality products for the cost of the higher quality stuff. On the other hand, the doctor is working to help you. |
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 10/26/2008 09:25:40 |
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Kil
Evil Skeptic
USA
13476 Posts |
Posted - 10/26/2008 : 10:05:22 [Permalink]
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Originally posted by Gorgo
Are you sure placebos have no side effects?
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Not directly. But an indirect side effect may be a worsening of the illness even though the patient feels relief for some of its symptoms.
What I mean by side effects is that list of things that the patient might be subject to, that comes with every prescription med, when taking medicine with active ingredients that are designed for and do cause a physical response in the body when taken.
A sugar pill or a homeopathic is unlikely to cause such reactions, because there is no medicine in that medicine. |
Uncertainty may make you uncomfortable. Certainty makes you ridiculous.
Why not question something for a change?
Genetic Literacy Project |
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Dave W.
Info Junkie
USA
26020 Posts |
Posted - 10/26/2008 : 12:49:07 [Permalink]
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Originally posted by Kil
A sugar pill or a homeopathic is unlikely to cause such reactions, because there is no medicine in that medicine. |
But still, the nocebo effect is just as real as the placebo effect. Told that a placebo is an actual medication, some percentage of patients will experience negative side effects because that's what they would expect from the real thing.
With homeopathy in particular, patients are told there will be no side effects, so they're probably reduced. |
- 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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tomk80
SFN Regular
Netherlands
1278 Posts |
Posted - 10/27/2008 : 06:35:49 [Permalink]
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Originally posted by Gorgo
Are you sure placebos have no side effects?
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Depends on what is used as a placebo. If a "real" placebo is used, ie a sugar pill, saline injection or similar, it will indeed not have side-effects. There is no active substance to cause any. If the placebo is something like an anti-biotic in case of a viral disease like a cold, it could potentially cause side-effects. |
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 - 10/27/2008 : 06:42:08 [Permalink]
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Depends on what is used as a placebo. If a "real" placebo is used, ie a sugar pill, saline injection or similar, it will indeed not have side-effects. There is no active substance to cause any. If the placebo is something like an anti-biotic in case of a viral disease like a cold, it could potentially cause side-effects.
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If you're saying that the placebo itself has no negative or positive effects, then that might be true. However, if you're saying that the nocebo effect doesn't exist, then I think you might have some people who disagree. |
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 - 10/27/2008 : 06:46:46 [Permalink]
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Originally posted by Dave W.
Originally posted by Kil
A sugar pill or a homeopathic is unlikely to cause such reactions, because there is no medicine in that medicine. |
But still, the nocebo effect is just as real as the placebo effect. Told that a placebo is an actual medication, some percentage of patients will experience negative side effects because that's what they would expect from the real thing.
With homeopathy in particular, patients are told there will be no side effects, so they're probably reduced.
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This is not entirely true. My experience from friends who use homeopathy is that they first go through a period with more severe symptoms before the "medicine" starts to work. They subsequently told me that this is something that usually occurs with homeopathy. I don't know whether this is something they heard before starting the treatment or after, but nocebo might very well be an explanation here, especially if the "therapist" warns them beforehand. |
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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Dave W.
Info Junkie
USA
26020 Posts |
Posted - 10/27/2008 : 07:05:53 [Permalink]
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Originally posted by tomk80
This is not entirely true. My experience from friends who use homeopathy is that they first go through a period with more severe symptoms before the "medicine" starts to work. They subsequently told me that this is something that usually occurs with homeopathy. I don't know whether this is something they heard before starting the treatment or after, but nocebo might very well be an explanation here, especially if the "therapist" warns them beforehand. |
Ah, yes. I'd forgotten that alt-med folks had leapt at the Herxheimer reaction to explain the fact that do-nothing treatments often seem to "make symptoms worse before they get better." It's all post hoc rationalization. |
- 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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tomk80
SFN Regular
Netherlands
1278 Posts |
Posted - 10/27/2008 : 07:11:30 [Permalink]
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Originally posted by chefcrsh
Originally posted by Ricky
| And if the placebo is to work they will need to charge as if the med is real in order to fool the patient. |
You have a rather uncreative mind, chef. "The government offers a subsidy reducing the price of this drug," would suffice.
| in the cases mentioned the doctor is using a placebo as a wild guess |
Where do you get this from?
|
The adhom is irrelevant, plus do you always equate creativity with ability to add one lie to another?
As to where I get this: QED. If there is only a 1 in 3 chance that a placebo will have any effect at all. Ordering placebo in the cases regarding arthritis and other joint problems, pain treatment and such, is at best a stab in the dark. Especially when actual pain medicine is proven to be significantly more efficacious for the management of pain. |
That depends on the case. Even where pain medication works better than placebos it is still a matter of averages, especially in the case of pain medication. In the case of pain medication, doctors will always need to do a stab in the dark to determine correct dosage and to determine which kind of medicine works best. In these cases a doctor will start with the lightest forms of medication that he thinks will work first and work up or down from there. Especially in cases where the pain is not severe, a placebo is not a stab in the dark, at least not more than prescribing any other real pain medication.
It is also important to note here that pain medication often has side-effects like fatigue and that habituation to pain medication will often take place. A placebo may help while avoiding these negative effects, although this again will differ from case to case.
In the case of vague symptoms like pain the effectiveness is close to 2/3 by the way.
| Which again is why we skeptics rail against such things as acupuncture or Reiki. Because they show no more benefit than placebo. i/e random shot-in-the-dark roll-of-the-dice chance. |
The effectiveness or not of a placebo is not the same as chance. At least not more than any other medication I know of.
I rile against acupuncture or reiki because they make claims they cannot uphold. I especially rile against alternative medicine when it purports to offer treatment for curable diseases when this treatment doesn't work, which can lead to fatal outcomes.
Personally, I am ambivalent in the use of alternative treatments for the treatment of symptoms or for the treatment of vague complaints or socalled MUPS (Medically Unexplained Physical Symptoms). Here, conventional medicine cannot cure the disease, or cannot even given an answer as to the underlying causes (which may well be psychological). Alternative treatments may well provide relief here and I'm not wholly against using it in these cases.
And even when I go to a casino, to play a game of chance, I want to know the rules first, I want to be fully informed. If the Casino is rigging the game and hiding the real odds from me, we call it fraud. Same so with a doctor, a butcher, a baker or a brewer.
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I don't know whether I agree with you if successful treatment with a placebo leads to a better quality of life. |
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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tomk80
SFN Regular
Netherlands
1278 Posts |
Posted - 10/27/2008 : 07:15:59 [Permalink]
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Originally posted by GorgoIf you're saying that the placebo itself has no negative or positive effects, then that might be true. However, if you're saying that the nocebo effect doesn't exist, then I think you might have some people who disagree.
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True. But even with the nocebo reaction taken into account, the potential negative reaction to a placebo is smaller than to the real McCoy. This because a real medicine will have a very real physical effect on the body which a placebo doesn't have. This also means that any possible side effects will last shorter if a nocebo reaction takes place. |
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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TFarnon
New Member
USA
17 Posts |
Posted - 11/07/2008 : 21:20:00 [Permalink]
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Originally posted by Dave W.
Originally posted by Kil
A sugar pill or a homeopathic is unlikely to cause such reactions, because there is no medicine in that medicine. |
But still, the nocebo effect is just as real as the placebo effect. Told that a placebo is an actual medication, some percentage of patients will experience negative side effects because that's what they would expect from the real thing.
With homeopathy in particular, patients are told there will be no side effects, so they're probably reduced.
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Yep...drives me NUTS. I hide patient information sheets from my mother, because if she reads one, she will have ALL the side effects. I let her have the sheet after she's been on a medication for 3 days, never before.
The "nocebo" effect in the warnings for Gardasil REALLY drive me nuts--the vaccine "may cause fainting or dizziness". Well, yeah, DUH... so does an injection of physiological saline in many preteen or teenaged girls. It's something girls of that age DO. Why don't they just put "Drama" as one of the other side effects? I know--they have to report the incidence of side effects, caused or merely coincidental, by law.
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Bacteria RULE, Hominids drool |
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Half of U.S. doctors use placebo
