Friday, October 24, 2008

Isn't This Why We're Fighting Alties?

Reverend Rob brings this article to my attention. Doctors prescribing placebos, often because the patient insists on getting something. I'm currently leaning towards this being fraud. I can understand a few times for particularly troublesome hypochondriacs, but nothing extensive. One direction I'd like to spread some of the blame is all the advertisements both alties and pharmaceutical companies (but especially alties) show to imply health requires only popping the right pills.

One minor annoyance with the article itself: Labeling the placebo effect as a "mystery."


William said...

Giving them placebos is better than giving them real drugs that they don't need (but demand).

I'd like to see a return to a ban on advertising prescription drugs to the public.

Dikkii said...

I can see why you'd consider this fraud, BD, but consider this:

Most of the doctors I know prescribe placebos only in cases of hypochondria, or where they're feeling pressured to prescribe anything at all for cases where drugs aren't absolutely necessary, such as mild flu or colds.

[trivia]Most of them, incidentally, put the initials AFT (Any Fucking Thing) or ABT (Any Bloody Thing) on a script where a placebo is being prescribed. [/trivia]

Fraud is where a financial advantage is gained from deceptive means.

So who would benefit financially?

Doctors? They'd be charging the normal consultancy fee, so it doesn't matter to them whether they're saying, "You're a hypochondriac. Go away," or "Here's a script. Go away," because they're going to be charging the same rate.
Plus, (not sure how it is in the States) they're not allowed to collect commissions on drugs prescribed. Placebo or otherwise.

Pharmacists? Last time I looked, they had a duty of care to follow the instructions on a script to the letter.

Drug companies? Unless they've invented a wholly overpriced placebo recently, they're not going to benefit.

Which leaves the patient. Who benefits financially by not paying for a drug which they wouldn't need anyway. And no court is going to convict them.

Over here, we have a fifth player in the federal government where a Pharmaceutical Benefits Scheme is in place to ensure that prescription medication is the same price regardless of whether it's basic antibiotics up to hardcore anti-virals. They'd benefit by not paying for more serious medication, but again, just like pharmacists, can use a doctor's script as a valid defence.

In addition, it would be hard to argue that they actually would be benefiting, as nothing should be being prescribed in the first place.

So "fraud"? Not really. Maybe a patient would have a case in common law via the tort of deceit.

One minor annoyance with the article itself: Labeling the placebo effect as a "mystery."

I'd add to that the incorrect impression that doctors routinely prescribe placebos for anything more serious than hypochondria and suchlike. It doesn't happen, and is unethical.

Gonzo said...

Selling meds to people who don't need them is definetely fraud, IMHO, maybe the doctors don't profit, but the pharma industry certainly does, and a doctor shouldn't participate in this scam.
They should be honest, and just say "It's a cold, you need to go to bed and rest" or "This pain/discomfort is caused by stress, and you should take it easy"
Giving patients placebos, is treating them like little children: "Aaaww, you hurt yourself? Here's a cookie. There! Don't you feel better, now?"
If the "cookie" is an antibiotic, you don't really need, it does more harm than good.

William said...

Say a hypochondriac patient comes in, and the doctor says "You don't need any drugs." So then the patient goes to another doctor, who says the same thing... Eventually, the patient will find someone to give him what he wants.

Now say that the first doctor prescribes a placebo instead. The patient is happy, and doesn't end up taking some real, dangerous drug that he doesn't need. He also doesn't take up any more doctors' time, although this is a relatively minor point.

Now, an antibiotic is not a placebo, and should not be used casually, I agree.

Gonzo said...

I know what you mean, but the article stated that antibiotics are prescribed as a placebo.
I'm not even sure if real placebos are produced by pharma companies at all, which is probably why sCAM is so popular.
I also wouldn't dismiss people as hypochondriacs so quickly, usually they have some slightly neurotic fear, and the doctor should take that seriously.
...but, I know this is time-consuming and therefore more expensive than meds.

Meh, I just realised that might be the dilemma, why we'll probably never get rid of sCAM.

Dikkii said...

the article stated that antibiotics are prescribed as a placebo.

The article, you would have noticed, also didn't cite specific examples, didn't give figures, and didn't quote anyone who actually said "lots of doctors prescribe antibiotics as placebos." (or words to that effect)

Nor did the article quote where the reporter picked up that snippet about antibiotics being used.

Given the well publicised problems of superbugs (methicillin-resistant staphylococcus aureus, anyone?), I'm not sure that I believe that the practice of prescribing antibiotics as a placebo is widespread. I certainly don't believe that enough doctors are irresponsible enough for this to be a widespread problem.

I also wouldn't dismiss people as hypochondriacs so quickly, usually they have some slightly neurotic fear, and the doctor should take that seriously.

Maybe so. But isn't this assessment between a doctor and their patient?

Anonymous said...

You may want to read this.

It turns out the word "placebo" was never used in the survey given to the doctors...

Anonymous said...

I'll read that post in a sec, but I should say right now that I honestly don't care what problem they are having with a hypocondriac. It's always dishonest to just give them something random and say it'll be better when it's just placebo.

If I'm at a family member's house and they (as they often do) say "could you see what's wrong with my computer?" and I can't find any problems, I don't just run their antivirus scanner and say "it's better now", I say "I can't find any problems, sorry".

Anonymous said...

And now I have read that article about the article.

Well, I guess the problem was more or less manufactured by poor news reporting. I still stand by it being a bad thing to do regardless of motivation, but no longer think it's some epidemic.

Bronze Dog said...

Orac's posted some stuff here. I think he can handle the argument better than I can.

But it's a good thing if it's not so widespread.

King Aardvark said...

It is a tricky question. Well performed placebos have a measurable beneficial effect on patients' assessment of their symptoms, so if you are a doctor concerned with providing the best care to your patients, placebos may actually provide a good solution. But you are lying to them, and you can't get informed consent that way. Unfortunately, the fact that most people aren't thoughtful or informed enough to actually give informed consent is not a sufficient loophole for fooling your patients.

Hmm, if placebos are only ethically useable in clinical trials, I propose that everyone everywhere be entered in a clinical trial measuring one placebo against a suspected placebo. That way, whenever a patient comes in demanding a treatment, you can tell them you want to try a new experimental drug on them, but they might also get a placebo. Then you just give them one or the other of the placebo.