The ethics of placebo medicine and Alternative health care

[bononos]

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I believe that it is ethical, and that it is predominately what alternative medicine is. It is a framework that can be used to maximize the placebo effect in patients, specifically important in the treatment of subjective illnesses such as emotions, fatigue, and pain. Here is a quick survey of doctors (http://www.bmj.com/content/337/bmj.a1938) 63% of who believe it is ethically permissible to treat with a placebo, and about half of which prescribe them regularly.

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Obviously I’m biased, even though I try to have a clear open mind to all sides. Make no mistake about it, a homeopathic ‘remedy’ is nothing. It is just water or a sugar pill. There is 100% absolutely guaranteed no active physical, chemical, mystical, or blah blah blah in it at all. It is a placebo and I have no problem with a regulated health care practitioner using the homeopathic intake method as a way of improving patient outcome if they so choose to do so. I’ve been given any manner of mood altering drugs, and you know what always helped more than any of them (once I was stabilized enough)? Talking to someone who had my best interest at heart and the time to listen in a relaxing environment (massage, acupuncture, and counseling; placebos the lot of them).
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Its disturbing that so many do not find it unethical to prescribe placebos.
Your reasoning goes like - if those accupuncture and homeopathic quacks can get away with it, why can't we, the real deal doctors do it too?

Maybe homeopathy is not just plain 'nothing' water but also time taken to have a decent conversation with the patient to get to the nature of some ailment which might lead to a lifestyle adjustment.

But conventional medicine allows very little time per patient and doctors even need to find some way to prescribe 'something' otherwise the session might not be billable, which I gather is a sore point among doctors leading to placebo treatments.

 

[Daedalus685]

Its disturbing that so many do not find it unethical to prescribe placebos.
Your reasoning goes like - if those accupuncture and homeopathic quacks can get away with it, why can't we, the real deal doctors do it too?

I was just sharing the stats on current acceptance. It is merely far more popular than I had suspected. You have to understand that I don't believe the item (the needles, the homeopathic remedy, or the sugar pill) are what gives the benefit. It is the ritual of taking the item, the one on one treatment by the doctor, and so forth that seems to be the real benefit. Current studies of placebo vs no treatment show that the effect can be drastically improved if you change the way the same item is presented (its referenced in one of the links in the OP).

I must say though, I do not find it ethical for a doctor to say for instance "take this pill to help with your headaches" if it is nothing and they profit from its sale, or if they lie if asked about what it is. Another issue is that the medical community does not mean sugar pill when they prescribe a placebo, at least not always. They often mean real drugs with real side effects used for something they are not usually helpful with. Such as a doctor prescribing aspirin for fatigue. I am unaware if there even is an entirely inert substance a doctor could "prescribe" and have delivered by a pharmacist.

Maybe homeopathy is not just plain 'nothing' water but also time taken to have a decent conversation with the patient to get to the nature of some ailment which might lead to a lifestyle adjustment.

But conventional medicine allows very little time per patient and doctors even need to find some way to prescribe 'something' otherwise the session might not be billable, which I gather is a sore point among doctors leading to placebo treatments.

This is exactly the point. A placebo is becoming to be known in the scientific research community not as an inert substance that causes some effect but as a result of the treatment protocols (time spent, words used, comfort, emotions, etc.). Clearly this really only applies for subjective illnesses but in these cases it makes a huge difference.

I don't personally find the selling of a 'placebo' ethical. I find the treatment with a placebo ethical. The distinction being that I am becoming under the impression that the structure of a treatment is what gives the 'placebo' improvements, thus promising that a treatment (such as an alternative technique) will help you regain health is not a lie. This is especially important if an alternative method is used in conjunction with something like chemotherapy to drastically improve the patient outcome. It absolutely needs ot be regulated though, it is not at all acceptable for someone to convince a patient to avoid a treatment for a critical illness because they 'don't like it'. Regardless of what you practice the patient-caregiver relationship is very easily exploited and needs a lot of safeguards.

I'm quite curious at what point the details of a treatment must be fully explained to a patient before it becomes ethical. I'm not entirely sure how much details one must know before the placebo effects start to drastically drop off either.

 

[Moonbeam]

The point, I believe, is that every psychological state has a corresponding physical reality in the body. As they say, one can worry oneself sick. One can then treat the sickness or one can treat the worry. It is understanding and treating this body mind connection that is part of ancient wisdom and separates the quack who uses people for his own egotistical benefit from a true healer. It is a fool who, in attempting to separate what the mind can fix through suggestion from say drug efficacy tests, seeks also to eliminate care for the whole person rather than just the symptoms. By this means we can see there are two kinds of quacks, one that threat only by faking something for a mental effect and one that treats only the symptoms.

 

[zinfamous]

My problem here is that you are removing the patient's choice (informed choice) from the treatment. A patient should always have choice. Always.

Agree with this, but that inherently removes the placebo effect, if it ever has a chance to work. So, not sure about that. :\

I like the "Here, give these pills a shot and see if you feel better."

This is why medicine has always been called "practice." Historically, we have come to trust our physicians and defer to their experience. Informed patients are good, but this idea that the patient must know everything is rubbish. The last thing we need are patients running into the clinic every time asking to get x pill because they saw this add that talked about symptoms that they are convinced that they have and that this amazing pill will fix them.

That is far more problematic, I think. One solution for this? Banning drug companies from TV advertising, like the tobacco industry. Boom.

 

[TridenT]

Unethical and you should be sent straight to prison for it. Get a new partner while you're at it.

It's unethical because a placebo effect is just everything that happens outside of the treatment pill. It means nothing. Sugar pills are best left to studies where the patients know what they're risking.

Ugh... Why can't we have useful threads instead of this? This topic has been resolved for many years.

 

[Daedalus685]

Unethical and you should be sent straight to prison for it. Get a new partner while you're at it.

It's unethical because a placebo effect is just everything that happens outside of the treatment pill. It means nothing. Sugar pills are best left to studies where the patients know what they're risking.

Ugh... Why can't we have useful threads instead of this? This topic has been resolved for many years.

Why don't you tell us how you really feel

You say yourself it is everything that happens outside of the treatment, which I agree with. But we as a society make no effort to maximize it in patient care. Isn't that worth some interest? The point is not to use only a placebo but to maximize those aspects which bring out the effect to get better results with conventional therapies. It is just in very grey moral ground depending on how it is done.

I'm not at all for the use of a sugar pill as a standalone replacement for medicine...

Sorry my thread offends you so very much, but it was a fine discussion with points on both sides. I assure you the use of bed side manner and patient comfort is not resolved out of medicine quite yet. The point is that these are big factors in the effect, not the sugar pill. Obviously we should add this to all medicine but if that is not possible due to time commitment issues is it ethical to supplement this aspect elsewhere?

I'll be keeping her for a while at least as well, thanks for reading! /P&N

 

[TheVrolok]

Agree with this, but that inherently removes the placebo effect, if it ever has a chance to work. So, not sure about that. :\

I believe there are other ways to put the placebo effect to work, aside from lying to a patient about what you're giving him. I think a lot of it has to do with properly framing treatment on a patient by patient basis.

That is far more problematic, I think. One solution for this? Banning drug companies from TV advertising, like the tobacco industry. Boom.

I've been a HUGE proponent of banning DTCA (direct to consumer advertising) in the pharm industry. In my anecdotal (admittedly) experience, find it to do far more harm than good.

 

[woolfe9998]

You make a good point but one that can't overcome my own life experience. When I was young I delivered papers to buy a fish tank because my parents, who could have easily paid for it, wanted me to comprehend for myself the value of things. I never did become magnetized by having money but I did learn to appreciate my capacity to earn it and to value and care for what I could buy. The greatest gift I ever game myself was paying for my own psychotherapy. I must be a truly incredibly valuable person because I've spent a fortune on me, all paid for by my own capacity and not a dime from anybody else. The hidden gift in health is the attitude you bring to living. You can buy that with money just by paying your own way only. It's part of the placebo effect. It begins with a decision that you are worth something and the manifestation of that reality achieved by paying.

You are thinking of health as a physical state and fail to factor in a more subtle psychological dimension I think.

The topic of the thread is the placebo effect, having to do with how a belief in the efficacy of a drug has an actual physical effect on the believer. I totally agree that people tend to place more value on things they work for and/or pay for, in general. However, even in our healthcare system, people don't usually pay much for drugs, because most of the time they're covered but for a small co-pay.

The placebo effect here comes from the fact that people tend to trust doctors, so if a doctor says it works, then people will believe it works, whether they pay for it or not.

 

[Moonbeam]

The topic of the thread is the placebo effect, having to do with how a belief in the efficacy of a drug has an actual physical effect on the believer. I totally agree that people tend to place more value on things they work for and/or pay for, in general. However, even in our healthcare system, people don't usually pay much for drugs, because most of the time they're covered but for a small co-pay.

The placebo effect here comes from the fact that people tend to trust doctors, so if a doctor says it works, then people will believe it works, whether they pay for it or not.

We would, of course, want to maximize the placebo effect to any extent possible. In addition to faith in doctors, as you suggest, I can give you two additional factors that a wise doctor can add. One is payment for service and the other is participation or ownership of treatment, a commitment on a personal level to getting well.

 

[bononos]

.......
This is exactly the point. A placebo is becoming to be known in the scientific research community not as an inert substance that causes some effect but as a result of the treatment protocols (time spent, words used, comfort, emotions, etc.). Clearly this really only applies for subjective illnesses but in these cases it makes a huge difference.

I don't personally find the selling of a 'placebo' ethical. I find the treatment with a placebo ethical. The distinction being that I am becoming under the impression that the structure of a treatment is what gives the 'placebo' improvements, thus promising that a treatment (such as an alternative technique) will help you regain health is not a lie. This is especially important if an alternative method is used in conjunction with something like chemotherapy to drastically improve the patient outcome. It absolutely needs ot be regulated though, it is not at all acceptable for someone to convince a patient to avoid a treatment for a critical illness because they 'don't like it'. Regardless of what you practice the patient-caregiver relationship is very easily exploited and needs a lot of safeguards.

I'm quite curious at what point the details of a treatment must be fully explained to a patient before it becomes ethical. I'm not entirely sure how much details one must know before the placebo effects start to drastically drop off either.

You make the assumption that other schools of medicine are based on thin scientific rationale your statement about those schools being 'lambasted by society'. Unless your society only consists of medical practitioners in the allopathic tradition who see them as competitors stealing billions of dollars of business away from them.

I think there needs to be more recognition in mainstream medicine to understand how the body heals itself and move away from the narrow focus on germs, vaccinations and expensive research on new miracle drugs. In the past, MD's weren't even properly trained in nutrition until the more recent discoveries about novel vitamin substances in organic foods. Maybe chiropractors have something going on when they fuss about correct posture and bone alignments.

 

[grohl]

I think the problem is that many practitioners of alternative medicines market their services as curative for a baffling amount of ailments - cancer, MS, diabetes, ADD. Thus the public perception is poor.

I agree with you that placebo treatment of pain, fatigue, emotional fragility, etc, has a definitive role. The PROBLEM is that in order for the placebo treatment to be effective the patient has to ACCEPT the treatment as legitimate.

That's where the ethical problems come to play. Treating someone with mild depression with an SSRI will work MOST of the time, whereas treatment with diet/exercise/supplements works SOME of the time. Is it ethical to give someone a treatment that is less effective? If so do you disclose that there are more effective treatments? Well, if you do, then the homeopathic treatment will be less effective since the patient will perceive there is a better treatment available.