Has your doctor ever prescribed "Obecalp" or "Cebocap" to calm your headache, reduce your stomach upset, or relieve your pain? If so, did it help you?
In fact, Obecalp and Cebocap are placebos -- fake drugs. Obecalp is simply the word placebo spelled backwards. Cebocap is a name of a pill made from lactose. Lactose is sugar.
This week, University of Chicago researchers issued the results of a study showing that 45% of the internists surveyed (all Chicago area family doctors) have prescribed placebos for their patients. Presumably then, those patients took the placebo pills for whatever their complaint was. That means they took the prescription for a fake medicine, went to a pharmacist, paid for the prescription, went home, and hopefully complied with a bogus treatment.
From the report, "Of the respondents who reported using placebos in clinical practice, 34 percent introduced the placebos to the patient as "a substance that may help and will not hurt." Nineteen percent said, "it is medication," and nine percent said, "it is medicine with no specific effect." Only four percent of the physicians explicitly said, "it is a placebo." In addition, 33 percent of the physicians reported they gave other information to patients, including, "this may help you but I am not sure how it works."
What's your immediate reaction to this information? Are you angered? Are you wondering whether any of the bottles in your medicine cabinet are placebos? Are you simply surprised that I would even raise this issue?
Here's the real surprise: Sometimes, often enough to be counted, placebos work to help the patient. Despite the fact that there is no real medicine being ingested, patients feel better. Their pain or other symptoms go away. Even in carefully controlled clinical trials where placebos have been used as the control in the experiment, some patients improve simply because they think they are getting the real medicine.
That effect -- the placebo effect -- is now front and center in discussions of the mind-body connection. Western medicine (as opposed to Eastern, usually more alternative medicine) is just now beginning to embrace this mind-body connection as having real therapeutic value.
However, the use of placebos for therapeutic reasons (as a way to treat patients), is fraught with ethical questions and implications:
- How does the doctor expect the patient's health to improve with fake sugar pills? What's the difference in effect between telling a patient they are fake, vs suggesting they are real medicine?
- Is the doctor simply defaulting to thinking the patient's problems are all in her head?
- What if a patient is really having a heart attack but gets sent home with a fake prescription?
- If someone dies because they were misdiagnosed or undiagnosed, does prescribing a placebo set the doctor up for a malpractice suit?
And what's my take on this study? It's this: In most cases, I think a placebo prescription is a cop out. Yes, I understand that sometimes they will help a patient -- and that's the bottom line, afterall. But there is a reason a patient has pain, regardless of whether it is real physical pain, or pain imagined -- it's still pain. That's true for other symptoms, too. By providing a script for a placebo, the doctor has made a decision that the root of the symptoms isn't important enough to warrant study, or further study.
Either that, or the doctor has decided that the patient has made up the malady -- it's all in her head. And that deduction is used way too frequently, according to the email I receive from patients every day.
There are already enough challenges to the rapport and trust issues between patients and doctors. Knowing now that 45% of primary care doctors are simply dismissing patients with fake medicine -- and that the patients and their insurance are paying for fake medicine, too -- does nothing to improve that trust, regardless of the positive or negative affects on a patient's health.
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