More than half of doctors offer prescriptions for placebos [NA]

[alaskaflyer]

More than half of doctors [in certain specialties] offer fake prescriptions to make patients feel better -- and that's OK, most doctors say.

The findings come from a survey of 679 internists and rheumatologists. Doctors in these specialties often see patients with chronic illnesses or chronic pains that are difficult, if not impossible, to cure. Sometimes fake medicine -- placebos -- make such patients feel better.

I know from personal experience with patients and relatives that placebos are useful in this way, but I had no idea the practice was so widespread. So my question: how much do the pills cost, and are they covered by part D? Also, what does it say on the prescription label on the bottle?

 

[mikea]

Better you get a prescription than go over the counter and spring for $179 for Leptotrim(?) (only for SERIOUS weight loss) or $19 for Head On or $50-$100 or more for a Q-Ray.

 

[ausrere]

I know from personal experience with patients and relatives that placebos are useful in this way, but I had no idea the practice was so widespread. So my question: how much do the pills cost, and are they covered by part D? Also, what does it say on the prescription label on the bottle?

That is interesting. We aren't seeing it with the docs we investigate, at least I've never seen a case of it. Prescribing for non-medical/dental reasons yes (straight up drug diversion), but not prescribing placebos. Seems to me it could border on fraud. I may have to discuss this with the next enforcement committee and see what their take on it is.

 

[gprellwitz]

What does it say about the consumer who doesn't check out what it is their doctor is prescribing? Or are they intimating that to the patient (and insurance company?) that it appears as if it's the real deal? That brings up some interesting questions, as Lisa's getting to.

Edit:
But then I actually read the article.

Over two-thirds of those who prescribed placebos told patients they were getting "medicine not typically used for your condition but which might benefit you."

Not quite my definition of a placebo.

And this asinine statement by the AMA:

Here's the official policy of the American Medical Association:

• Use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.

I mean, use of a placebo with the patient's knowledge? Doesn't that kind of defeat the purpose? Okay, they try to get to that with

The AMA policy says doctors should explain to patients that they can better understand their condition if they try different medicines, including a placebo. If the patient agrees to this, the doctor does not have to identify which medicine is fake, nor does the doctor have to get the patient's specific consent before giving the patient the fake treatment.

 

[4CornerFlyer]

Seems to be yet another example of the press exaggerating and misinterpreting the study.

Here's the actual abstract from the British Medical Journal:
Prescribing "placebo treatments": results of national survey of US internists and rheumatologists



Objective To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself. Design Cross sectional mailed survey.
Setting Physicians’ clinical practices.
Participants 1200 practising internists and rheumatologists in the United States.
Main outcome measures Investigators measured physicians’ self reported behaviours and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a "placebo treatment," their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.
Results 679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).
Conclusions Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.

So despite the headline only 2-3% of doctors use what people commonly interpret as a "placebo," ie saline or sugar pills, hardly an epidemic of fraud. They are including advice to take over-the-counter analgesics (tylenol, aspirin etc) and vitamins as placebos. While those drugs might not be specific to the condition, they may help in some way, and a huge percentage of the population takes vitamins all the time even though there is no proven benefit except in case of a deficiency. And antibiotics? Yes, they are overprescribed, but next time you have a sinusitis and the doctor tells you there is no proven benefit to antibiotics, how happy will you be?

We all know how horribly inaccurate the press is with aviation matters. Believe me, they are no better with medical stories.

Jon, MD