If a drug company treats a doctor to a nice lunch and a presentation on their newest products, is prescribing affected? Doctors generally think not, but the research evidence overwhelmingly says yes. And if these events do affect doctors’ decisions on patient care, should we be worried?
Couldn’t they just prescribe placebos? Of course not! Where’s the profit in that?
Placebo beats pill for all but most severely depressed, study shows.
“Antidepressants are little better than placebos except for in severely clinically depressed samples,” Johnson said. “The implication was that medical doctors are overprescribing antidepressants because most patients are not severely depressed.”
“A common operation for back pain is not only ineffective but often leads to complications, a former spinal surgeon is claiming in a new book. In Surgery, The Ultimate Placebo Ian Harris says that when spine fusion operations appear to work, it’s usually because of a placebo effect.” Full article here
An interesting distinction between ‘pure’ and impure’ placebos! (Universal Placebos are unapologetically PURE!)
“A pure placebo is a straightforwardly fake treatment – a saline injection or a sugar pill, for instance, that is represented as a drug.
An impure placebo is a substance or treatment that does have clinical value, but not for the condition for which it is being prescribed.
Impure placebos can be vitamins, nutritional supplements, antibiotics for viral infections, sub-clinical doses of drugs, unproven complementary and alternative medicines, or unnecessary blood tests to calm an anxious patient.”
A UK survey in 2012 showed that 1% of GPs use ‘pure’ placebos at least once a week, and an extraordinary 77% use ‘impure’ placebos at the same rate (though we suspect that’s often the habit of prescribing so-called ‘useless’ antibiotics for viral infections).
By mixing placebos and active drugs, doctors may be able to keep treatments effective for longer.
Fascinating research into the use of placebos to enhance and prolong the effect of the conventional treatment of Parkinsons.
“Britain’s Princess Alexandra Hospital NHS Trust wants to hire a reiki therapist for a hospital in Epping.”
This caused a controversy and a flurry of disgruntled email. BUT …
“If drugs are effective and placebo responses small, this does not matter much. But people tend to turn to alternative medicine for subjective, stress-related conditions such as chronic pain, depression, nausea and fatigue (all problems that can affect cancer patients in treatment). Drugs for these conditions have significant downsides, such as unpleasant side effects and addiction, and placebo responses often account for most of the effect of the drug. So it becomes plausible that compared to popping a pill, a patient might get more relief — and fewer side effects — from an hour with a sympathetic therapist.”
More on the Americans developing a ‘tolerance’ to placebos. Can the answer be genetic?
In May, researchers from Harvard Medical School described a set of variants in 11 genes that they say are linked to the placebo effect and called it the ‘placebome.’ Scientists have known for quite some time that some people are more prone to experiencing the effect than others. And early investigations implicated the body’s natural pain control systems, including the opioid-like chemicals made and released in our own brains.
(Medical Xpress)—Imagine that your doctor knows from evidence-based studies that if he tells you about certain, small side-effects to a particular drug, you are significantly more likely to experience that side effect than if he did not tell you about it. Given the three values of autonomy, beneficence, and nonmaleficence, what should he do?
On the flip side, what if your doctor knew that statistically patients who are gradually weaned off of a chronic pain medication by decreasing their dosage until it is a placebo will still experience relief from their pain as a result of habituation? Should the doctor lie to you about your dosage in an effort to help your chronic pain while mitigating side effects?
Mark Alfano, bioethicist at Delft University of Technology in the Netherlands writes a compelling argument for re-defining our views of placebos and placebo effects and how, by defining them in terms of classical conditioning, expectation fulfilment, and somatic attention and feedback, the ethics of informed consent changes by doing so. His is the target article in this month’s issue of the American Journal of Bioethics.
More information: “Placebo Effect and Informed Consent” American Journal of Bioethics, 15:10, 3-12.
More research from Ted Kaptchuk, in the New England Journal of Medicine.
“Placebos don’t necessarily provide cures, but they provide relief. In medical situations in which no cure is available, supportive and attentive health care can help patients to feel better, and when effective drugs do exist, placebo effects can enhance their impact.”
And …
“A significant body of research has resulted in a shift from thinking of placebos as just ‘dummy’ treatments to recognizing that placebo effects encompass numerous aspects of the health care experience and are central to medicine and patient care. Recent scientific advances have enabled us to identify a trove of neurotransmitters and detect relevant neural brain pathways as well as genetic markers that help explain the biology of the placebo effect.”