Tuesday, October 28, 2008

Prescribing Placebo Treatment Study Is Flawed and Misleading

A recent study suggested that doctors common prescribe placebo treatments and that this behavior is considered ethically permissible. The article received a lot of press. Pity that the study is terribly flawed and misses the point.

Researchers admit that the behavior of doctors recommending treatments that weren't proven to be helpful (i.e. antibiotics for colds, which are caused by viruses and therefore can't be killed with antibiotics) was best captured by the world "placebo". Very misleading. The problem is that placebo "is a substance or procedure a patient accepts as medicine or therapy, but which has no specific therapeutic activity. Any therapeutic effect is thought to be based on the power of suggestion." Antibiotics do have therapeutic activity, just not against viruses, and can cause major side effects.

Doctors don't write prescriptions for antibiotics for the placebo effect. They prescribe it because patients demand it and to ensure that patients come back again, doctors feel pressured to comply. Research shows when patients demand advertised medications, more often then not they get exactly what they wanted. Unlike the conclusion of this study, many doctors felt ambivalent that they wrote the medication.

Saying that recommending over the counter analgesics is also a placebo is also a problem. These actually do have therapeutic effects like decreasing pain or fever. As the researchers found practically no one prescribed sugar pills.

Doctors are prescribing antibiotics and sedatives for conditions which they might not help, not because of the placebo effect, but because patients demand something be done and the offered therapies probably won't cause harm (and the doctors simply want to avoid a confrontation or discussion of why no therapy would work), doctors aren't practicing evidence-based medicine (the vast majority of sinus infections - sinusitis and bronchitis in healthy individuals does not require antibiotics and vitamin b12 injections don't help with general fatigue), or doctors just want to do something. In all three scenarios, potential harm can occur.

This is contradictory to the meaning of placebo and why the study's claim is so flawed and misleading. As the authors noted, "Few of the physicians we surveyed recommend inert placebo treatments. " i.e. pills that do nothing, like sugar pills. Why? Because unlike other cultures, like Israel where doctors about a third of the time do prescribe sugar pills, placebo treatment is not considered acceptable treatment.

Claiming that doctors commonly prescribe placebo treatments and are ethically fine with it is wrong. It is a shame that the media didn't have the level of sophistication necessary to dissect this out.

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