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An article on WebMD this week addressed a very interesting issue. Should doctors give patients placebo (non-active) pills in any circumstances. It turns out this is a surprisingly common practice when doctors are faced with poorly understood chronic conditions such as fibromyalgia.
A recent survey revealed that more than half of doctors give out fake prescriptions to patients and that the majority of doctors feel this practice is OK.
Scientists questionned 679 internists and rheumatologists; doctors working in specialties where they often see patients with chronic illnesses or chronic pain syndromes including fibromyalgia that are difficult, and in many cases imposible, to cure.
It was revealed that doctors find that placebos often provide significant benefit to such patients. The placebo effect is something that has been known of for a long time and is in fact an integral part of scientific research. It is central to the gold standard of medical research; the double-blind, placebo-controlled trial.
The placebo effect is thought to work because a patient thinks they are getting a powerful medicine and this belief is powerful enough to cause beneficial changes in the body all by itself.
Lead researcher Jon C. Tilburt, M.D., said "Twenty to thirty percent of the benefit seen in rheumatism drug studies are due to the placebo effect. Real changes in health go along with the belief that patients will get better."
Tilbert, former NIH researcher and now assistant professor of medicine at the Mayo Clinc, and his colleagues asked the doctors a series of questions about their use of placebos including:
If a clinical trial showed a sugar pill was better than no treatment for fibromyalgia, would you recommend sugar pills to fibromyalgia patients? Yes, 58% of the doctors said.
Do you ever actually recommend treatments primarily to enhance a patient's expectations? Yes, 80% of the doctors said.
In the last year, did you recommend a placebo treatment to a patient? Yes, 55% of the doctors said.
In addition, over two-thirds of those doctors who prescribed placebos told patients they were getting "medicine not typically used for your condition but which might benefit you."
When asked if it was appropropriate to "fool" patients in this way - 62% of the doctors said yes.
So is it right or wrong for doctors to give placebos?
In certain circumstances I would have to say I would be open to the use of placebos. It has been proven that they work. The double-blind placebo-controlled trial - the gold standard of medical research shows they work. Patients given placebos in this trials often improve considerably and many medications are only slightly more effective.
The extent of the mind-body connection has also been well established by research in areas such as psychoneuroimmunology. Thoughts can produce significant physiological effects on the body. In a negative context for example chronic activation of the stress system (e.g. chronically raised stress hormones e.g. cortisol and adrenaline) has been linked to serious diseases such as Alzheimer's disease and cardiovascular disease.
Conversely, if a fibromyalgia patient believes they are being given a powerful pain medication this can trigger the patient's body to produce its own opiate-like painkilling chemicals such as endorphins.
Of course there are ethical issues surrounding the use of placebos. Is it right to give a patient a placebo without their knowledge? To this I have to say no. It is a break in the trust that must exist between doctor and patient. However, if the patient knows they are receiving a placebo it is highly unlikely to have an effect.
Fortunately there is a way around this problem which is endorsed by the American Medical Association (AMA). Doctors may explain to patients that they can better understand their condition and find appropriate therapeutic interventions with trials of different treatments.....including a placebo. This way there is no deception but the patient still doesn't know when they are receiving the placebo.
In the end Professor Tilbert believes that the relationship between doctor and patient is the biggest key to successful treatment of fibromyalgia and other hard to treat conditions.
What do you think about this issue? As a patient would you be happy for your doctor to prescribe a placebo if it had been shown to be as effective or more so than an actual medication for your condition? Leave us your comments below...