Half of US Doctors Routinely Prescribe Placebos(nytimes.com)
nytimes.com
Half of US Doctors Routinely Prescribe Placebos
http://www.nytimes.com/2008/10/24/health/24placebo.html?_r=1&em&oref=slogin
6 comments
Err, excuse me. I've taken my daughter to A&E (the UK equivalent of ER) a couple of time in her life due to high fever and a very nasty hacking cough. On both occassions, they prescribed ibuprofen, liquids and on one occassion put her in a cooling bath to reduce temperature.
On both occassions I was satisfied: I was pretty sure that it was a viral infection, but with a temperature that high, I wanted to be sure. I would be bloody annoyed if the docs prescribed unnecessary antibiotics. Not all patients are dense and doctors shouldn't treat us as if we are - that just spreads ignorance.
Actually, we are lucky over here now. NHS is a really very good phone consulting service. You phone up with a sick child and they take you through a very VERY detailed list of symptoms and questions. This phone service has saved me a couple of night trips to the hospital since it started.
On both occassions I was satisfied: I was pretty sure that it was a viral infection, but with a temperature that high, I wanted to be sure. I would be bloody annoyed if the docs prescribed unnecessary antibiotics. Not all patients are dense and doctors shouldn't treat us as if we are - that just spreads ignorance.
Actually, we are lucky over here now. NHS is a really very good phone consulting service. You phone up with a sick child and they take you through a very VERY detailed list of symptoms and questions. This phone service has saved me a couple of night trips to the hospital since it started.
I'm sorry if I came across as condescending. That was not my intention at all. I went to an Urgent Care 2 years ago, I waited for 2 hours, only to be told that I should take Tylenol, get rest and drink fluids. I was very upset.
I don't think those expectations are the fault of the patient. It's a natural extension of our drive-thru, fast-food.
At very least, I've found those expectations to be common in most of the 20+ hospitals/ER's that I've worked in over the past 15 years.
I field at least 3-4 calls a night asking for advice. I am not allowed to give any advice over the phone because of liability reasons. People's only option in the middle of the night is to go to the ER and wait their turn which creates frustration and high expectations. It's a bad system, not bad patients.
I don't think those expectations are the fault of the patient. It's a natural extension of our drive-thru, fast-food.
At very least, I've found those expectations to be common in most of the 20+ hospitals/ER's that I've worked in over the past 15 years.
I field at least 3-4 calls a night asking for advice. I am not allowed to give any advice over the phone because of liability reasons. People's only option in the middle of the night is to go to the ER and wait their turn which creates frustration and high expectations. It's a bad system, not bad patients.
I waited for 2 hours, only to be told that I should take Tylenol, get rest and drink fluids. I was very upset
Why? There was nothing wrong. Would you have been happier if they diagnosed cancer? I find the (mostly American) obsession with pills very very strange. I hate seeing this getting imported to Canada, but more and more this seems to be the case.
Why? There was nothing wrong. Would you have been happier if they diagnosed cancer? I find the (mostly American) obsession with pills very very strange. I hate seeing this getting imported to Canada, but more and more this seems to be the case.
Yes, iamelgringo's reaction does seem irrational but I can relate.
I've been dealing w/ a knee injury for a year+ and recently decided to bite the bullet (it's expensive!) and have it checked out. (Being an bootstrapping entrepreneur tends to have the side effect of having less-than-comprehensive health insurance) When the results of the MRI and X-Ray came in I found myself rather disappointed that there were no tears or fractures. I guess I just wanted a definite answer to why my knee was messed up so I could put a rehab plan into place and get back into running and mixed martial arts. Hearing "Don't know what's wrong. Rest it" was rather frustrating.
I've been dealing w/ a knee injury for a year+ and recently decided to bite the bullet (it's expensive!) and have it checked out. (Being an bootstrapping entrepreneur tends to have the side effect of having less-than-comprehensive health insurance) When the results of the MRI and X-Ray came in I found myself rather disappointed that there were no tears or fractures. I guess I just wanted a definite answer to why my knee was messed up so I could put a rehab plan into place and get back into running and mixed martial arts. Hearing "Don't know what's wrong. Rest it" was rather frustrating.
Having seen tons of knee injuries from my army days, I would only say this: Don't get surgery.
Not that I'm planning on getting knee surgery (more rehab . . . sigh) but I'm intrigued.
Care you expand on that?
Care you expand on that?
Well, fully anecdotal here, but every guy I know (at least 10) that got knee surgery to "correct" a problem continued to have the same problems.
It seems to me that most of them regarded this as simply a stop gap or "treatment" and not a cure. Those that thought they would not have any more issues with their knees were not happy. Many who got it earlier on suggested that they would have chosen to go as long as possible without the post surgery rehab if they could.
I've been fortunate enough not to have any knee or foot issues myself, so I'm certainly not claiming to be an authority here.
It seems to me that most of them regarded this as simply a stop gap or "treatment" and not a cure. Those that thought they would not have any more issues with their knees were not happy. Many who got it earlier on suggested that they would have chosen to go as long as possible without the post surgery rehab if they could.
I've been fortunate enough not to have any knee or foot issues myself, so I'm certainly not claiming to be an authority here.
I don't think it has anything to do with obsession with medicine, more to do with wanting to feel that the couple of hours you wasted in the ER were for something.
...and the ones that don't are doing their patients a disservice. Placebos are safe, and can be surprisingly effective.
More people should demand placebos from their doctor...
cough Anyway. I found this line from the article amusing: Only 5 percent described the treatment to patients as “a placebo.”
cough Anyway. I found this line from the article amusing: Only 5 percent described the treatment to patients as “a placebo.”
Yes so did I. To me it means the title of the article was speculative at best. Inaccurate is another word one could use.
Great point. Radiolab had a great episode on the placebo effect and how powerful it can be. It's a great listen if you have time:
http://www.wnyc.org/shows/radiolab/episodes/2007/05/18
http://www.wnyc.org/shows/radiolab/episodes/2007/05/18
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"Antibiotics and sedatives" don't sound like placebos to me.
Tragically, antibiotics are often used as a placebo. For example, prescribing an antibiotic is a good way to get the flu patient to leave your office in a happy mood, secure in the knowledge that Something Is Being Done, even though antibiotics are useless against flu.
That's a big problem, because sugar pills don't breed antibiotic-resistant bacteria. There's a serious argument to be made for homeopathy here: homeopathic treatments don't have side effects.
That's a big problem, because sugar pills don't breed antibiotic-resistant bacteria. There's a serious argument to be made for homeopathy here: homeopathic treatments don't have side effects.
homeopathic treatments don't have side effects.
Indeed. Most of us could stand to drink more water anyways.
Indeed. Most of us could stand to drink more water anyways.
Actually, now that you mention it, I suppose it is possible to overdose on homeopathics.
Moreover, there is a significant side effect: A financial one. That's why I prefer to advocate DIY homeopathics. If yours don't seem to be working, try making them by the light of the full moon. No kidding.
Moreover, there is a significant side effect: A financial one. That's why I prefer to advocate DIY homeopathics. If yours don't seem to be working, try making them by the light of the full moon. No kidding.
It would be pretty hard to overdose on homeopathics. They are basically sugar, and they are tiny. Add in the cost, and it would cost a fortune to overdose. You could probably clean out an entire store's inventory and not overdose.
It's the water he's talking about: http://seattletimes.nwsource.com/html/nationworld/2003529990...
Apparently I left out a necessary ;) on that sentence. ;)
"Prescribing" homeopatic treatments in mock cases instead of real drugs is actually an incredibly neat idea. I can't believe the doctors didn't already think of it. It makes everyone happy. (Except sometime down the road, when someone attempts to heal something serious with homeopatic medicine...but I suppose that is already a problem.)
I can't believe the doctors didn't already think of it.
Oh, they have. Homeopathy is much more popular in Europe than in the USA, and according to Wikipedia some European health insurance actually covers it:
http://en.wikipedia.org/wiki/Regulation_and_prevalence_of_ho...
Covering homeopathy with health insurance strikes me as smart. For one thing, it saves everybody money. Sadly, an over-the-counter homeopathic remedy is more effective if it costs $25 per dose than if it is sold at cost (keep in mind how the treatment works). But an Officially Sanctioned Government Treatment, the true cost of which (5 cents, for the formal-looking box) is hidden from you, is probably almost as good as the $25 stuff. Especially if the box has lots of testimonials and some impressive-sounding Latin words.
It also encourages people to get their homeopathy from an actual doctor, who is able to make use of actual medical science when it proves necessary. This helps discourage the problem of overenthusiastic entrepreneurs cutting out the middleman by convincing people to treat their diabetes and Stage I cancer with nothing but an extremely dilute, patent-pending snake oil solution.
Oh, they have. Homeopathy is much more popular in Europe than in the USA, and according to Wikipedia some European health insurance actually covers it:
http://en.wikipedia.org/wiki/Regulation_and_prevalence_of_ho...
Covering homeopathy with health insurance strikes me as smart. For one thing, it saves everybody money. Sadly, an over-the-counter homeopathic remedy is more effective if it costs $25 per dose than if it is sold at cost (keep in mind how the treatment works). But an Officially Sanctioned Government Treatment, the true cost of which (5 cents, for the formal-looking box) is hidden from you, is probably almost as good as the $25 stuff. Especially if the box has lots of testimonials and some impressive-sounding Latin words.
It also encourages people to get their homeopathy from an actual doctor, who is able to make use of actual medical science when it proves necessary. This helps discourage the problem of overenthusiastic entrepreneurs cutting out the middleman by convincing people to treat their diabetes and Stage I cancer with nothing but an extremely dilute, patent-pending snake oil solution.
Indeed, all sorts of faith healing (homeopathy, Jesus-powered medicine, crystal energies, etc) would be useful in this regard. Faith healing has the advantages of being cheap and free of side effects. Medicine has the advantage that it sometimes works.
For the cases when medicine doesn't work, faith healing wins. It's cheaper, and equally effective. Of course, it will never happen, due to irrational faith in doctors.
Robin Hanson is an interesting read on this topic.
http://www.overcomingbias.com/2008/05/faith-in-docs.html
http://www.overcomingbias.com/2007/05/rand_health_ins.html
For the cases when medicine doesn't work, faith healing wins. It's cheaper, and equally effective. Of course, it will never happen, due to irrational faith in doctors.
Robin Hanson is an interesting read on this topic.
http://www.overcomingbias.com/2008/05/faith-in-docs.html
http://www.overcomingbias.com/2007/05/rand_health_ins.html
Medicine has the advantage that it sometimes works.
So does faith healing.
So does faith healing.
Sounds like a needed service: we need something that the doctors can prescribe and get from a pharmacist that actually is a harmless placebo instead of antibiotics. Maybe it can go under many different technical sounding names.
This exists. That is actually the de facto way to prescribe placebos.
Would anyone happen to know some of these "facade" drug names? (If anyone here is on meds right now, please don't look at the replies--you might decrease their efficacy!)
I have a friend who does general medicine - he says that sometimes they will prescribe a saline nasal spray as placebo.
This idea is related and hilarious http://inventedbyamother.com/
Does it have FDA approval?
Even better. It doesn't have FDA disapproval.
I'm not sure about the details. I would imagine because it contains no narcotics, it wouldn't be necessary to test responses. But considering how fucked the FDA approval process is, my intuition doesn't mean much.
when I had bronchitis, my doctor told me "I can give you antibiotics and it will go away in three weeks. You can go without antibiotics and it will still go away in three weeks. What do you want to do?"
I declined.
I declined.
The problem is that patients frequently demand antibiotics for infections that don't require them and patients demand XRays for injuries that are obviously not fractures.
If someone is going to take little Jonny to the ER at 3 in the morning because the child has a fever and a cough, the last thing that the parents want to hear is "give him Tylenol, push fluids, plenty of rest..." Plain and simple, if they're going through the trouble to see the doctor, they want a prescription. So, instead of spending 20 minutes explaining to the parents why little Jonny doesn't need a prescription, they spend 5 minutes with them, prescribe an antibiotic that they _might_ but probably don't need, and run off to see the next patient.