In many circles, the term ‘placebo’ sounds antiquated, and may even remind older readers of the country’s psychiatric hospital craze circa the 1950s and ’60s.
And like widespread psychiatric hospitalization, placebos also have a longstanding history with controversy. In 1903, Richard Cabot dismissed placebos despite his upbringing, claiming “I have not yet found any case in which a lie does not do more harm than good.”
Yet, many academics have become increasingly interested in researching the placebo effect, and in 2011, Harvard Medical School even set up its own Program in Placebo Studies.
Therefore, we’re wondering whether placebos are still significant for contemporary practices.
Are Placebos Even Ethical?
At first glance, it seems a sugar pill or some other pseudo-treatment that betters patient health would be an ends-justify-the-means kind of situation, and that any harm done by lying to a patient would be validated by his or her better health.
Well, for one, a patient is still being misled and his/her discovery of the truth could result in disastrous consequences, including reversion of treatment benchmarks, distrust, and psychological trauma like depression.
Not to mention, researcher Ben Z. Krentzman, M.D. reported that some patients can actually become addicted to placebos. A patient he observed ingested 10,000 placebo units in a calendar year, while another increased the dosage and couldn’t wean off the meds without a psychiatrist. The result? Abstinence syndrome.
A physician may also interpret a positive placebo effect as evidence that a patient’s illness is entirely psychosomatic or illusionary when instead it’s only providing momentary alleviation for a condition that may still very well exist. And since there are no standards for dealing with the consequences of administering a placebo, the patient-doctor relationship is constantly at risk.
However, you still shouldn’t dismiss all therapeutic uses of placebos. Just keep in mind that prescribing placebos outside of an experimental setting requires great care, and perhaps even more meticulousness than you’d exercise with actual pharmaceuticals.
Placebos in a Digital World
Many writers have exposed the repercussions of web-savvy patients gone wrong. It’s not unheard of for an ePatient to become a bit of a cyberchondriac, where the definition of placebo becomes larger in scope.
Research-based placebos are important for the Google-happy cyberchondriacs, who vet pharmaceuticals and analyze clinical trial results. But would prescribing a placebo do more damage than good?
Dr. Danielle Ofri, assistant professor of medicine at NYU Medical School, realized she’d prescribed placebos in the past, suggesting multivitamins to patients who suffered from fatigue, despite there being no conclusive evidence that multivitamins help revitalize.
Ofri doesn’t consider her practice to be deceptive per se, but a web-savvy e-patient may think otherwise, possibly leading to physician mistrust and accusations of malpractice.
Imagine – what does it look like for a doctor to suddenly suggest a placebo, even though he/she was in the habit of ePrescribing during past visits? This kind of behavior endangers the doctor-patient relationship, which in and of itself has been shown to have positive effects on patient health.
And lastly, ePrescribing makes it increasingly easier for doctors to prescribe medication like antibiotics and sedatives as placebos. In fact, 13 percent of doctors in a recent NIH study admitted to doing so with both. And since ePrescriptions boast a higher first-fill rate, it’s more likely to end up in immunity and dependency.
Our conclusion? Yes, the place of placebos in contemporary practices can be justified, but the advent of technology and greater patient connectedness changes the game a tad. Proceed with caution and always with the patient’s best interests in mind.
Do you prescribe placebos at your practice? How do you go about doing so?
