Prescribing placebos: The “unintended” side-effects
Posted: October 27th, 2008 by Steve TrinwardIt may not be the hottest topic in healthcare news, but it sure caught my eye:
Study: Half of U.S. doctors often prescribe placebos
This story was posted widely across news sources from MSNBC to the New York Times, on a study published Friday in BMU (fka the British Medical Journal). The survey of American physicians revealed something probably not all that surprising: When in doubt as to prescribing a “cure” for an ailment, many doctors just prescribe something they think won’t harm the patient, and hope the body will cure itself, once the patient’s stress and anxieties are allayed. Such things as vitamin supplements, even medical-testing “sugar pills.” are used for this purpose; they won’t harm the patient, and may actually convince their minds to let go and let the body heal itself, as it’s designed to.
Outside of the obvious deception of the patient, this does seem to go along with the Hippocratic Oath: First, do no harm. According to the story, “Half the doctors reported using placebos several times a month, nearly 70 percent of those described the treatment to their patients as ‘a potentially beneficial medicine not typically used for your condition.’ Only 5 percent of doctors explicitly called it a placebo treatment.”
In these cases, where the substance being “prescribed” is truly a neutral agent, the only real question might be how much these “healers” are charging for their innocuous recommendations, or how much the pharmacy gets for filling the prescription. If this practice is inflating prescription costs, it should be ended immediately, or at least be severely diverted to produce a lessened effect on “real” medical cost-issues. (One could speculate that, given the present “insulation”—of patient and pharmacy, as well as of physician—from the actual costs of such “care” … we have no clue as to the effect this practice has on prescription-costs!)
However, in many case, the study found, doctors knowingly advise their patients to ingest a variety of substances with known side-effects, even dangerous ones. The survey found that “[m]ost doctors used actual medicines as a placebo treatment: 41 percent used painkillers, 38 percent used vitamins, 13 percent used antibiotics, 13 percent used sedatives, 3 percent used saline injections, and 2 percent used sugar pills.” Furthermore, “In the survey, doctors were asked if they would recommend a sugar pill for patients with chronic pain if it had been shown to be more effective than no treatment. Nearly 60 percent said they would.”
Now we have something maybe at least bordering on medical malpractice, IMNSHO:
· If nearly half of them are prescribing “painkillers” (for something besides temporary relief of actual pain), they may be contributing to creating a drug-dependency, on something that has no relationship to the ailment involved. What effect is this having on the “prescription painkiller” black-market?
· If “13 percent used antibiotics” … these have been shown to contribute to reduced immunity to REAL viruses and microbes, when overused. What are they doing to distort the natural healing-functions bodies of the bodies of those patients, and to create the next “superbug” epidemic?
· If “38 percent used vitamins” … did they tell their patients to fill the “prescription” at the local health-food store? Or did they write some arcane prescription, fillable only at a pharmacy and then (in collusion with said local pharmacies) charge “medicinal” prices for those vitamins, knowing full well that the insurance companies would pay the bills for their “legitimate” prescriptions? What effect has this had on drug prices and other medical costs?”
· Those “13 percent [who] used sedatives” … were these the usual run of “anti-depressants”—the ones we now know may be linked to teenage suicide, sexual side-effects, etc.? How many severe emotional disturbances have been caused by these practices, and the refusal to own up to them … all in the name of “easing the patient’s anxiety”?
· And even the saline injections and sugar pills … how ethical is it to present such things as healing techniques, if one knows they have no medicinal effect (except the easing of the patient’s mind through deception and fraud)? And how much is being charged (to patients, more often to their insurers, most often to the taxpayers—for Medicare/Medicaid) for these meaningless practices?
We don’t know any of these answers, from the news-story or the study itself. But these are questions that beg for cogent replies.
I’ve personally consulted with a few naturopathic practitioners, even bought supplements from a couple of them. At no time did they claim this would “cure” all my ills, only that it might help — alongside better diet and exercise, and paying more attention to how my body was reacting to the changes.
If I had any confidence that the allopathic medical world was being as conscientious and open about its alleged “cures” … I might be more willing to let this slide.
I don’t, and so I’m not.

October 27th, 2008 at 2:04 am
[…] Irina and Thordur wrote an interesting post today onHere’s a quick excerptWhat are they doing to distort the natural healing-functions bodies of the bodies of those patients, and to create a future “superbug” epidemic? · If “38 percent used vitamins” … did they tell their patients to fill the “prescription” … […]
October 27th, 2008 at 4:58 am
[…] Prescribing placebos: The “unintended” nside-effects If “38 percent used vitamins” … did they tell their patients to fill the “prescription” at the local health-food store? Or did they write some arcane prescription, fillable only at a pharmacy and then (in collusion with said local … […]
October 28th, 2008 at 5:40 pm
Allopathic and even my osteopathic colleagues have blasted me for opinions I’ve expressed in medical websites about using osteopathic manipulative techniques for various conditions. I’ve especially found it useful for flus and other viral infections. The discussions have gotten very heated with them claling me a quack and me responding in kind. One challenge I’ve issued that not one has ever answered in several venues was about using antibiotics for colds, standard viral URIs. I’ve asked them if any one of them can state that he’s never prescribed an antibiotic for a cold. Not one has ever answered. Talk about a placebo; an antibiotic for a cold is not only worthless but, ultimately, counter-productive.
December 3rd, 2008 at 11:38 pm
Rod - Just saw this in my travels … deserves a response …
I consider about 75% of the things I’ve seen non-allopathic healers do to be far more useful than a similar percentage of things allopaths insist on. Knowing as I do now how many of the latter resort to “witch doctory” when they are in doubt (any pill will do?), I am tempted to push the percentages accordingly
December 18th, 2008 at 11:15 pm
More Questions than Answers
What would you do if you found out that your physician was prescribing placebos for your acute medical condition? That’s far from a rhetorical question:
December 26th, 2008 at 5:20 pm
Since I have no ‘acute medical conditions” (that I know of), it is a rhetorical questin for me personally. However, the point is very well taken.
Beyond that, I wonder about the number of NON-acute conditions, for which doctors are treating/masking symptoms (instead of seeking to cure causes) — by prescribing things that have devastating side-effects for those who do not need them for physical ailments. (Good example: Some Rx painkillers are very effective at mitigating chronic pain, but if one does not HAVE chronic pain to relieve, they are viciously addictive and even fatal (cf. the recent wave of deaths and near-deaths due to misuse of Actiq and other “pain lollipops”).
If half the doctors around are mis-prescribing these kinds of high-level painkillers, antidepressants (which are closely related to almost every psycho school-shooting in recent memory?) and other “harmless” substances … we’ve got a much bigger problem than just healthcare reform on our hands.