NationStates Jolt Archive

Half of Doctors Routinely Prescribe Placebos

By GARDINER HARRIS
Published: October 23, 2008

Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. The results trouble medical ethicists, who say more research is needed to determine whether doctors must deceive patients in order for placebos to work.

The study involved 679 internists and rheumatologists chosen randomly from a national list of such doctors. In response to three questions included as part of the larger survey, about half reported recommending placebos regularly. Surveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.

The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.

In most cases, doctors who recommended placebos described them to patients as “a medicine not typically used for your condition but might benefit you,” the survey found. Only 5 percent described the treatment to patients as “a placebo.”

The study is being published in BMJ, formerly The British Medical Journal. One of the authors, Franklin G. Miller, was among the medical ethicists who said they were troubled by the results.

“This is the doctor-patient relationship, and our expectations about being truthful about what’s going on and about getting informed consent should give us pause about deception,” said Dr. Miller, director of the research ethics program in the department of bioethics at the National Institutes of Health.

Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.

But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. “Is that a placebo treatment? Depending on how you define it, I guess it is.”

But antibiotics and sedatives are not placebos, he said.

The American Medical Association discourages the use of placebos by doctors when represented as helpful.

“In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient,” the group’s policy states.

Controlled clinical trials have hinted that placebos may have powerful effects. Some 30 percent to 40 percent of depressed patients who are given placebos get better, a treatment effect that antidepressants barely top. Placebos have also proved effective against hypertension and pain.

But despite much attention given to the power of placebos, basic questions about them remain unanswered: Are they any better than no treatment at all? Must people be deceived into believing that a treatment is active for a placebo to work?

Some studies have hinted at answers, but experts say far more work is needed.

Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in Galveston, said the popularity of alternative medical treatments had led many doctors to embrace placebos as a potentially useful tool. But, Dr. Brody said, doctors should resist using placebos, because they reinforce the deleterious notion that “when something is the matter with you, you will not get better unless you swallow pills.”

Earlier this year, a Maryland mother announced that she would start selling dextrose tablets as a children’s placebo called Obecalp, for “placebo” spelled backward.

Dr. Ezekiel J. Emanuel, one of the study’s authors, said doctors should not prescribe antibiotics or sedatives as placebos, given those drugs’ risks. Use of less active placebos is understandable, he said, since risks are low.

“Everyone comes out happy: the doctor is happy, the patient is happy,” said Dr. Emanuel, chairman of the bioethics department at the health institutes. “But ethical challenges remain.”

Link to New York Times article. (http://www.nytimes.com/2008/10/24/health/24placebo.html?ref=health)
Link to actual study. (http://www.bmj.com/cgi/content/short/337/oct23_2/a1938)

I came across this article reading the NY Times website and found it very interesting. I had previously heard of a study done involving doctors and their use of placebos, but I was amazed to read here that 50% of doctors prescribe placebos on a regular basis.

There have been some other studies performed demonstrating the positive (http://serendip.brynmawr.edu/bb/neuro/neuro99/web1/Kinser.html) effect of placebos on psychosomatic diseases (http://www.fda.gov/fdac/features/2000/100_heal.html). Though placebos have no clinical effect (http://content.nejm.org/cgi/content/full/344/21/1594), they have a powerful psychosomatic effect. Placebos work by convincing the brain to heal the body without the use of medication by making it believe the medication or treatment the patient is receiving has theraputic value when it in fact has none. Psychosomatic disorders are particularly affected by placebos because they can often be cured when the patient believes the treatment they received has alleviated the symptoms, as most patients with psychosomatic disorders often malinger (fabricate) physical symptoms. That is to say, whether or not placebos have any clinical effect, the psychological effect they produce is strong enough to aid in the treatment of psychosomatic diseases.

This made me want to pose the question: Is it ethical for doctors to prescribe placebos (such as vitamins) to patients with psychosomatic diseases, where they might have beneficial psychosomatic effects even without any actual, clinical effects?

Also, I wanted to share this study (http://www.healthmadeeasy.com/content/view/455/363/) that demonstrates that the more expensive the placebo, the greater the effect it had.

According to a report released in the Journal of the American Medical Association, patients who believe they are taking a drug that costs more, are more apt to report positive effects from the medication, even if the medication is a placebo.

The study included 80 participants who were paid to undergo a series of electric shocks to the wrist area of the body. One half of the patients were given a placebo painkiller and told the medication costs $2.50 retail per pill. The other half were given the same placebo painkiller, but were told the medication retailed for only 10 cents a pill.

By the end of the study, 60% of the patients who were given the 10 cent placebo reported a reduction in pain from the electric shock. The higher priced placebo painkiller, on the other hand, reduced pain in 85% of the participants.

Not directly related, but I found the psychological impact of price to be amusing. :)

This was actually a placebo article. Fifty percent of newspapers regularly run them.

I suspect doctors are lying in terms of their answers somewhat.

Most health problems disappear within a week naturally, often where it's just a heavy cold or some stomach bug.

It's impossible for a doctor to thoroughly test every patient that comes through the door, far easier to prescribe a placebo to ease the mind of the patient and let the illness take its natural cause.

If it persists, that's the time to look more deeply into the situation.

So I don't think it's necessarily that the placebo is working, more that the illness naturally disappears but we ascribe the cure to whatever we were given.

Considering all the idiots who walk into hospitals with a sore leg or cold, I'm not surprised at all. Giving a placebo is much easier than telling a patient that there's nothing wrong.

I, for one, think doctors are sexy. Particularly when they post articles about placebos.

Oh, and, yeah, I absolutely think they should prescribe placebos.

When I grew up, it was common to hear doctors prescribe "OBCalp" to the "frequent fliers" of the ER...OBCalp is placebo spelled backwards. Bad, but true.


That said, the placebo effect is actually quite powerful. What is the most common color for medication? Red. There have actually been studies done where a medication colored red is more effective than one colored blue. This has held true for both placebo and actual medication (tylenol, for example). The major exception has been sleep aids, which are colored blue.


It is important to understand that the standard virus or bacterial infection will have a 7-10 day course. Three days getting sick, a day or two at peak, and then recovery. Antibiotics take three days to work, assuming you take them properly. By the time you feel the need to see a doctor (usually as you near the peak of sickness, about two or three days), you are about half way to full recovery.



I do take issue with the articles definition of "placebo". A placebo, by definition is an inert thing...this article defined them as any medication given outside of common usage. A headache pill, for example, can have an impact on blood flow, and therefore treat a symptom or disease that has absolutly nothing to do with headaches.

It's why, when I break bones, I always wait for a week before going to the doctor, just in case it heals itself rather than bothering anyone about it. Sure, it means I hobble, screaming in pain and agony for a week or so but I do hate to trouble people.

So they are charging me $25.50 a pill for something that does not even work?

*Throws away 'happy' pills.*

I can feel the power course throw my vains!

*Vikings begin to ravage the streets of Boise, Idaho.*

When I grew up, it was common to hear doctors prescribe "OBCalp" to the "frequent fliers" of the ER...OBCalp is placebo spelled backwards. Bad, but true.

OBECALP ;)

I do take issue with the articles definition of "placebo". A placebo, by definition is an inert thing...this article defined them as any medication given outside of common usage. A headache pill, for example, can have an impact on blood flow, and therefore treat a symptom or disease that has absolutly nothing to do with headaches.

In medical school we were just taught to call them "dummy pills" or a treatment "dummy treatment." The effect of the placebo on the "blood flow" would be minimal enough that the psychological effects on the disorder would outweigh any clinical effect.

Whatever works. Since every night on TV ads keep telling us that there's a pill for stuff you didn't even know was wrong with you there are probably that many patients who won't leave without one.

It's why, when I break bones, I always wait for a week before going to the doctor, just in case it heals itself rather than bothering anyone about it. Sure, it means I hobble, screaming in pain and agony for a week or so but I do hate to trouble people.

Believe me, that $2,500 you pay to have your bone set isn't a bother at all ;).

I suspect doctors are lying in terms of their answers somewhat.

Most health problems disappear within a week naturally, often where it's just a heavy cold or some stomach bug.

It's impossible for a doctor to thoroughly test every patient that comes through the door, far easier to prescribe a placebo to ease the mind of the patient and let the illness take its natural cause.

If it persists, that's the time to look more deeply into the situation.

So I don't think it's necessarily that the placebo is working, more that the illness naturally disappears but we ascribe the cure to whatever we were given.

It's why, when I break bones, I always wait for a week before going to the doctor, just in case it heals itself rather than bothering anyone about it. Sure, it means I hobble, screaming in pain and agony for a week or so but I do hate to trouble people.

Lets be fair. By and large, the people who you will see to diagnose a problem are a) emergency room doctors or b) a general practicioner.

In both cases, the doctor will take what they know of your medical history, as well as what you provide them on the spot, and diagnose, to the best of their ability, what the problem is.

For the average, infrequent visitor to the ER, you will get standard treatment..."you have a severe sore throat, you can't swallow, your glands are swollen. I'm going to run a strep culture and put you on these antibiotics". Your GP will give you more thorough care, but then, they can. They know more of your medical history usually, and have more time.

It is the frequent fliers...those who come in with a condition like "migranes" or "chronic back pain", and list allergies to tylenol, motrin, and asprin...who will be likely to get the placebo treatment

Doctors legally cannot lie to you. They may struggle to put it in terms you can understand, they may oversimplify, but they cannot lie.

OBECALP ;)

*sigh* Sarky is tired.

Oh, by the way, *tackles*
long time no see :)

In medical school we were just taught to call them "dummy pills" or a treatment "dummy treatment." The effect of the placebo on the "blood flow" would be minimal enough that the psychological effects on the disorder would outweigh any clinical effect.
That's actually a really interesting change in terminology.

My "medical training" is the result of growing up in the ER, crossed with having a nurse for a mom and doctor for a dad. It's given me a functioning knowledge of my own problems, enough common sense to say "You need to see a doctor" to my friends, and a huge interest in the field.

*sigh* Sarky is tired.

Oh, by the way, *tackles*
long time no see :)


That's actually a really interesting change in terminology.

My favourite thing to write on the chart is HIBGIA.

And people....Is it ethical for doctors to prescribe placebos (such as vitamins) to patients with psychosomatic diseases, where they might have beneficial psychosomatic effects even without any actual, clinical effects?

^Thats the question being asked.

My favourite thing to write on the chart is HIBGIA.

My doctor always writes that next to clamydia.

My favourite thing to write on the chart is HIBGIA.

And people....Is it ethical for doctors to prescribe placebos (such as vitamins) to patients with psychosomatic diseases, where they might have beneficial psychosomatic effects even without any actual, clinical effects?

^Thats the question being asked.

I'm very torn. Patients have the right to be informed about their treatement, and have all questions answered in a truthful manner.

That said, if there is reason to believe that a placebo will treat symptoms or cure the root issue, I do not see the doctor being out of line. They are doing exactly what their job asks...treating the illness and/or its symptoms. The doctor must be prepared to answer for their choice-- to the patient, the patients family, the AMA, and a jury. If they are prepared to do so and can provide reasonable justification for their choice, I do not see an issue.


And my favorite medical acronym is "GOOMER"

I'm very torn. Patients have the right to be informed about their treatement, and have all questions answered in a truthful manner.

That said, if there is reason to believe that a placebo will treat symptoms or cure the root issue, I do not see the doctor being out of line. They are doing exactly what their job asks...treating the illness and/or its symptoms. The doctor must be prepared to answer for their choice-- to the patient, the patients family, the AMA, and a jury. If they are prepared to do so and can provide reasonable justification for their choice, I do not see an issue.


And my favorite medical acronym is "GOOMER"

Well normally if the placebo didn't work the first time around, you switch to more mainstream treatment. Thus you avoid having to answer to the AMA and the jury....

And also GOMER? Its the medical equivalent of GTFO.

Well normally if the placebo didn't work the first time around, you switch to more mainstream treatment. Thus you avoid having to answer to the AMA and the jury....Most of the time, you are definatly right. But there is always a risk of malpractice.

And also GOMER? Its the medical equivalent of GTFO.

My dad was in a motorcycle accident over the summer...he was placed in the rehab facility that his medical clinic staffs. This led to a huge number of his coworkers coming in to see him in the "Gomer home", and to "poke the gomer".


And that is one awesome book. I hope to write a similar one for education.

Most of the time, you are definatly right. But there is always a risk of malpractice.

There is the risk of malpractice in everything we do anymore. :(

There is the risk of malpractice in everything we do anymore. :(
Tell me about it.

I would be a med student were it not for this risk...my dads happiest moment was when I said "Nah, I think medical school is out. I'd rather teach". This just after his malpractice lawsuit (which he won. Yay!)

There is the risk of malpractice in everything we do anymore. :(

Not spankings. I recommend more of them.

On topic... that's actually the problem. The point is that if you were doing something that you reasonably should have thought would be helpful, you should be alright. If only, right?

So they are charging me $25.50 a pill for something that does not even work?

*Throws away 'happy' pills.*

I can feel the power course throw my vains!

*Vikings begin to ravage the streets of Boise, Idaho.*

You crazy southerners :rolleyes: Just stay down south of Moscow please.

many medications are prescribed for their "side effects" rather than for their primary effect these days. I was once prescribed a sleep aid that was actually an antidepressant. Had quite a drowsiness effect, so it was assigned double duty, I guess. I'm not taking it anymore.

*tries to slit wrists but fails miserably due to a month without sleep* :p

The whole point of a placebo is it is nothing that will have an effect on an individual other than mentally. Placebos are generally sugar pills or something similar. The doctor would have to tell the patient that it's really a drug for it to work otherwise, what would be the point of telling the patient that it's a placebo before they try it?

The question is ethical... the patient is paying a ridiculous price for a sugar pill. And it's considered deceit in the realm of psychological experimentation on human beings.

Then again, I think many doctors in the US are more apt to prescribe medication rather than to suggest alternatives like therapy of whatever kind would be appropriate.

In addition to that, placebos are generally prescribed or tested on mental conditions, not physical illness. It's like taking a Tylenol and thinking it works instantly when the time release coating hasn't even dissolved yet.

It's also one of the main debates between traditional western and eastern medicinal options and practices.

lulz.

The question is ethical... the patient is paying a ridiculous price for a sugar pill. And it's considered deceit in the realm of psychological experimentation on human beings.

Ironically, if they were given away for free, they'd be less effective - part of the effect is thinking: 'They cost me, so they must work'.

You silly humans.

It's similar to art... jack up the price and suddenly it's more valuable and somehow more tasteful.

Ironically, if they were given away for free, they'd be less effective - part of the effect is thinking: 'They cost me, so they must work'.

You silly humans.

And the more they cost, the better they work.

While I'm not totally against doctors giving placebos to people they know to be hypochondriacs, it's irresponsible to prescribe unneeded antiobiotics. Overprescribing and misusing antiobiotics are the major causes of antibiotic resistant bacteria

While I'm not totally against doctors giving placebos to people they know to be hypochondriacs, it's irresponsible to prescribe unneeded antiobiotics. Overprescribing and misusing antiobiotics are the major causes of antibiotic resistant bacteria

Well, only 86 (13%) of the 679 physicians prescribed antibiotics as their placebo of choice.

Well, I'm going to have to fight my lovely doctor on this issue.

Lying is wrong, especially in the medical profession. It doesn't matter if the doctor thinks the end is a "greater good." If the means to meet that end are immoral (i.e. lying to someone that has placed their trust in you), then the end is not justified.

My favourite thing to write on the chart is HIBGIA.

And people....Is it ethical for doctors to prescribe placebos (such as vitamins) to patients with psychosomatic diseases, where they might have beneficial psychosomatic effects even without any actual, clinical effects?

^Thats the question being asked.

I think it is ethical to do it in some circumstances.

If the patient really does have nothing physically wrong with them -- or nothing serious that has a drug treatment available -- and the only thing wrong with them is their sense that they are sick, then a placebo "cure" is not an inappropriate course.

However, if the doctor is prescribing placebos just because he/she is assuming there is nothing physically wrong with the patient -- the way, many years ago, chronic illnesses in women such as hypertension, heart disease, etc., were dismissed as "hysteria" even though they were treated properly in men -- that is not ethical.

However, even when placebo is acceptable, I do not think it is ethical to charge prescription drug prices for it.

Of course, that creates a problem, because one set of "drugs" having significantly lower prices than other kinds of (advertised) drugs may eventually raise suspicions among the patients. Also, there is the placebo effect that some people experience of thinking that if it costs more, it does more.

Well, I'm going to have to fight my lovely doctor on this issue.

Lying is wrong, especially in the medical profession. It doesn't matter if the doctor thinks the end is a "greater good." If the means to meet that end are immoral (i.e. lying to someone that has placed their trust in you), then the end is not justified.

You don't need antibiotics for a cold. Ask for them and get prescribed sugar pills. This is a wholly acceptable lie. Colds are caused by a virus, antibiotics kill bacteria, not viruses. Doctors will give a prescription just to shut a whiny patient up. I commend those who give placebos instead of passing out amoxicillin like it's candy.

You don't need antibiotics for a cold. Ask for them and get prescribed sugar pills. This is a wholly acceptable lie. Colds are caused by a virus, antibiotics kill bacteria, not viruses. Doctors will give a prescription just to shut a whiny patient up. I commend those who give placebos instead of passing out amoxicillin like it's candy.

"Shut them up" is not a good enough reason to violate the trust and lie. The doctor tells them there's nothing that can be done and tells them to GTFO out of the office.

"Shut them up" is not a good enough reason to violate the trust and lie. The doctor tells them there's nothing that can be done and tells them to GTFO out of the office.
And then they go doctor shopping. Or self medicate with pills they trade with their hypochondriac friends.

My grandmother was a hypochondriac. She had a few things really wrong with her, but she was obsessed with the idea that she was "seriously ill" and always in search of a magic pill. She had so many prescriptions that, honestly, they should have combined to kill her. I believe that many of them were placebos, because her case was managed for many years by one physician who networked with all the specialists she went to. He was my and my mother's doctor, too, and he used to question us about my grandma's pill taking habits at home. We were his spies. I think he coordinated with the other docs to avoid poisoning his patient.

Well, I'm going to have to fight my lovely doctor on this issue.

Lying is wrong, especially in the medical profession. It doesn't matter if the doctor thinks the end is a "greater good." If the means to meet that end are immoral (i.e. lying to someone that has placed their trust in you), then the end is not justified.

So the deception is never justifiable, even when it has demonstrable health benefits? Even when the deception is part of the treatment?

Is it ethical for doctors to prescribe placebos (such as vitamins) to patients with psychosomatic diseases, where they might have beneficial psychosomatic effects even without any actual, clinical effects?
Yes, although that's based on the assumption that a doctor's job is to make a patient feel better rather than actually cure them.

I would imagine, however, that the vast majority of cases in which a placebo is prescribed involve common complaints such as headaches, sore throats etc., which a doctor will be limited in their ability to actually cure. In these cases, if it shuts the patient up and they feel better in themselves as a result of taking the placebo, yes, it is ethical.

And then they go doctor shopping. Or self medicate with pills they trade with their hypochondriac friends.

My grandmother was a hypochondriac. She had a few things really wrong with her, but she was obsessed with the idea that she was "seriously ill" and always in search of a magic pill. She had so many prescriptions that, honestly, they should have combined to kill her. I believe that many of them were placebos, because her case was managed for many years by one physician who networked with all the specialists she went to. He was my and my mother's doctor, too, and he used to question us about my grandma's pill taking habits at home. We were his spies. I think he coordinated with the other docs to avoid poisoning his patient.

Then she should have been referred to a psychiatrist or psychologist to treat her hypochondria. The doctors should not have merely ignored her actual problem by lying to her.

So the deception is never justifiable, even when it has demonstrable health benefits? Even when the deception is part of the treatment?

No, the deception is never justifiable. If the means are unethical, then the ends are not justifiable. Period.

No, the deception is never justifiable. If the means are unethical, then the ends are not justifiable. Period.That's stupid, because most medicine is poison. Should we stop chemo therapy because it hurts people? Medicine is supposed to make you feel better, and if a mind trick will make you feel better, it is just as, if not more, justified as fucking up your immune system to keep you alive.

That's stupid, because most medicine is poison. Should we stop chemo therapy because it hurts people? Medicine is supposed to make you feel better, and if a mind trick will make you feel better, it is just as, if not more, justified as fucking up your immune system to keep you alive.

The difference is, the patient isn't being lied to and consents to the treatment, knowing the consequences. A placebo is lying to them.

Consent is the kicker here. Now, granted, if, when signing up with that doctor, they consented to being lied to if it would make them "feel better," then there's no real problem. But it's unethical of that previous statement of consent was not already acquired.

No, the deception is never justifiable. If the means are unethical, then the ends are not justifiable. Period.

So it is more ethical to let the patient suffer, and maintain that integrity?

The difference is, the patient isn't being lied to and consents to the treatment, knowing the consequences. A placebo is lying to them.

Consent is the kicker here. Now, granted, if, when signing up with that doctor, they consented to being lied to if it would make them "feel better," then there's no real problem. But it's unethical of that previous statement of consent was not already acquired.

So, to be fair, you should qualify your statement to say that the ends do not justify the means, period, only in reference to deception. When discussing brutally painful cancer treatment, the ends certainly justify the means.

The difference is, the patient isn't being lied to and consents to the treatment, knowing the consequences. A placebo is lying to them.

Consent is the kicker here. Now, granted, if, when signing up with that doctor, they consented to being lied to if it would make them "feel better," then there's no real problem. But it's unethical of that previous statement of consent was not already acquired.

Man, I wish I lived in such a black and white world.

Kidding, I like color.

Do no harm. Sometimes telling the patient the explicit truth is harmful to them. It's in the interest of the patient, and thus the role of the doctor, to help them. If placebos help them, they should receive placebos and be told taking those pills will help them. It's not lying. The pills will help them. It doesn't just make them "feel better". There are butloads of evidence that a positive attitude aids in treatment. It's rather obvious that a patient will be more positive toward some treatment over no treatment.

It's no more lying than comforting a man whose wife is in a dangerous surgery or keeping doctor/patient confidentiality.

Well, I'm going to have to fight my lovely doctor on this issue.

Lying is wrong, especially in the medical profession. It doesn't matter if the doctor thinks the end is a "greater good." If the means to meet that end are immoral (i.e. lying to someone that has placed their trust in you), then the end is not justified.

The Hippocratic Oath I took states:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

If one of those "required measures" is a placebo I will glady prescribe a vitamin in place of an actual medication. I will also strive to stay away from overtreatment. Sending a patient to see a psychologist, who would charge them more for a therapy session than I would charge for the "dummy pills" is, in my mind, overtreatment. And though I will respect the privacy of my patient, I won't jeopardize their health. If I have to tell a lie to a patient during the course of their treatment to make them feel more at ease, I will. I feel that my job is to ease the suffering of my patients and sometimes that means prescribing a sugar pill.

Then she should have been referred to a psychiatrist or psychologist to treat her hypochondria. The doctors should not have merely ignored her actual problem by lying to her.

1) She was perfectly functional except for this particular attention addiction. She was also very elderly. The chances that her behavior could have been altered by therapy were low, and the need for direct intervention small. Also, due to her personality and her upbringing, she had a very negative reaction to the very idea of psychiatry/psychotherapy. If she could be kept safe and happy without any conflict by a few sugar pills among her real medications, why would it have been better to try to push her into a course of treatment she certainly would have refused, which could also have led to the destruction of her relationship with a doctor who knew her real health conditions as well as mental hang-ups and knew how to medicate her safely?

2) If the patient is told the pill will alleviate their symptoms, and if their symptoms are alleviated when they take it, is the doctor lying?

EDIT: Footnote: I should point out that this particular doctor in my grandmother's case did not actually lie to her. He told her outright that she was a hypochondriac and which conditions she thought she had, she didn't really have, etc. I know this because I had occasion to be present at some of their meetings.

2) If the patient is told the pill will alleviate their symptoms, and if their symptoms are alleviated when they take it, is the doctor lying?


Doctors have become increasingly creative at twisting the truth.

Telling a patient "This may help with some of the symptoms," isn't really lying, its just not saying "This is a placebo, you're malingering."

Am I the only person who has given themselves a psychosomatic headache from reading this?

Am I the only person who has given themselves a psychosomatic headache from reading this?

This thread has caused you some sort of emotional distress (http://www.ncbi.nlm.nih.gov/pubmed/16362712)? I apologize.

I would, however, be happy to prescribe you this new n=1 trial medication, it may help alleviate some of those symptoms. ;)

The difference is, the patient isn't being lied to and consents to the treatment, knowing the consequences. A placebo is lying to them.

Consent is the kicker here. Now, granted, if, when signing up with that doctor, they consented to being lied to if it would make them "feel better," then there's no real problem. But it's unethical of that previous statement of consent was not already acquired.

What is the difference between "I am prescribe you OBCALP for the next five days. If you don't see improvment, please come back" vs."I'm going to prescribe you a ZPak for the next five days. If you don't see improvement, please come back"?

Informed concent is an inane concept to begin with. A layman will not have the requisite knowledge to make a truly informed decision. The doctor does not need to lie to inform the patient that they will be on a placebo if they have reason to believe it will help

The difference is, the patient isn't being lied to and consents to the treatment, knowing the consequences. A placebo is lying to them.

Consent is the kicker here. Now, granted, if, when signing up with that doctor, they consented to being lied to if it would make them "feel better," then there's no real problem. But it's unethical of that previous statement of consent was not already acquired.Not really an issue. It's a doctor's job to heal a patient. If the situation requires misleading the patient for the patient's mind to heal him, then it's fully justified.

Not really an issue. It's a doctor's job to heal a patient. If the situation requires misleading the patient for the patient's mind to heal him, then it's fully justified.

Indeed. I have never seen the harm in misleading a patient to believe that what they are taking is, in fact, medication. If I were to tell my patients, "This will help with your reoccuring headaches," I would not be lying to them. It will help them. I'm just not telling them that what they're actually taking is a vitamin. The effect is lost if I tell them that they're receiving a placebo.

So, to be fair, you should qualify your statement to say that the ends do not justify the means, period, only in reference to deception. When discussing brutally painful cancer treatment, the ends certainly justify the means.

You're right, I should have qualified the statement, but not how you suggested.

The basic point is consent vs coercion, whether realized or not. If a person consents, then there is no ethical question. However, if they don't, and would rather not be lied to (and I see deception as a form of coercion), and he/she is, then it is unethical, regardless of the good that may or may not come.

Man, I wish I lived in such a black and white world.

Kidding, I like color.

Do no harm. Sometimes telling the patient the explicit truth is harmful to them. It's in the interest of the patient, and thus the role of the doctor, to help them. If placebos help them, they should receive placebos and be told taking those pills will help them. It's not lying. The pills will help them. It doesn't just make them "feel better". There are butloads of evidence that a positive attitude aids in treatment. It's rather obvious that a patient will be more positive toward some treatment over no treatment.

It's no more lying than comforting a man whose wife is in a dangerous surgery or keeping doctor/patient confidentiality.

Arrogant, condescending, and patronizing as usual, I see. :)

Doctor/patient confidentiality doesn't (or at least shouldn't) involve lying -- it involves not releasing information, and the inquiring / potentially receiving parties understanding that there will be no transaction of information.

And it is[ deception. The person has no idea what they're actually being given. If a doctor is being deliberately vague as to the treatment, then they are being deceptive, which is immoral. If I'm going to the doctor, I want to know exactly what I'm being given. I am not consenting to being lied to or deceived, passively or overtly.

Ethically, it does not matter if it helps them; if the doctor deceived the patient in any way (without prior consent to deception), then it is unethical, regardless of the good that came from it.

I'm sorry, Jocabia, that you feel the need to be so Machiavellian in your ethical standards, rather than remain consistent and...well, actually having a real set of ethics.

If one of those "required measures" is a placebo I will glady prescribe a vitamin in place of an actual medication. I will also strive to stay away from overtreatment. Sending a patient to see a psychologist, who would charge them more for a therapy session than I would charge for the "dummy pills" is, in my mind, overtreatment. And though I will respect the privacy of my patient, I won't jeopardize their health. If I have to tell a lie to a patient during the course of their treatment to make them feel more at ease, I will. I feel that my job is to ease the suffering of my patients and sometimes that means prescribing a sugar pill.

Firstly, the Hippo oath also prohibit(s/ed?) abortion and surgery. It's a bit outdated. And just because you have to swear to it doesn't make it ethical.

I mean, I know where you're coming from, and it is a noble goal. However, if you're using deception (of which was not granted permission when signing on to you agreeing to treatment) to reach that goal, then the end - while pleasing - is not justified.

I may or may not get to the other posts later. Depends on how I'm feeling. I'm fucking tired, and performing at the Renaissance Faire (lol america) tomorrow (again), so I'll be beat. XD

I'd totally fire my doctor for perscribing me a placebo. I'd be extremely angry. If I have headaches and they're psychogenic, then I need a psychiatric evaluation and proper treatment. If whatever is going on in my head is profound enough to make me sick (or feel sick), then it's affecting other areas of my life as well.

I'd totally fire my doctor for perscribing me a placebo. I'd be extremely angry. If I have headaches and they're psychogenic, then I need a psychiatric evaluation and proper treatment. If whatever is going on in my head is profound enough to make me sick (or feel sick), then it's affecting other areas of my life as well.
And what if it turns out there's nothing wrong with you psychologically? A psychosomatic illness does not necessarily have to be caused by a psychological disorder or disturbance.

Moods and states of mind, especially if they are sublimated and/or have an ongoing cause (such as can happen during times of financial crisis), can affect physiology in lots of ways. Being unhappy during unhappy times is not a disorder, and it is likely that no amount of psych therapy is going to change it as long as the bad times continue. What are you supposed to do until the economy turns around -- keep vomiting up your breakfast? A pill that helps you keep your breakfast down, even if it only works because your belief that it does calms you down enough to eat normally, is not a bad thing.

I speak as a person who has experience with psychosomatic illness. The doctor who treated my hypochondriac grandmother, also treated me. I'm the opposite of a hypochondriac -- I tend to ignore symptoms even when they are real. But one year I got so sick, and kept getting so sick, that I finally went to see him. It took three doctors seven months to get me healthy again, and in the end the verdict was that my respiratory infections were caused by working for a Typhoid Mary who kept getting sick and kept using other people's phones in the office while they weren't looking, my unstable blood pressure was probably genetic but aggravated by stress, and my skin condition was entirely psychosomatic, as lab testing showed no physical cause whatsoever and it responded to no treatment whatsoever.

Prescription: A program of antibiotics and bed rest for my lungs. For the rest of my health issues, quit that job, dump my then-boyfriend for a better one, and in the future, try to avoid talking to annoying people.

I'm serious. That's what the doctor told me. He told me that because I was me -- a patient who routinely refused most medications. If he had given me a pill -- real or fake -- I would have tossed it and his advice together. If I had been my grandmother -- a patient who routinely refused non-medical treatments -- he would have included a sugar pill prescription as part of the advice in order to get her to use both.

Btw, I followed his advice and got 100% better almost instantly.

You're right, I should have qualified the statement, but not how you suggested.

The basic point is consent vs coercion, whether realized or not. If a person consents, then there is no ethical question. However, if they don't, and would rather not be lied to (and I see deception as a form of coercion), and he/she is, then it is unethical, regardless of the good that may or may not come.

That's absurd. The entire basis for the treatment relies on the misdirection. You are honestly sitting there saying that it is more moral for a doctor to allow a patient to suffer pain than it is to treat that person, if the treatment involves deception. The world isn't so black and white.

And what if it turns out there's nothing wrong with you psychologically? A psychosomatic illness does not necessarily have to be caused by a psychological disorder or disturbance.
If it's not psychogenic and it's not biological, then what is it?

Moods and states of mind, especially if they are sublimated and/or have an ongoing cause (such as can happen during times of financial crisis), can affect physiology in lots of ways. Being unhappy during unhappy times is not a disorder, and it is likely that no amount of psych therapy is going to change it as long as the bad times continue. What are you supposed to do until the economy turns around -- keep vomiting up your breakfast? A pill that helps you keep your breakfast down, even if it only works because your belief that it does calms you down enough to eat normally, is not a bad thing.
If you are so profoundly affected by the economy that you can't keep your food down, yes, you have a problem.

I speak as a person who has experience with psychosomatic illness. The doctor who treated my hypochondriac grandmother, also treated me. I'm the opposite of a hypochondriac -- I tend to ignore symptoms even when they are real. But one year I got so sick, and kept getting so sick, that I finally went to see him. It took three doctors seven months to get me healthy again, and in the end the verdict was that my respiratory infections were caused by working for a Typhoid Mary who kept getting sick and kept using other people's phones in the office while they weren't looking, my unstable blood pressure was probably genetic but aggravated by stress, and my skin condition was entirely psychosomatic, as lab testing showed no physical cause whatsoever and it responded to no treatment whatsoever.

And this is which somatoform disorder?

Prescription: A program of antibiotics and bed rest for my lungs. For the rest of my health issues, quit that job, dump my then-boyfriend for a better one, and in the future, try to avoid talking to annoying people.
So you had a biological problem and a psychological one. You weren't perscribed a placebo.

I'm serious. That's what the doctor told me. He told me that because I was me -- a patient who routinely refused most medications. If he had given me a pill -- real or fake -- I would have tossed it and his advice together. If I had been my grandmother -- a patient who routinely refused non-medical treatments -- he would have included a sugar pill prescription as part of the advice in order to get her to use both.
Sounds like your GP was operation outside of his scope of practice unless he's also a board certified psychiatrist. I must also say, discusssing another patient's medical history with you a HUGE HIPPA violation. It doesn't matter that you are part of the same family.

Btw, I followed his advice and got 100% better almost instantly.
And you weren't given a placebo. You were given general life advice and antibiotics for a biological condition.

Firstly, the Hippo oath also prohibit(s/ed?) abortion and surgery. It's a bit outdated. And just because you have to swear to it doesn't make it ethical.


The "classical" version of the Hippocratic Oath contained the line:

"I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art."

As surgery was not a speciality at that time.

Today, however, most doctors take the modern version of the hippocratic oath that I posted above. The modern version of the hippocratic oath was updated in accordance with the GMC's "Duties of Doctors (http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp) which also advocates making "the care of your patient your first concern." And though it does say to "Never abuse your patients' trust in you or the public's trust in the profession," I feel that treating the psychosomatic symptoms of your patient fall under the "first concern" category. If you can save your patient from overtreatment, you're supposed to. You don't have to lie to your patients, you can tell them that the little orange pill you're prescribing will help with their symptoms. 'Tis not a lie.

Arrogant, condescending, and patronizing as usual, I see. :)

Doctor/patient confidentiality doesn't (or at least shouldn't) involve lying -- it involves not releasing information, and the inquiring / potentially receiving parties understanding that there will be no transaction of information.

And it is[ deception. The person has no idea what they're actually being given. If a doctor is being deliberately vague as to the treatment, then they are being deceptive, which is immoral. If I'm going to the doctor, I want to know exactly what I'm being given. I am not consenting to being lied to or deceived, passively or overtly.

Ethically, it does not matter if it helps them; if the doctor deceived the patient in any way (without prior consent to deception), then it is unethical, regardless of the good that came from it.

I'm sorry, Jocabia, that you feel the need to be so Machiavellian in your ethical standards, rather than remain consistent and...well, actually having a real set of ethics.

I love how you suggest I'm being condescending while you tell everyone in thread the only way to be moral is to follow your standards.

You're right. If my choice is to heal someone by giving them a placebo and telling them it will heal them (which is of course true) or harming them by making no effort to help them, I will choose the first. I'm Machiavellian like that.

You'd harm people so you can feel good about your "ethics". That's not ethical. It's selfish.

Doctors have become increasingly creative at twisting the truth.

Telling a patient "This may help with some of the symptoms," isn't really lying, its just not saying "This is a placebo, you're malingering."

They wouldn't have be malingering. A positive attitude toward an illness, an actual illness, can be beneficial. Actually you talked to me about this once. There are many physical issues that one can go through where it is simply necessary to ride it out. It's possible for a placebo to make riding it out easier or occur faster.

Sounds like your GP was operation outside of his scope of practice unless he's also a board certified psychiatrist. I must also say, discusssing another patient's medical history with you a HUGE HIPPA violation. It doesn't matter that you are part of the same family.

That's...not true at all. There are a multitude of ways a doctor can disclose PHI to someone without it being a HIPAA (notice the two A's) violation. It could be something as simple as Mura being in the doctor's office with her grandmother, and having her grandmother give the okay to discuss it with Mura. Or, Mura could have a medical POA for her grandmother, which allows her to receive PHI and make medical decisions on her grandmother's behalf. Also, HIPAA allows a doctor to disclose PHI if the doctor feels the patient is a threat to herself, so the doctor could inform Mura of her grandmother's health if he had reason to suspect that her grandmother might abuse the medication (which based on the accounts given by Mura, seems entirely likely).

The point is, there are a multitude of reasons why a doctor could disclose PHI and not violate HIPAA. Of course, it's all academic, since nowhere did Mura say that the doctor disclosed any information about her grandmother to her. The entire post was discussing Mura's own condition.

If it's not psychogenic and it's not biological, then what is it?

Psychosomatic is psychogenic. The issue here is that it doesn't have to actually be caused by a disorder.

Your body is designed to react to stress. Continuous stress can be dangerous to a person. People find all kinds of ways to deal with this, but placebos can often help until a long-term solution can be found.

No one is claiming placebos are the end-all and be-all, but if you can spared some unnecessary pain and/or damgae by a placebo, it would be unethical to not attempt to help you avoid that pain and damage.

It's also complete assumption that a doctor prescribing a placebo wouldn't suggest to you some form of follow up or lifestyle change that covers you for the long-term.

If it's not psychogenic and it's not biological, then what is it?

Somatoform disorders are characterized by physical symptoms, which have no medical basis, yet the symptoms actually exist. The pain someone is feeling is real, the nausea they feel is also real. Somatoform disorders are psychogenic, but they not considered a psychological disorder. Psychogenic disorders are simply the bodies way of reacting to an adverse situation, its way of coping.

And this is which somatoform disorder?

As this is part of "patient privacy" Mur does not have to disclose any of her medical history, nor her current medical state to you. ;)

Sounds like your GP was operation outside of his scope of practice unless he's also a board certified psychiatrist.

This is basic psychology, something any physician is well aware of. Doctor's know their patients, discussing the way a patient is/was treated doesn't require a "board certified psychiatrist." In fact, a psychiatrist could not begin to treat the physical symptoms Mur was experiencing, but a doctor is very much allowed to treat a patients mental symptoms. A psychiatrist must order lab tests from clinics, request MRIs/PETs and relate physical symptoms which are out of his scope. Its why medicine is specialized and segmented.

I must also say, discusssing another patient's medical history with you a HUGE HIPPA violation. It doesn't matter that you are part of the same family.

I'll leave this to Sdaeriji.

If it's not psychogenic and it's not biological, then what is it?


If you are so profoundly affected by the economy that you can't keep your food down, yes, you have a problem.


And this is which somatoform disorder?


So you had a biological problem and a psychological one. You weren't perscribed a placebo.


Sounds like your GP was operation outside of his scope of practice unless he's also a board certified psychiatrist. I must also say, discusssing another patient's medical history with you a HUGE HIPPA violation. It doesn't matter that you are part of the same family.


And you weren't given a placebo. You were given general life advice and antibiotics for a biological condition.
It's easy to reach conclusions when you ignore half the evidence.

Did you not notice my reference to my hypochondriac grandmother, whose story I told in earlier post? She also had both physical chronic ailments and psychosomatic ones. But because of her mindset, in order to keep her cooperating with him in his course of treatments for her real illnesses, the same doctor prescribed her placebos for her fake illnesses.

He got the same result -- patients who achieved healthfulness -- but he used the opposite approach with each one. For the hypochondriac, he resorted to placebos. For the non-hyochondriac, he didn't.

Also, I told my story to show that even non-hypochondriacs can get psychosomatic symptoms.

Finally, your all-or-nothing, black/white attitude that, if your symptoms don't have a physical cause, then you need psyciatric care, end of discussion, ignores one important detail: The symptoms are still there and still causing problems.

If your psychosomatic symptoms -- painful skin rash or digestive disturbance -- are caused by an ongoing emotional problem -- especially one that is directly caused by real life conditions over which you have little control -- then it may take months, even years, of therapy to adjust your mindset. It may be impossible to adjust it until the circumstances causing it change. And what are you supposed to do in the meantime? Keep suffering pain and vomiting?

Or are you allowed to alleviate your symptoms WHILE you work on figuring out what causes them? Hello, sugar pill, my reassuring friend.

That's...not true at all. There are a multitude of ways a doctor can disclose PHI to someone without it being a HIPAA (notice the two A's) violation. It could be something as simple as Mura being in the doctor's office with her grandmother, and having her grandmother give the okay to discuss it with Mura. Or, Mura could have a medical POA for her grandmother, which allows her to receive PHI and make medical decisions on her grandmother's behalf. Also, HIPAA allows a doctor to disclose PHI if the doctor feels the patient is a threat to herself, so the doctor could inform Mura of her grandmother's health if he had reason to suspect that her grandmother might abuse the medication (which based on the accounts given by Mura, seems entirely likely).

The point is, there are a multitude of reasons why a doctor could disclose PHI and not violate HIPAA. Of course, it's all academic, since nowhere did Mura say that the doctor disclosed any information about her grandmother to her. The entire post was discussing Mura's own condition.
It was the bolded two situations.

My grandmother preferred to have me and/or my mom present with her during consultations, though not during the actual examinations. This is why we knew what she was taking and for which conditions. It was also how we knew about the doctor's concerns about her taking her medications correctly -- we were there when he gave her advice and warnings.

He obviously never discussed with us anything he had discussed with her privately, or any other information about her.

As for us "spying" for him -- having had him as our family doctor for so long, we knew that he was completely familliar with her entire medical history, and we took it upon ourselves to notify him if she had gone to see another doctor on her own. He would not ask us questions about it, but would contact my grandmother directly to get the contact info for the other doctor. What the doctors discussed among each other about her, I have no idea. That was not my business, but knowing her, we all knew it was extremely unlikely that she had informed the other doctor about what medications she was already taking.

Psychosomatic is psychogenic. The issue here is that it doesn't have to actually be caused by a disorder.

Your body is designed to react to stress. Continuous stress can be dangerous to a person. People find all kinds of ways to deal with this, but placebos can often help until a long-term solution can be found.
I am very sorry I gave the impression that I thought psychosomatic was anything but psychogenic. That wasn't my intent at all.

No one is claiming placebos are the end-all and be-all, but if you can spared some unnecessary pain and/or damgae by a placebo, it would be unethical to not attempt to help you avoid that pain and damage.
The question becomes what happens if the patient seeks a second opinion and finds out they were given a placebo? Or they look online and see that they were only given a vitamin? Or the pharmacist lets the cat out of the bag? That has a high potential of damaging the trust the patient has with the medical system. It will make the problem worse, though.

It's also complete assumption that a doctor prescribing a placebo wouldn't suggest to you some form of follow up or lifestyle change that covers you for the long-term.
I'm not assuming that at all. I'm terribly sorry that I've given that impression by my post. I was talking of the placebo pill in and of itself, not concurrent treatments.

That's...not true at all. There are a multitude of ways a doctor can disclose PHI to someone without it being a HIPAA (notice the two A's) violation. It could be something as simple as Mura being in the doctor's office with her grandmother, and having her grandmother give the okay to discuss it with Mura. Or, Mura could have a medical POA for her grandmother, which allows her to receive PHI and make medical decisions on her grandmother's behalf. Also, HIPAA allows a doctor to disclose PHI if the doctor feels the patient is a threat to herself, so the doctor could inform Mura of her grandmother's health if he had reason to suspect that her grandmother might abuse the medication (which based on the accounts given by Mura, seems entirely likely).

The point is, there are a multitude of reasons why a doctor could disclose PHI and not violate HIPAA. Of course, it's all academic, since nowhere did Mura say that the doctor disclosed any information about her grandmother to her. The entire post was discussing Mura's own condition.
She said her doctor told her he would have perscribed a "sugar pill" to her grandmother if she was seen for the same thing. That's discussing one patient with another and would indeed be a HIPAA violation.

Somatoform disorders are characterized by physical symptoms, which have no medical basis, yet the symptoms actually exist. The pain someone is feeling is real, the nausea they feel is also real. Somatoform disorders are psychogenic, but they not considered a psychological disorder. Psychogenic disorders are simply the bodies way of reacting to an adverse situation, its way of coping.
Yeah, I must have fucked up my post, because I totally didn't mean to imply that they didn't. I guess I left too much out.



As this is part of "patient privacy" Mur does not have to disclose any of her medical history, nor her current medical state to you. ;)
Of course not. She was the one who brought it up, I asked a question on her post. She's free to answer, not answer or make something up (not implying she would make something up).


This is basic psychology, something any physician is well aware of. Doctor's know their patients, discussing the way a patient is/was treated doesn't require a "board certified psychiatrist." In fact, a psychiatrist could not begin to treat the physical symptoms Mur was experiencing, but a doctor is very much allowed to treat a patients mental symptoms. A psychiatrist must order lab tests from clinics, request MRIs/PETs and relate physical symptoms which are out of his scope. Its why medicine is specialized and segmented.
Basic psychology yes, but to me, this seems to be treading a fine line. If your mental state is making you physically ill, it seems prudent to maybe explore that a little more. And when you get into these mind/body illnesses it can take multiple docs to treat. Just like any other medical condition.





It's easy to reach conclusions when you ignore half the evidence.
I have no idea what you're responding to here.

Did you not notice my reference to my hypochondriac grandmother, whose story I told in earlier post? She also had both physical chronic ailments and psychosomatic ones. But because of her mindset, in order to keep her cooperating with him in his course of treatments for her real illnesses, the same doctor prescribed her placebos for her fake illnesses.
And hypochondria is a disorder that warrents psychiatric treatment.

He got the same result -- patients who achieved healthfulness -- but he used the opposite approach with each one. For the hypochondriac, he resorted to placebos. For the non-hyochondriac, he didn't.

Of course, that makes sense. It would be like perscribing any medication that wasn't indicated. But that's not my point. I'm quite certain these 50% of doctors don't randomly perscribe placebos to all their patients. My concern is that they percribe them period.

And it's how the patient is informed. Aerou's approach, for example, isn't exactly lying. As long as she's perscribing fairly inert pills and not opiates or antibiotics (for example) that aren't indicated, I'd trust her clinical judgement. It's the out and out deception, or the perscribing of antibiotics (pet peeve) or optiates when not indicated that concerns me.

Also, I told my story to show that even non-hypochondriacs can get psychosomatic symptoms.
Of course they can. I never meant to imply they couldn't.

Finally, your all-or-nothing, black/white attitude that, if your symptoms don't have a physical cause, then you need psyciatric care, end of discussion, ignores one important detail: The symptoms are still there and still causing problems.
And the treatment for them would be psychiatric.

If your psychosomatic symptoms -- painful skin rash or digestive disturbance -- are caused by an ongoing emotional problem -- especially one that is directly caused by real life conditions over which you have little control -- then it may take months, even years, of therapy to adjust your mindset. It may be impossible to adjust it until the circumstances causing it change. And what are you supposed to do in the meantime? Keep suffering pain and vomiting?
I'm not implying that at all. I'm just saying that's a little out of the realm of general psychology and should be treated by a specialist. And many people with somatoform disorders do have very real chronic illnesses. It doesn't have to be an either/or proposition. One doesn't have to seek psychiatric or other medical treatment. A psychiatrist and an internist can work together on a patient.

Or are you allowed to alleviate your symptoms WHILE you work on figuring out what causes them? Hello, sugar pill, my reassuring friend.
And what happens if the patient finds out?

It was the bolded two situations.

My grandmother preferred to have me and/or my mom present with her during consultations, though not during the actual examinations. This is why we knew what she was taking and for which conditions. It was also how we knew about the doctor's concerns about her taking her medications correctly -- we were there when he gave her advice and warnings.

He obviously never discussed with us anything he had discussed with her privately, or any other information about her.
Ah, so it was directly with her consent. I retract my previous statement.

As for us "spying" for him -- having had him as our family doctor for so long, we knew that he was completely familliar with her entire medical history, and we took it upon ourselves to notify him if she had gone to see another doctor on her own. He would not ask us questions about it, but would contact my grandmother directly to get the contact info for the other doctor. What the doctors discussed among each other about her, I have no idea. That was not my business, but knowing her, we all knew it was extremely unlikely that she had informed the other doctor about what medications she was already taking.
Oh, that's totally not something I took issue with. Of course family members or friends can give a doctor information. Even if it's not a family doctor.

Basic psychology yes, but to me, this seems to be treading a fine line. If your mental state is making you physically ill, it seems prudent to maybe explore that a little more. And when you get into these mind/body illnesses it can take multiple docs to treat. Just like any other medical condition.


But the doctor can easily treat the mental problems causing the physical. If a doctor understands that the disorder can't be treated with a simple placebo, they will refer them to a psychiatrist. In fact, the doctor would be more than happy to refer the patient to a psychiatrist/psychologist if they thought it would be damaging to treat the patient rather than refer them to a mental health professional.

But the doctor can easily treat the mental problems causing the physical. If a doctor understands that the disorder can't be treated with a simple placebo, they will refer them to a psychiatrist. In fact, the doctor would be more than happy to refer the patient to a psychiatrist/psychologist if they thought it would be damaging to treat the patient rather than refer them to a mental health professional.

Symptom control isn't the same as treating the underlying condition. All a placebo can do is control symptoms until the patient figures out that they've been percribed.

Symptom control isn't the same as treating the underlying condition. All a placebo can do is control symptoms until the patient figures out that they've been percribed.

False. Again, it's been well documented that people heal better when they have a positive attitude. Heal. Not manage, heal.

You're positioning this like placebos are only prescribed when there is some underlying mental disorder. Sometimes there are passing events in life that a placebo can help you deal with, unusual stressors.

But it's even more than that. Sometimes the patient needs to time for a regular treatment to work and a positive attitude will help BOTH the regular treatment and the symptoms they'll endure until the regular treatment addresses the underlying issue.

There are lots of examples of issues that you're ignoring and then pretending like you aren't. Psychiatric problems aren't the only issues that people face that can result in psychosomatic problems. Your body reacts to stress. It's normal. It's not a disorder.

False. Again, it's been well documented that people heal better when they have a positive attitude. Heal. Not manage, heal.
The study isn't talking about positive mental attitudes, it's talking about drugs being perscribed that have no theraputic effect on the condition that treatment is being sought for.

You're positioning this like placebos are only prescribed when there is some underlying mental disorder. Sometimes there are passing events in life that a placebo can help you deal with, unusual stressors.
No, that's your assumption. Whether it's a passing mental condition, or a somatoform disorder, it doesn't change the fact that this person is experiencing emotions severe enough to affect their body. It also doesn't change the fact that someone with a physical reaction to temporary stress could just as easily be told that their rash or stomach ailment is likely an effect of the stress.

Okay, Joe rather not know than know, for example, that his rash is caused from the stress of losing a job. He'd rather be perscribed a placebo, to get the placebo effect, and have relief from his rash.

Sally would rather know that her rash is a stress reaction and will go away when her stress is under control. Her having that knowledge makes her symptoms less bothersome and also signals to her how badly her stress is affecting her.

So Sally knows why she has a rash, and Joe thinks this pill he's taking is making it better. What happens when Joe gets on the internet and finds out he was perscribed a compound that couldn't possibly treat his rash?

But it's even more than that. Sometimes the patient needs to time for a regular treatment to work and a positive attitude will help BOTH the regular treatment and the symptoms they'll endure until the regular treatment addresses the underlying issue.
Again, I'd never dispute that a positive attitude isn't extremely beneficial, I'm questioning whether or not placebos are the right way to affect that attitude. I'm also concerned that not-so-intert substances are being perscribed to patients. Like anti-biotics.

There are lots of examples of issues that you're ignoring and then pretending like you aren't. Psychiatric problems aren't the only issues that people face that can result in psychosomatic problems. Your body reacts to stress. It's normal. It's not a disorder.
I haven't written nearly enough on this topic for you to assume that. You are taking a very narrow supposition from a very broad study. The study said there were mixed motivations for reccomending placebos. I also don't think a person has to have a somatoform disorder for psychiatric interventions to be effective. Talk therapy does wonders when you are under stress. Especially stress that's severe enough to make you sick. One doesn't need a disorder to need someone to talk to.

The study isn't talking about positive mental attitudes, it's talking about drugs being perscribed that have no theraputic effect on the condition that treatment is being sought for.

The drug themselves, not the application of a placebo. This is why you've been accused of only looking at half the evidence. You prove it pretty consistently to be true.


No, that's your assumption. Whether it's a passing mental condition, or a somatoform disorder, it doesn't change the fact that this person is experiencing emotions severe enough to affect their body. It also doesn't change the fact that someone with a physical reaction to temporary stress could just as easily be told that their rash or stomach ailment is likely an effect of the stress.

Surely they could and sometimes are. But it's the decision of the doctor to determine what is best for the patient.




Okay, Joe rather not know than know, for example, that his rash is caused from the stress of losing a job. He'd rather be perscribed a placebo, to get the placebo effect, and have relief from his rash.

Sally would rather know that her rash is a stress reaction and will go away when her stress is under control. Her having that knowledge makes her symptoms less bothersome and also signals to her how badly her stress is affecting her.

Perhaps. Again, you're broadbrushing patients, which works about as well as any broadbrushing. In some cases, a person would be comforted to know that. In other cases, a person wants something that will fix it. Placebos work so well that every study requires that you test performance against a placebo to address that effect. It's interesting that medical professionals respect that effect enough to address it in experiments and you'd dismiss it so easily to disfunction.



So Sally knows why she has a rash, and Joe thinks this pill he's taking is making it better. What happens when Joe gets on the internet and finds out he was perscribed a compound that couldn't possibly treat his rash?

And Joe finds out he's in the same position as Sally. No harm, no foul. You keep acting like people will feel so betrayed. Some people would. Some people wouldn't. You've not shown the first bit of evidence that such a feeling would outweigh the benefits or even make any significant difference at all. It's an assertion you've made but not supported.



Again, I'd never dispute that a positive attitude isn't extremely beneficial, I'm questioning whether or not placebos are the right way to affect that attitude. I'm also concerned that not-so-intert substances are being perscribed to patients. Like anti-biotics.

And you're questioning it without the slightest bit of support. "I really don't like it" isn't a reasoned argument.

On the "not-so-inert" substances bit, I think that's a decision for medical boards. Personally, I'd not support giving a drug when a sugar pill would work just as well. Incidentally, giving a drug with another usage undermines your claims of betrayal and searching the internet.


I haven't written nearly enough on this topic for you to assume that. You are taking a very narrow supposition from a very broad study. The study said there were mixed motivations for reccomending placebos. I also don't think a person has to have a somatoform disorder for psychiatric interventions to be effective. Talk therapy does wonders when you are under stress. Especially stress that's severe enough to make you sick. One doesn't need a disorder to need someone to talk to.

I'm taking a very narrow supposition? Only one of us is making an assertion that's unsupported by the evidence. Nothing you've said is supported by the evidence made available by this study and you've not added any.

It's nice that you'd put everyone in therapy. Unfortunately, you're like of therapy is hardly an argument. I think everyone should receive a flower when under stress. Should doctors be sending flowers to their patients? Or perhaps, we should let doctors choose from a bunch of potential therapies and determine what's best for their patients without the help of people who pretty clearly demonstrate their bias?

Actually, it might be more effective if I specifically cite from the study the specific scenarios that concern me.

This is what Aerou does and isn't the practice I'm concerned with:
about 68% (241) said they usually describe placebo treatments as "a medicine not typically used for your condition but might benefit you,"
That doctor isn't lying. When the patient looks it up online and sees that his or her condition isn't listed, they don't feel betrayed. Or if they do, the doctor can easily explain their rationale. Essentially the doctor wasn't being deceptive.

I'm also not concerned with this group:
9% (31) said they typically describe placebo treatments as "a medicine with no known effects for your condition." Only 5% (18) reported typically describing the treatment as "a placebo" (table 3).

This is what I take issue with:
18% (62) introduced placebo treatments as "a medicine,"
Those patients are being lied to. If they find out, that's going to damage the trust the patient had in their doctor, and possibly in the medical system as a whole. In the US, where distrust of doctors is so rampant, this doesn't seem like a good idea.

I also don't care what a patient is described with the following execption:
antibiotics (13%), and sedatives (13%)
I also take issue with docs who perscribe opiates when not indicated, but that's not what this study focuses on and their defition of placebo eliminates those instances. Antibiotics and sedatives are not inert substances and there are consequences to perscribing them.

The drug themselves, not the application of a placebo. This is why you've been accused of only looking at half the evidence. You prove it pretty consistently to be true.
I'm looking at the study that was talked about in the OP. The one the article was based on.


Surely they could and sometimes are. But it's the decision of the doctor to determine what is best for the patient.

That's not the topic of debate. It's the ethics and potential harm of perscribing a placebo.




Perhaps. Again, you're broadbrushing patients, which works about as well as any broadbrushing. In some cases, a person would be comforted to know that. In other cases, a person wants something that will fix it. Placebos work so well that every study requires that you test performance against a placebo to address that effect. It's interesting that medical professionals respect that effect enough to address it in experiments and you'd dismiss it so easily to disfunction.
Please quote where I said placebos were ineffective. I haven't said either way. I'm not addressing the placebo effect. None of my posts have either. They focus around the potential harm in decieving a patient. I've also stated in my first or second response to Mur, that what Aerou does isn't what I take issue with. She doesn't lie to her patients.




And Joe finds out he's in the same position as Sally. No harm, no foul. You keep acting like people will feel so betrayed. Some people would. Some people wouldn't. You've not shown the first bit of evidence that such a feeling would outweigh the benefits or even make any significant difference at all. It's an assertion you've made but not supported.
And you make the same assumption. It's a concern that was even brought up in the NYT artice.

Googling of "placebo, doctor, patient, and distrust" yielded a number of stories and studies, here's a few that caught my eye:


Adverse responses to a placebo occur in almost every clinical trial and occasionally approach the levels reported for some newer, highly specific medications. Like therapeutic effects, adverse responses to a placebo may have many determinants, including negative expectations or conditioning that might result from a distrust of doctors, many failed treatment attempts, or the side-effect warnings included in the informed consent. Often, however, these adverse placebo effects may reflect spontaneous occurrences of common everyday complaints such as headaches, fatigue, insomnia, irritability, and nasal congestion (12).
http://pubs.acs.org/hotartcl/mdd/99/aug/mysterious.html

Read the reations of people to the story:
http://blogs.wsj.com/health/2008/01/04/is-your-doctor-giving-you-placebos/

A talk about the growing problem of patient distrust. Not all because of placebos, but it illustrates that there is a problem.
http://www.nytimes.com/2008/07/29/health/29well.html

And you're questioning it without the slightest bit of support. "I really don't like it" isn't a reasoned argument.
That's not what I'm saying at all. I'm saying that there is an ethical problem when informed consent doesn't exist.

On the "not-so-inert" substances bit, I think that's a decision for medical boards. Personally, I'd not support giving a drug when a sugar pill would work just as well.
And it's been discussed and been found over and over to be a problem:
http://www.google.com/search?hl=en&client=opera&rls=en&hs=vnV&sa=X&oi=spell&resnum=0&ct=result&cd=1&q=doctors+prescribing+antibiotics+for+viruses&spell=1



Incidentally, giving a drug with another usage undermines your claims of betrayal and searching the internet.
You're lumping two seperate arguments into the same argument here.


I'm taking a very narrow supposition? Only one of us is making an assertion that's unsupported by the evidence. Nothing you've said is supported by the evidence made available by this study and you've not added any.
Neither have you. The study in question, that the NYT is discussing, talks only of the practice, not of the placebo effect in and of itself.

It's nice that you'd put everyone in therapy. Unfortunately, you're like of therapy is hardly an argument. I think everyone should receive a flower when under stress. Should doctors be sending flowers to their patients? Or perhaps, we should let doctors choose from a bunch of potential therapies and determine what's best for their patients without the help of people who pretty clearly demonstrate their bias?
If evidence supported the sending of flowers to patients, then yes.

Talk therapy has been shown to be effective.
http://edition.cnn.com/HEALTH/library/DS/00584.html

She said her doctor told her he would have perscribed a "sugar pill" to her grandmother if she was seen for the same thing. That's discussing one patient with another and would indeed be a HIPAA violation.
Wrong. What that is, is you putting words in my mouth.

What my statement actually meant was that I happened to have good reason to believe, from the way my grandmother was treated and the way she acted, that she was being prescribed placebos as well as actually medications. Having personally observed both the doctor's interactions with my grandmother and with me, I surmised that he would be more likely to give her a placebo in a situation in which he would not give me a placebo.

But if you find it easier to press your argument if you cast me as having said things I didn't, I can understand that.


I have no idea what you're responding to here.
I told you what I meant in the very next sentence.

Of course, that makes sense. It would be like perscribing any medication that wasn't indicated. But that's not my point. I'm quite certain these 50% of doctors don't randomly perscribe placebos to all their patients. My concern is that they percribe them period.
You seem very attached to your concern, as you reject out of hand every explanation for the practice that is offered to you, and you do so always on the same grounds of your concern, not on any examples of bad results from it.

And it's how the patient is informed. Aerou's approach, for example, isn't exactly lying. As long as she's perscribing fairly inert pills and not opiates or antibiotics (for example) that aren't indicated, I'd trust her clinical judgement. It's the out and out deception, or the perscribing of antibiotics (pet peeve) or optiates when not indicated that concerns me.
Opiates and antibiotics are not placebos. That has already been pointed out by another poster earlier in this thread. Knowingly prescribing active drugs that are not indicated for the patient's condition is not the same as prescribing an inert substance because, after due examination and testing, the doctor decides this is the best approach to helping the patient.


And what happens if the patient finds out?
That's what personal injury lawyers are for.

Ah, so it was directly with her consent. I retract my previous statement.
Good, especially as you were criticizing something I never said.

Symptom control isn't the same as treating the underlying condition. All a placebo can do is control symptoms until the patient figures out that they've been percribed.

You have to treat the symptoms in order to treat the underlying condition, first rule of medicine. In fact, the entire point of a case is to deduce from the symptoms the underlying condition. Many diseases are characterized by the same symptoms, you have to treat the symptoms in order to figure out what is causing them. I can't just treat a patient who may or may not have a disorder for that disorder. I have to treat each symptom until I am able to accurately diagnose the condition.

The problem with mind/body disorders is that psychiatric care can not always help the patient. Many patients really believe they are sick and until they are prescribed medication, they will continue to seek medical help. If I can help a patient by treating the symptoms with a placebo, instead of telling them they aren't sick I will. Patients with psychosomatic disorders will "shop around" until they find a doctor willing to prescribe them unneeded medication. This is overtreatment and should always be avoided.

You have to be proactive in diagnosing a patient, if you know someone is not going to listen to advice until they have a bottle of medication in their hand, you have to get creative. Medicine isn't about following strict rules, its about finding ways to help patients. In fact, one of the greatest comforts a medical professional can give is just that, comfort. "To heal sometimes, to comfort always. (http://www.bioethics.gov/bookshelf/reader/chapter3.html)"

It depends. If the patient is paying the same amount for the placebo as they would be for the name brand drug, then the price of the placebo is artificially inflated by the doctor's deception.
If the patient pays the market price of sugar pills, then it's fine. I suppose the doctor could tell the patient the price is lowered because of a marketing campaign or something.

Symptom control isn't the same as treating the underlying condition. All a placebo can do is control symptoms until the patient figures out that they've been percribed.
You never answered my question about whether we are allowed to alleviate our symptoms WHILE we seek treatment to find the underlying causes.

Well? Are we?

If our symptoms have a psychological cause, it may take years to work that out. In the meantime, are we supposed to stay sick with our symptoms, even if a placebo could get us back to physical health while we work on our emotional health?

It depends. If the patient is paying the same amount for the placebo as they would be for the name brand drug, then the price of the placebo is artificially inflated by the doctor's deception.
If the patient pays the market price of sugar pills, then it's fine. I suppose the doctor could tell the patient the price is lowered because of a marketing campaign or something.

People rarely, if ever, pay full market price for a drug. Most people merely pay a copay depending on whether the drug is formulary or not. A doctor could easily deflect suspicions about the price by saying they are prescribing a generic equivalent or such.

Wrong. What that is, is you putting words in my mouth.

What my statement actually meant was that I happened to have good reason to believe, from the way my grandmother was treated and the way she acted, that she was being prescribed placebos as well as actually medications. Having personally observed both the doctor's interactions with my grandmother and with me, I surmised that he would be more likely to give her a placebo in a situation in which he would not give me a placebo.

But if you find it easier to press your argument if you cast me as having said things I didn't, I can understand that.
When you clarified, I retracted my statement. I misread. If I was putting words into your mouth, I wouldn't have admitted an error.


I told you what I meant in the very next sentence.
Then that was adressed by my comment. It seemed like that was a specific response to a specific comment.


You seem very attached to your concern, as you reject out of hand every explanation for the practice that is offered to you, and you do so always on the same grounds of your concern, not on any examples of bad results from it.
I've made several posts since the one you're quoting, might be better to read those first.

Opiates and antibiotics are not placebos. That has already been pointed out by another poster earlier in this thread. Knowingly prescribing active drugs that are not indicated for the patient's condition is not the same as prescribing an inert substance because, after due examination and testing, the doctor decides this is the best approach to helping the patient.
The study defines them as such. That's what we're discussing afterall. The study.


That's what personal injury lawyers are for.
That stament makes it sound like the doctors aren't doing their patients a service by percribing placebos.


Ah, you did read ahead, you just decided to bitch me out for no reason. :D
[QUOTE=Aerou;14137574]You have to treat the symptoms in order to treat the underlying condition, first rule of medicine. In fact, the entire point of a case is to deduce from the symptoms the underlying condition. Many diseases are characterized by the same symptoms, you have to treat the symptoms in order to figure out what is causing them. I can't just treat a patient who may or may not have a disorder for that disorder. I have to treat each symptom until I am able to accurately diagnose the condition.

The problem with mind/body disorders is that psychiatric care can not always help the patient. Many patients really believe they are sick and until they are prescribed medication, they will continue to seek medical help. If I can help a patient by treating the symptoms with a placebo, instead of telling them they aren't sick I will. Patients with psychosomatic disorders will "shop around" until they find a doctor willing to prescribe them unneeded medication. This is overtreatment and should always be avoided.

You have to be proactive in diagnosing a patient, if you know someone is not going to listen to advice until they have a bottle of medication in their hand, you have to get creative. Medicine isn't about following strict rules, its about finding ways to help patients. In fact, one of the greatest comforts a medical professional can give is just that, comfort. "To heal sometimes, to comfort always. (http://www.bioethics.gov/bookshelf/reader/chapter3.html)"
The way you go about perscribing placebos isn't where my concern lies. You, and according to the survey, most of the doctors that engange in this practise don't decieve the patients. Telling them something to the effect of "this isn't routinely perscribed, but this may help you" isn't the problem.

I'm looking at the study that was talked about in the OP. The one the article was based on.

You definitely managed to read and apply parts of it.


That's not the topic of debate. It's the ethics and potential harm of perscribing a placebo.[/QUOTE]

You're going to try to seperate the ethics and potential harm from whether or not the doctor should make a determination and the potential benefits? Gee, why would anyone accuse you of only looking at half the evidence. I know I, for one, can't think of a single problem with refusing to look at the whole picture.

No matter how many times you cry "stop destroying my argument by not focusing enough on only what I say and bringing up the actual arguments for and against placebos", I'm going to continue to put your arguments in context. Why? Because the ignorance of them is demonstrable, and like all ignorant arguments, adding context destroys them.



Please quote where I said placebos were ineffective. I haven't said either way. I'm not addressing the placebo effect. None of my posts have either. They focus around the potential harm in decieving a patient. I've also stated in my first or second response to Mur, that what Aerou does isn't what I take issue with. She doesn't lie to her patients.

Like I said, you want to seperate the benefits, but not the detriments. Of course, not considering all aspects is irrational.



And you make the same assumption. It's a concern that was even brought up in the NYT artice.

Googling of "placebo, doctor, patient, and distrust" yielded a number of stories and studies, here's a few that caught my eye:




http://pubs.acs.org/hotartcl/mdd/99/aug/mysterious.html

You mean, that when people are told they're on an experimental drug with potentially large side-effects, they psychosomatically experience those side-effects. How is that remotely relevant to what we're discussing? These patients were part of a study. That article is all over the map on placebos. It's not a rounded argument and, unsurprisingly, doesn't actually support your claim.

Read the reations of people to the story:
http://blogs.wsj.com/health/2008/01/04/is-your-doctor-giving-you-placebos/

Gee. Anecdotal evidence. That's practically a study. You really don't understand how evidence works, do you? At all.


A talk about the growing problem of patient distrust. Not all because of placebos, but it illustrates that there is a problem.
http://www.nytimes.com/2008/07/29/health/29well.html

Okay, that's three links that don't actually support your claim. When I ask you to provide evidence, it's supposed to be relevant and actually demonstrate that what you're saying is accurate.

I did a google search for "accurate" and "argument".

http://books.google.com/books?id=695iPC4ef4cC&pg=PA157&lpg=PA157&dq=Accurate+argument&source=web&ots=xjGh9b0cdL&sig=95iOxH6-RxEoyjKG1koavlOVm8A&hl=en&sa=X&oi=book_result&resnum=1&ct=result

http://en.wikipedia.org/wiki/2channel

http://www.ingentaconnect.com/content/oso/590208/1995/00000001/00000001/art00014

They don't actually help my argument, but since you seem to think that just supplying links supports your argument, I figured I might as well join the fun.


That's not what I'm saying at all. I'm saying that there is an ethical problem when informed consent doesn't exist.

What precisely are they not being informed of? Are they being told about potential side-effects? Yup. In fact, you linked to an article the demonstrates that they're being informed of this. Are they being told about potential benefits? Yup. In fact, that's kind of the point. Do those benefits occur? Yup. Again, that's the point. The only information they're not being given is a bit of information that undermines the treatment.



And it's been discussed and been found over and over to be a problem:
http://www.google.com/search?hl=en&client=opera&rls=en&hs=vnV&sa=X&oi=spell&resnum=0&ct=result&cd=1&q=doctors+prescribing+antibiotics+for+viruses&spell=1

Duh. What you're failing to understand here is that, even by your own link, it's being addressed? You're conflating two seperate problems.


You're lumping two seperate arguments into the same argument here.

Heh. It's so funny that you'd say that. You're trying to mix issues with overprescription with the use of placebos, while accusing me of conflating arguments because I want to examine the entirety of the placebo effect and not just those bits you THINK help your argument.

If someone is given a placebo that has a real indication, then searching the internet isn't an issue. Again, you need to consider where your arguments apply and what benefits there are to be compared to what detriments. Prescribing an actual drug has down-sides as compared to sugar pills, but has some benefits, one of which I pointed out was a down-side for sugar pills, according to you.

I know what you to seperate this all out. Of course, you do. A rational argument doesn't support your claim, so you have to pretend like you can take all of these things apart to the point of nonsense.



Neither have you. The study in question, that the NYT is discussing, talks only of the practice, not of the placebo effect in and of itself.

Which doesn't mean the placebo effect is irrelevant. The placebo effect is well-documented. The article is focusing on whether or not the benefits outweigh the ethical issues and the detriments. They're limited by space, but it doesn't mean they expect you to do your best to remain willfully ignorant while reading their article. The context of their statements are relevant.



If evidence supported the sending of flowers to patients, then yes.

Talk therapy has been shown to be effective.
http://edition.cnn.com/HEALTH/library/DS/00584.html

Evidence supports placebos. It's amusing how inconsistent your argument is.

I can post studies that show mild excercise can help with sports injuries. I wonder if that means that doctors should avoid taking other measures and just prescribe mild excercise.

Seriously, Snaf, you should learn when to quit. You're not just making a bad argument, but you're making an argument that is so far from the facts, that we're going to have to load down this thread with information to show what's wrong with it. It's okay that you don't know anything more about placebos than what's in the article, but you're going to have to face the fact that many of us DO. Our knowledge outside the article is going to come into play. Aerou isn't going to forget her medical training so she sticks to information that you find applicable. Sd isn't going to forget his knowledge of ethical and medical issues just so you can have an argument based on limited information. And I'm not going to forget what I know about placebos and our body's relationship with our mental state, just because you don't like losing. If you want to make an argument, go for it. But quit bitching because you can't argue about anything that is relevant that wasn't including in the article.

You never answered my question about whether we are allowed to alleviate our symptoms WHILE we seek treatment to find the underlying causes.

Well? Are we?

If our symptoms have a psychological cause, it may take years to work that out. In the meantime, are we supposed to stay sick with our symptoms, even if a placebo could get us back to physical health while we work on our emotional health?
Where on earth did you get that?

It's quite easy for a doctor to creatively inform you that you're getting a placebo.

The way you're making it sound placebos are highly effective when in fact, there's many instances they aren't. It's hilarious that I'm the one accused of painting with a broad brush when you just spoke for the entire population of people with psychogenic illnesses.

Although I can not see a specific reference to it in the published paper, over 100 media outlets[1] are reporting that this study found, amongst other conditions, doctors have prescribed placebos for Chronic Fatigue Syndrome (CFS) patients.

Many people may not be aware that there has actually been a systematic review and meta-analysis of the placebo response in the treatment of chronic fatigue syndrome[2]. It found that "the pooled placebo response was 19.6% (95% confidence interval, 15.4-23.7), lower than predicted and lower than in some other medical conditions." The authors summarised this as, "In contrast with the conventional wisdom, the placebo response in CFS is low."

Another study found that positive thinking ("positivity in illness") did not improve outcomes in CFS[3].

These studies suggest that, although at the current time CFS can be a frustrating condition for professionals to deal with (partly because of a lack of biomedical research and clinical trials in the area), it may not be the best condition if one wants to see good outcomes from using placebos. And of course, as the authors point out, there are ethical issues involved in using placebos anyway.

[1] Results from a Google (www.google.com) search under the News heading.

[2] Cho HJ, Hotopf M, Wessely S. The placebo response in the treatment of chronic fatigue syndrome: a systematic review and meta- analysis. Psychosom Med. 2005 Mar-Apr;67(2):301-13.

[3] Hyland ME, Sodergren SC, Lewith GT. Chronic fatigue syndrome: the role of positivity to illness in chronic fatigue syndrome patients. J Health Psychol. 2006 Sep;11(5):731-41.

http://www.bmj.com/cgi/eletters/337/oct23_2/a1938

As you can see from the comments from medical proffessionals, this is a highly controversial issue. If doctors can't agree on whether this is ethical, why do you assume your position is the correct one.

http://pubs.acs.org/hotartcl/mdd/99/aug/mysterious.html

^ This is just a general history of placebos and different trials. It's actually a pro-placebo article

Read the reations of people to the story:
http://blogs.wsj.com/health/2008/01/04/is-your-doctor-giving-you-placebos/

These people posting are idiots. Comments posted in regards to an article.....not the best evidence.

A talk about the growing problem of patient distrust. Not all because of placebos, but it illustrates that there is a problem.
http://www.nytimes.com/2008/07/29/health/29well.html

This talks more about fixing the healthcare system and how the "broken system" is causing the mistrust.

Where on earth did you get that?

It's quite easy for a doctor to creatively inform you that you're getting a placebo.

The way you're making it sound placebos are highly effective when in fact, there's many instances they aren't. It's hilarious that I'm the one accused of painting with a broad brush when you just spoke for the entire population of people with psychogenic illnesses.

Mura did no such thing. Mura said that it should be an available therapy, not that it should be applied on all cases, or even most. Really, please, don't say things if you don't know what they mean. Broad-brushing means you're broadly applying something. Saying everyone should be allowed to decide if they wish to smoke pot isn't broad-brushing just because it includes the word, everyong. Nor is saying "we" when talking about what therapeutic options should be made available.

The point of a placebo is that you believe it works. Knowledge that it's just sugar undermines it. They are generally effective when applied properly, much like other therapies.

"Hey, this drug doesn't do anything except make you think you'll get better. It only works if you think it's fixing something for you, which I just told you, it doesn't. Good luck."




http://www.bmj.com/cgi/eletters/337/oct23_2/a1938

As you can see from the comments from medical proffessionals, this is a highly controversial issue. If doctors can't agree on whether this is ethical, why do you assume your position is the correct one.
The difference is that those doctors are considering the depth and bredth of the issue. You aren't.

Of course its a controversial issue, not all doctors agree with it. It is, however, practiced daily with hundreds of patients across the US who leave the doctor happy that they have their pills and feeling better in no time.

And its not lying if a doctor says "I'm going to prescribe you something to help you feel better." I rarely, if ever, have a patient ask for a complete chemical breakdown of the medication I'm prescribing. They take the medication and thank me later. Most patients just want a script or a call in to a pharmacy. Then all is well.

People rarely, if ever, pay full market price for a drug. Most people merely pay a copay depending on whether the drug is formulary or not. A doctor could easily deflect suspicions about the price by saying they are prescribing a generic equivalent or such.Sure, but there are cases where the copay would be more than the cost of a bottle of sugar pills, or worse, when a person doesn't have insurance at all.

Sure, but there are cases where the copay would be more than the cost of a bottle of sugar pills, or worse, when a person doesn't have insurance at all.

They don't cost different amounts based on what you're prescribing them for. Also, they are often being paid for by insurance. You think insurance companies are being widely bilked by doctors who prescribe placebos?

You definitely managed to read and apply parts of it.
Really, what am I missing in this study?




You're going to try to seperate the ethics and potential harm from whether or not the doctor should make a determination and the potential benefits? Gee, why would anyone accuse you of only looking at half the evidence. I know I, for one, can't think of a single problem with refusing to look at the whole picture.
What??? Where in the study does it discuss the number of patients that improve?

No matter how many times you cry "stop destroying my argument by not focusing enough on only what I say and bringing up the actual arguments for and against placebos", I'm going to continue to put your arguments in context. Why? Because the ignorance of them is demonstrable, and like all ignorant arguments, adding context destroys them.
Please show me the parts of the BMJ article I'm ignoring.






Befits and detriments aren't discussed in the study.






[quote]You mean, that when people are told they're on an experimental drug with potentially large side-effects, they psychosomatically experience those side-effects. How is that remotely relevant to what we're discussing? These patients were part of a study. That article is all over the map on placebos. It's not a rounded argument and, unsurprisingly, doesn't actually support your claim.




Gee. Anecdotal evidence. That's practically a study. You really don't understand how evidence works, do you? At all.




Okay, that's three links that don't actually support your claim. When I ask you to provide evidence, it's supposed to be relevant and actually demonstrate that what you're saying is accurate.
There's more results from google. Why not try to refute them with your own instead of saying "nu-uh"?

I did a google search for "accurate" and "argument".

http://books.google.com/books?id=695iPC4ef4cC&pg=PA157&lpg=PA157&dq=Accurate+argument&source=web&ots=xjGh9b0cdL&sig=95iOxH6-RxEoyjKG1koavlOVm8A&hl=en&sa=X&oi=book_result&resnum=1&ct=result

http://en.wikipedia.org/wiki/2channel

http://www.ingentaconnect.com/content/oso/590208/1995/00000001/00000001/art00014

They don't actually help my argument, but since you seem to think that just supplying links supports your argument, I figured I might as well join the fun.
Now you're just being silly.:P




What precisely are they not being informed of? Are they being told about potential side-effects? Yup. In fact, you linked to an article the demonstrates that they're being informed of this. Are they being told about potential benefits? Yup. In fact, that's kind of the point. Do those benefits occur? Yup. Again, that's the point. The only information they're not being given is a bit of information that undermines the treatment.
I think you misread that article. The patients are informed of negative placebo effects in the context of a clinical trial.



Duh. What you're failing to understand here is that, even by your own link, it's being addressed? You're conflating two seperate problems.
And there's as many opponents as there are proponents.




Heh. It's so funny that you'd say that. You're trying to mix issues with overprescription with the use of placebos, while accusing me of conflating arguments because I want to examine the entirety of the placebo effect and not just those bits you THINK help your argument.
Antibiotics not perscribed for bacterial infections were considered placebos in the context of the study. I'm going by the study's defition, not yours.

If someone is given a placebo that has a real indication, then searching the internet isn't an issue. Again, you need to consider where your arguments apply and what benefits there are to be compared to what detriments. Prescribing an actual drug has down-sides as compared to sugar pills, but has some benefits, one of which I pointed out was a down-side for sugar pills, according to you.
And again, when informed consent exists, there's no problem with the practice.

I know what you to seperate this all out. Of course, you do. A rational argument doesn't support your claim, so you have to pretend like you can take all of these things apart to the point of nonsense.
No, I want to seperate it out, because I don't roundly condemn the practice.




Which doesn't mean the placebo effect is irrelevant. The placebo effect is well-documented. The article is focusing on whether or not the benefits outweigh the ethical issues and the detriments. They're limited by space, but it doesn't mean they expect you to do your best to remain willfully ignorant while reading their article. The context of their statements are relevant.
It's irrelevant to the debate because it's not addressed in the study.





Evidence supports placebos. It's amusing how inconsistent your argument is.
Supports giving them without informed consent when it's very possible for it to be perscribed with informed consent?

I can post studies that show mild excercise can help with sports injuries. I wonder if that means that doctors should avoid taking other measures and just prescribe mild excercise.
A patient who's perscribed mild exercise is fully informed. A doctor that says "this is medicine" when it's not isn't.

Seriously, Snaf, you should learn when to quit. You're not just making a bad argument, but you're making an argument that is so far from the facts, that we're going to have to load down this thread with information to show what's wrong with it. It's okay that you don't know anything more about placebos than what's in the article, but you're going to have to face the fact that many of us DO. Our knowledge outside the article is going to come into play. Aerou isn't going to forget her medical training so she sticks to information that you find applicable. Sd isn't going to forget his knowledge of ethical and medical issues just so you can have an argument based on limited information. And I'm not going to forget what I know about placebos and our body's relationship with our mental state, just because you don't like losing. If you want to make an argument, go for it. But quit bitching because you can't argue about anything that is relevant that wasn't including in the article.
It's funny that you so roundly dismiss my stance when the comments on the article from professionals show the controversy exists amongst themselves.

Sure, but there are cases where the copay would be more than the cost of a bottle of sugar pills, or worse, when a person doesn't have insurance at all.

If the person doesn't have insurance, then that might be more problematic. Doctors will not refuse treatment, so if a person is unable to pay, then whatever prescription they get will be free of charge. If the person can pay but doesn't have insurance, then maybe the placebo prescription might be hard to explain.

A bottle of placebos would never cost less than the generic copay, though, usually $5 or $10.

They don't cost different amounts based on what you're prescribing them for.No, but they cost different amounts based on what they are. Penicillin, for instance, costs less than my copay. If I'm being prescribed penicillin as a placebo for something that I as a patient believe is more serious, I'm likely to become suspicious if it costs less than what my copay is.

Also, they are often being paid for by insurance. You think insurance companies are being widely bilked by doctors who prescribe placebos?If not, then the doctor has some way of convincing the patient that the lower cost of the placebo is not because it's a placebo.

If the person doesn't have insurance, then that might be more problematic. Doctors will not refuse treatment, so if a person is unable to pay, then whatever prescription they get will be free of charge. If the person can pay but doesn't have insurance, then maybe the placebo prescription might be hard to explain.That's what I figured. As long as the patient isn't paying inflated prices for a placebo, I don't have a problem with the prescribing of placeboes.

Really, what am I missing in this study?

What??? Where in the study does it discuss the number of patients that improve?

Please show me the parts of the BMJ article I'm ignoring.

Befits and detriments aren't discussed in the study.

Antibiotics not perscribed for bacterial infections were considered placebos in the context of the study. I'm going by the study's defition, not yours.

It's irrelevant to the debate because it's not addressed in the study.
If other people want to continue to play, they're welcome to, but I'm not going to play the game of "please, pretend like no other information on placebos exist".

I get it. You don't know anything else and as soon as we look at the actual picture that this study fits into we're over your head, but stop pretending we should cater to that. Congrats, you read the study. You want everyone else here to pretend like it's the only thing that exists so you can be on equal ground. I'll give you that at least it shows that you recognize that if we ACTUALLY discuss the issues brought up by the study, you're over your head.

No, but they cost different amounts based on what they are. Penicillin, for instance, costs less than my copay. If I'm being prescribed penicillin as a placebo for something that I as a patient believe is more serious, I'm likely to become suspicious if it costs less than what my copay is.

If not, then the doctor has some way of convincing the patient that the lower cost of the placebo is not because it's a placebo.

That's what I figured. As long as the patient isn't paying inflated prices for a placebo, I don't have a problem with the prescribing of placeboes.

Lots of medications are inexpensive or even given to you directly by your doctor.

You keep acting like the cost of medication is completely determined by the cost to develop it. Obviously this isn't true. If a placebo is going to help you heal, why shouldn't it cost a reasonable amount for that service?

^ This is just a general history of placebos and different trials. It's actually a pro-placebo article



These people posting are idiots. Comments posted in regards to an article.....not the best evidence.



This talks more about fixing the healthcare system and how the "broken system" is causing the mistrust.
I know it's a variety of articles, I didn't know exactly what Joccy was taking issue with so I was having a hard time being specific.

Mura did no such thing. Mura said that it should be an available therapy, not that it should be applied on all cases, or even most. Really, please, don't say things if you don't know what they mean. Broad-brushing means you're broadly applying something. Saying everyone should be allowed to decide if they wish to smoke pot isn't broad-brushing just because it includes the word, everyong. Nor is saying "we" when talking about what therapeutic options should be made available.
"We're just supposed to suffer then?" sounded like she was speaking for everyone or at least a sizeable chunk of psychogenic conditions.

The point of a placebo is that you believe it works. Knowledge that it's just sugar undermines it. They are generally effective when applied properly, much like other therapies.
And sometimes patient knowledge has no effect. Some doctors tell their patients outright it's a placebo or that it's a non-standard/not been proven effective. In fact, most doctors in the study actually do that.

"Hey, this drug doesn't do anything except make you think you'll get better. It only works if you think it's fixing something for you, which I just told you, it doesn't. Good luck."
Why does it have to be so extreme? What's wrong with "there's no proven effect of this medication, but some of my patients report that it helps."





The difference is that those doctors are considering the depth and bredth of the issue. You aren't.
When you fit my concerns into that tiny little box of yours, yes. If you're looking for a professional debate, you can either put everyone but Aerou and Fass onto ignore or you can go to a professional forum. Of course I don't have years of experience, neither do you.

Of course its a controversial issue, not all doctors agree with it. It is, however, practiced daily with hundreds of patients across the US who leave the doctor happy that they have their pills and feeling better in no time.

And its not lying if a doctor says "I'm going to prescribe you something to help you feel better." I rarely, if ever, have a patient ask for a complete chemical breakdown of the medication I'm prescribing. They take the medication and thank me later. Most patients just want a script or a call in to a pharmacy. Then all is well.
That's not lying, that's not what I take issue with at all. Again, I apologise if it sounds like I was.

If other people want to continue to play, they're welcome to, but I'm not going to play the game of "please, pretend like no other information on placebos exist".

I get it. You don't know anything else and as soon as we look at the actual picture that this study fits into we're over your head, but stop pretending we should cater to that. Congrats, you read the study. You want everyone else here to pretend like it's the only thing that exists so you can be on equal ground. I'll give you that at least it shows that you recognize that if we ACTUALLY discuss the issues brought up by the study, you're over your head.

OIC. I ask you to show me what I'm ignoring in the study and now you're taking your toys and playing elsewhere.

And sometimes patient knowledge has no effect. Some doctors tell their patients outright it's a placebo or that it's a non-standard/not been proven effective. In fact, most doctors in the study actually do that.

I take it back, even when limited to the study, you don't actually get it.

placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.

They're not talking about a medication that hasn't yet been been proven effective. It's something where there is no physiological mechanism. As such, telling your patient there is no physiological effect of the medication they're being given undermines the psychosomatic effects. You've asked that they be told there are no physiological effects, which is what you'd be telling them by telling them it's a placebo. The actual attempts you've made to describe what doctors should say doesn't actually encapsulate telling them it's a placebo.

"This doesn't actually do anything other than make you think it'll make you better" would be telling them it's a placebo. ""there's no proven effect of this medication, but some of my patients report that it helps" would not be telling them it's a placebo.

OIC. I ask you to show me what I'm ignoring in the study and now you're taking your toys and playing elsewhere.

Several people have shown you explicitly what aspects of the study and it's implications you're ignoring. I don't feel the need to regurgitate their arguments. I was pointing out that you'd not just ignoring parts of the study, but ignoring half the evidence. You seem to think "ignoring half the evidence" means "ignoring half of the evidence in this study, because it's the only thing relevant to this discussion".

Also, a medicine doesn't have to be chemical. The definition of medicine (http://www.merriam-webster.com/dictionary/Medicine) specifically states that it is a "substance or preparation used in treating disease" and that it is "something that affects well-being" a placebo falls under both.

So the doctors who said:

18% (62) introduced placebo treatments as "a medicine,"

Never actually lied to their patients.

Also, a medicine doesn't have to be chemical. The definition of medicine (http://www.merriam-webster.com/dictionary/Medicine) specifically states that it is a "substance or preparation used in treating disease" and that it is "something that affects well-being" a placebo falls under both.

That's not in the study and, thus, Snafturi is unaware of it and you're being unfair.

I don't see what's wrong with prescribing placebos. Does one really need to know the exact details of what a pill will do to your body to be informed enough to consent? I don't think so. Once you know the possible risks and how likely they are and the possible benefits and how likely they are, then you're good to go, I figure.

I don't see what's wrong with prescribing placebos. Does one really need to know the exact details of what a pill will do to your body to be informed enough to consent? I don't think so. Once you know the possible risks and how likely they are and the possible benefits and how likely they are, then you're good to go, I figure.

You just described informed consent. It's not required that you explain why it works. (Well, it's more than that, but that's the relevant part to the discussion.)

You just described informed consent. It's not required that you explain why it works. (Well, it's more than that, but that's the relevant part to the discussion.)

So I got something right, all on my own, without using the google or the wiki?



Yay!

I take it back, even when limited to the study, you don't actually get it.

placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.

They're not talking about a medication that hasn't yet been been proven effective. It's something where there is no physiological mechanism. As such, telling your patient there is no physiological effect of the medication they're being given undermines the psychosomatic effects. You've asked that they be told there are no physiological effects, which is what you'd be telling them by telling them it's a placebo. The actual attempts you've made to describe what doctors should say doesn't actually encapsulate telling them it's a placebo.

"This doesn't actually do anything other than make you think it'll make you better" would be telling them it's a placebo. ""there's no proven effect of this medication, but some of my patients report that it helps" would not be telling them it's a placebo.
Well then, by your definition they're not being told. I'm satisfied if that's explained to them.
Several people have shown you explicitly what aspects of the study and it's implications you're ignoring. I don't feel the need to regurgitate their arguments. I was pointing out that you'd not just ignoring parts of the study, but ignoring half the evidence. You seem to think "ignoring half the evidence" means "ignoring half of the evidence in this study, because it's the only thing relevant to this discussion".
No, several people have added their own personal stories and are trying to argue things not covered by the original study.
Also, a medicine doesn't have to be chemical. The definition of medicine (http://www.merriam-webster.com/dictionary/Medicine) specifically states that it is a "substance or preparation used in treating disease" and that it is "something that affects well-being" a placebo falls under both.

So the doctors who said:



Never actually lied to their patients.
I see where you're coming from on that. That's not how I first read it. After reading the comments, it sounds like they authors intentionally or unintentionally were misleading.

Either way, by your explanation, no not lying.

That just leaves the antibiotics that I take issue with.

That's not in the study and, thus, Snafturi is unaware of it and you're being unfair.
No, because she's actually adressing my point, unlike you.

So I got something right, all on my own, without using the google or the wiki?



Yay!

I can give you the relevant bit in America.

The following are required to be discussed by the doctor to the patient or a relevant caregiver:
The patient's diagnosis, if known;
The nature and purpose of a proposed treatment or procedure;
The risks and benefits of a proposed treatment or procedure;
Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
The risks and benefits of the alternative treatment or procedure; and
The risks and benefits of not receiving or undergoing a treatment or procedure.

The issue here is that the doctor isn't making a diagnosis, they're addressing the symptoms as best they can, so the first is out the window. The nature and purpose of the treatment is being discussed.

The issue when people talk about counterindicated medication and placebos is whether or not they've been informed of the risks and benefits, which is what you brought up.

Well then, by your definition they're not being told. I'm satisfied if that's explained to them.

See, there you go. Not by my definition. By the study's definition. Seriously, if you don't understand the study and don't want to apply the context of relevent ethical, medical, psychological and physiological data, then why are you even involved in the discussion?


No, several people have added their own personal stories and are trying to argue things not covered by the original study.

Really? Aerou is just adding her personal stories? Sd is? I am? We're adding information based on what we've learned. The only really one that is mainly focused on a personal story, as an example, was mura, an that was explained.



I see where you're coming from on that. That's not how I first read it. After reading the comments, it sounds like they authors intentionally or unintentionally were misleading.

Either way, by your explanation, no not lying.

That just leaves the antibiotics that I take issue with.


No, because she's actually adressing my point, unlike you.

Really? So you're willing to look at actual medical and industrial knowledge in order to form a decision on placebos? Hmmm... I wonder if I can find an examples where complained every time something outside the study was mentioned. Nah, prolly not.

Well I do not agree with the prescribing of antibiotics as placebos, as I think in the long it does more harm than good. As far as vitamins and "dummy pills," I don't see a problem with them.

See, there you go. Not by my definition. By the study's definition. Seriously, if you don't understand the study and don't want to apply the context of relevent ethical, medical, psychological and physiological data, then why are you even involved in the discussion?
Which if you'll go back, was the group I said, specifically, I didn't have a problem with.




Really? Aerou is just adding her personal stories? Sd is? I am? We're adding information based on what we've learned. The only really one that is mainly focused on a personal story, as an example, was mura, an that was explained.
I haven't responded to SD since my second post in this thread. This was something I also retracted when Mur gave more info.

Aerou, if you've been following, I haven't been arguing with.





Really? So you're willing to look at actual medical and industrial knowledge in order to form a decision on placebos? Hmmm... I wonder if I can find an examples where complained every time something outside the study was mentioned. Nah, prolly not.
That has what to do with the fact that my concerns are not valid but other people, with the exact same concerns are?

Well I do not agree with the prescribing of antibiotics as placebos, as I think in the long it does more harm than good. As far as vitamins and "dummy pills," I don't see a problem with them.

ZOMG stop arguing with me! I said that I didn't agree with doctors perscribing antibiotics as placebos!!!!!!!!1111

Which if you'll go back, was the group I said, specifically, I didn't have a problem with.


I haven't responded to SD since my second post in this thread. This was something I also retracted when Mur gave more info.

Aerou, if you've been following, I haven't been arguing with.


That has what to do with the fact that my concerns are not valid but other people, with the exact same concerns are?

Let's see, so you're not arguing with Sd, Mur or Aerou. But you're arguing with people who are just giving personal stories? Who are you referencing? I'm certainly not arguing about anything personal, and I'm mostly arguing along with one of the three of them. It's amusing how much backpeddling you're doing here.

Not arguing with Aerou is a wise decision. She's actually speaking from a position of knowledge.

As for that last bit, what? Who else has the exact same concerns? Who else suggested that people who are prescribed placebos should instead be sent to mental health professionals? Who else has made blanket statements based on misassessments of the meaning of placebo and slowly retracted the statement all the while pretending they have some sort of valid core argument?

After all of this, you're down to bitching about overprescription.

Let's see, so you're not arguing with Sd, Mur or Aerou. But you're arguing with people who are just giving personal stories? Who are you referencing? I'm certainly not arguing about anything personal, and I'm mostly arguing along with one of the three of them. It's amusing how much backpeddling you're doing here.
Oh no, you misread. I have been arguing with Mur. I was arguing a point with SD about Mur. That's the only think we've been talking about. Nothing from the study. So really it's just you and Mur.

As for that last bit, what? Who else has the exact same concerns? Who else suggested that people who are prescribed placebos should instead be sent to mental health professionals? Who else has made blanket statements based on misassessments of the meaning of placebo and slowly retracted the statement all the while pretending they have some sort of valid core argument?
First you say that I hold the same postion as others, now I don't. I find it quite hilarious that I'm quite able to have a rational coversation with the one person in this thread qualified to discuss this subject, while you've seen fit to turn this into an epic debate.

After all of this, you're down to bitching about overprescription.
I thought I was here to have a discussion. One that I managed to have with a doctor despite your best efforts.

I'd totally fire my doctor for perscribing me a placebo. I'd be extremely angry. If I have headaches and they're psychogenic, then I need a psychiatric evaluation and proper treatment. If whatever is going on in my head is profound enough to make me sick (or feel sick), then it's affecting other areas of my life as well.


If If you are so profoundly affected by the economy that you can't keep your food down, yes, you have a problem.

...

Sounds like your GP was operation outside of his scope of practice unless he's also a board certified psychiatrist. I must also say, discusssing another patient's medical history with you a HUGE HIPPA violation. It doesn't matter that you are part of the same family.

I'm quite certain these 50% of doctors don't randomly perscribe placebos to all their patients. My concern is that they percribe them period.

...
Finally, your all-or-nothing, black/white attitude that, if your symptoms don't have a physical cause, then you need psyciatric care, end of discussion, ignores one important detail: The symptoms are still there and still causing problems.
And the treatment for them would be psychiatric.

Symptom control isn't the same as treating the underlying condition. All a placebo can do is control symptoms until the patient figures out that they've been percribed.

You've been making the ever-morphing argument with one common thread, that you claim that rather than prescribe placebos a doctor should ALWAYS send them to a psychiatrist, so much so that you claimed that a doctor that addresses psychosomatic symptoms is working outside of their bailiwick.

These are claims and they have nothing to do with what Mura said. It's a general issue you have based on your understanding or lack thereof relating to placebos and psychosomatic symptoms or even just psychosomatic benefits.

These aren't the entirety of quotes available. I completely left out all the quotes about "what if the patient discovers that you tried to help them without overprescribing medication?"

That last one is pretty funny since you claimed that placebos work even when the patient is informed they've prescribed while you'd earlier in the thread said that placebos only work until the patient becomes aware of it.

First you say that I hold the same postion as others, now I don't.

I did? Quote me? Whose shares your position that I said was valid?

As far as your discussion with Aerou, she's being nice. Don't mistake that for thinking she doesn't have the exact same issues with the remarkable ignorance of claims about psychosomatic symptoms requiring a psychiatrist to treat, as well as your general claims about placebos and your disturbing assumptions about the roles of physicians in family care.

You've been making the ever-morphing argument with one common thread, that you claim that rather than prescribe placebos a doctor should ALWAYS send them to a psychiatrist, so much so that you claimed that a doctor that addresses psychosomatic symptoms is working outside of their bailiwick.

These are claims and they have nothing to do with what Mura said. It's a general issue you have based on your understanding or lack thereof relating to placebos and psychosomatic symptoms or even just psychosomatic benefits.

These aren't the entirety of quotes available. I completely left out all the quotes about "what if the patient discovers that you tried to help them without overprescribing medication?"
Yeah, leaving out that last part has been the one thing you've been consistent with. Totally missed the point on what I was saying, but that's not really relevant.

So are we back to arguing the psychiatric tangent or are we arguing the study or should we just continue to argue about arguing? I vote for the last one, it's where we're bound to return to, and it's the most entertaining.

I did? Quote me? Whose shares your position that I said was valid?
No, you said it wasn't valid because I wasn't qualified even though it was the exact same opinion that others held.
The difference is that those doctors are considering the depth and bredth of the issue. You aren't.

As far as your discussion with Aerou, she's being nice. Don't mistake that for thinking she doesn't have the exact same issues with the remarkable ignorance of claims about psychosomatic symptoms requiring a psychiatrist to treat, as well as your general claims about placebos and your disturbing assumptions about the roles of physicians in family care.
Now you're speaking for Aerou. No, she adressed my posts rationally and you know, discussed vs debated. She wasn't being nice, as you put it, she was being reasonable. She posted this on NSG knowing full well there's only one other poster on this board qualified to have a debate on this issue.

That's what I figured. As long as the patient isn't paying inflated prices for a placebo, I don't have a problem with the prescribing of placeboes.

This brings up an interesting point, however. Aerou quoted a study that showed that the more a patient is charged for a placebo, the more pronounced its effects are. What are the ethical implications of charging a patient more for a placebo than its actual cost if that dollar figure is directly linked to it's psychological effect? Perhaps a method could be introduced where a doctor can prescribe the more "expensive" placebo so the patient thinks they're getting the better drug, and then have the insurance company underbill the doctor's visit or some other bill the patient has to compensate?

Also, Jocabia, TG.

You keep acting like the cost of medication is completely determined by the cost to develop it. Obviously this isn't true. If a placebo is going to help you heal, why shouldn't it cost a reasonable amount for that service?It can cost a reasonable amount - the same amount the placebo would cost if the patient was told that it was a placebo. Any more than that isn't reasonable.

This brings up an interesting point, however. Aerou quoted a study that showed that the more a patient is charged for a placebo, the more pronounced its effects are. What are the ethical implications of charging a patient more for a placebo than its actual cost if that dollar figure is directly linked to it's psychological effect? That other study was part of the reason that I brought up the argument that I did.

Yeah, leaving out that last part has been the one thing you've been consistent with. Totally missed the point on what I was saying, but that's not really relevant.

So are we back to arguing the psychiatric tangent or are we arguing the study or should we just continue to argue about arguing? I vote for the last one, it's where we're bound to return to, and it's the most entertaining.

I love that you keep pretending like it's a tangent. You claimed to have an issue with a doctor ever prescribing a placebo and that unless one is a licensed psychiatrist that one is operating outside of their field. It's not tangential to a discussion as to whether doctors should prescribe placebos. It's right in the middle of it. Shall I take that you're now desperately trying to escape those wildly ignorant claims that you recognize them as such?


No, you said it wasn't valid because I wasn't qualified even though it was the exact same opinion that others held.

You mean the doctors who are discussing the ethics of prescribing placebos? Your opinion isn't valid because your arguments are ignorant. Your conclusions are based on your arguments. You don't get to say you're right because you happen to agree with some people who are questioning placebos for entirely different reasons. And I didn't say their conclusion was valid either, only that they are capable of making educated arguments.



Now you're speaking for Aerou. No, she adressed my posts rationally and you know, discussed vs debated. She wasn't being nice, as you put it, she was being reasonable. She posted this on NSG knowing full well there's only one other poster on this board qualified to have a debate on this issue.

Speaking TO Aerou. You've heard of IM, right? Aerou and Sd discussed this thread before it was even posted, and I joined that discussion with Aerou. She and I have been talking about the thread the entire time.

She's away for a while, but I assume when she returns she'll take issue with your claim that she agrees with you on ANY of this. Every once in a while you follow a bad argument to an otherwise reasonable conclusion that most of us agree with, but it doesn't change that your making bad arguments and that the basis for them, ranging from a misunderstanding of HIPAA obligations, to a misunderstanding of informed consent, to a misunderstanding what a placebe even is, is invalid and ignorant.

You may notice I'm using the word ignorant frequently. It's because you're not stupid and we both know it. Unfortunately, rather than simply admitting you have no idea what you're talking about, you suggested that Mura's doctor is violating their medical obligations in several ways. You later suggested that Aerou also is, given that she is also not a psychiatrist and also admits to prescribing placebos. You suggested that Mura needs a psychiatrist. And you suggested doctors should tell patients they are prescribing a placebo even after you, yourself, admitted that they lose their effect when patients become aware they are placebos.

The entirety of the argument is ridiculous, and because it's backs an attempt to accuse doctors of behaving in unethical and untrustworthy ways, is another of your arguments in which you put forward a dangerous misunderstanding of health and the human body.

That other study was part of the reason that I brought up the argument that I did.

It's an interesting dilemma, to be sure. One the one hand, I don't know of many people who would disagree that purposely overcharging someone for medication is at the very least morally suspect. But on the other hand, there are demonstrable medical benefits TO overcharging. It's quite the quandry.

It can cost a reasonable amount - the same amount the placebo would cost if the patient was told that it was a placebo. Any more than that isn't reasonable.

Patients who know it's a placebo aren't given them. The value of the placebo is zero when you've undermined the point of them. They provide health benefits and those benefits give them a value. Incidentally, as you've noted, increasing their cost increasing that value. It's interesting that you'd like to undermine the health benefit they provide by quibbling over money.

The question, the true ethical question, is would a reasonable patient be willing to pay the cost of the pill and the visit in order to feel better and would that patient prefer to be prescribed a placebo if it made them feel better? If the answer is yes, there is no ethical dillemma. And if the patient is reasonable, I think there's no doubt that they actually DID pay the money and take the advice in order to feel better.

It's an interesting dilemma, to be sure. One the one hand, I don't know of many people who would disagree that purposely overcharging someone for medication is at the very least morally suspect. But on the other hand, there are demonstrable medical benefits TO overcharging. It's quite the quandry.

See the post below yours.

I think it's a matter of whether a reasonable person would be happy to pay that charge for that service. Obviously, they would because they did. I don't pay $20/pill because I really like the ingredients. I pay because I was told it take away my symptoms until whatever is wrong with me improves, or improve whatever is wrong with me. The placebo does that.

Speaking TO Aerou. You've heard of IM, right? She's away for a while, but I assume when she returns she'll take issue with your claim that she agrees with you on ANY of this. Every once in a while you follow a bad argument to an otherwise reasonable conclusion that most of us agree with, but it doesn't change that your making bad arguments and that the basis for them, ranging from a misunderstanding of HIPAA obligations, to a misunderstanding of informed consent, to a misunderstanding what a placebe even is, is invalid and ignorant.
I didn't say she agreed with me, I said I agreed with her. We had a discussion, unlike the argument I'm having with you.

You may notice I'm using the word ignorant frequently. It's because you're not stupid and we both know it. Unfortunately, rather than simply admitting you have no idea what you're talking about, you suggested that Mura's doctor is violating their medical obligations in several ways. You later suggested that Aerou also is, given that she is also not a psychiatrist and also admits to prescribing placebos. You suggested that Mura needs a psychiatrist. And you suggested doctors should tell patients they are prescribing a placebo even after you, yourself, admitted that they lose their effect when patients become aware they are placebos.
That's why I said several times, even using Aerou as an example, that wasn't the practice I had issue with.

I admitted no such thing. Nor would I ever since I regularly use stomach medicine for anxiety knowing full well that an antacid doesn't do anything for my anxiety. I intentionally avoided that, because I knew you'd want a source for a study on people knowingly taking placebos and I didn't feel like digging it up.

In the past I've also used rather expensive, totally worthless diet pills knowing full well there was nothing in them that actually helped me lose weight, sort of lose weight, or anything like that. They helped me lose weight anyway.

So yeah, totally didn't go there.

The entirety of the argument is ridiculous, and because it's backs an attempt to accuse doctors of behaving in unethical and untrustworthy ways, is another of your arguments in which you put forward a dangerous misunderstanding of health and the human body.
Not all doctors, or most even. Just a small percent.

I didn't say she agreed with me, I said I agreed with her. We had a discussion, unlike the argument I'm having with you.

You don't agree with her. You can't claim the things your claiming and be in agreement with her.


That's why I said several times, even using Aerou as an example, that wasn't the practice I had issue with.

Yes, you changed your argument. I noticed. Now you're down to one tiny little claim that you think vindicates you so you can save face. No one argued with you about the antibiotics thing. Not one person. We took issue with the several completely wrong things you claimed about doctors and their obligations, and the effects of placebos.


I admitted no such thing. Nor would I ever since I regularly use stomach medicine for anxiety knowing full well that an antacid doesn't do anything for my anxiety. I intentionally avoided that, because I knew you'd want a source for a study on people knowingly taking placebos and I didn't feel like digging it up.

"Symptom control isn't the same as treating the underlying condition. All a placebo can do is control symptoms until the patient figures out that they've been percribed.

You're on a forum. I can quote you. Just blatantly lying about what you did and did not say is going to get you caught.



In the past I've also used rather expensive, totally worthless diet pills knowing full well there was nothing in them that actually helped me lose weight, sort of lose weight, or anything like that. They helped me lose weight anyway.

So yeah, totally didn't go there.


Not all doctors, or most even. Just a small percent.

I notice you ignored about half of that sentence. Your attempts to make people rely on disinformation that you provide rather than real evidence or the information of experts is dangerous. I'll not allow you to spread disinformation and I'm happy to push you until you backpedal until you're just trying to save face, as you're doing here.

See the post below yours.

I think it's a matter of whether a reasonable person would be happy to pay that charge for that service. Obviously, they would because they did. I don't pay $20/pill because I really like the ingredients. I pay because I was told it take away my symptoms until whatever is wrong with me improves, or improve whatever is wrong with me. The placebo does that.

Well then perhaps this is where you and I diverge in our respective opinions of this discussion. I do not have a concern with deception being applied for the sake of the patient's health. I do have a problem with someone directly profitting from such deception. Someone is making a lot of extra money if a person is paying $20 a pill for a placebo that costs $0.25 a pill otherwise, simply because saying it costs more makes people heal themselves better. I don't agree with that. There have to be reasonable workarounds possible to allow the patient to still believe they're paying for an expensive brand-name drug without making them pay an obscene price for sugar pills.

You don't agree with her. You can't claim the things your claiming and be in agreement with her.
We had a discussion, after reading what she wrote, I agreed with her. It's quite simple really.


Yes, you changed your argument. I noticed. Now you're down to one tiny little claim that you think vindicates you so you can save face. No one argued with you about the antibiotics thing. Not one person. We took issue with the several completely wrong things you claimed about doctors and their obligations, and the effects of placebos.
I'm not still here to save face, I'm here for an argument.

"Symptom control isn't the same as treating the underlying condition. All a placebo can do is control symptoms until the patient figures out that they've been percribed.

You're on a forum. I can quote you. Just blatantly lying about what you did and did not say is going to get you caught.
Except I was talking about a patient who didn't know they had a placebo in that instance. In no way does that quote imply that a person must unknowinly take a placebo for it to be effective. I'd never ever say that.

Ah ha! I see what you did there. I guess I assumed we'd be talking about the patients like in the study. Those other than the 3% that were told it was a placebo.

I notice you ignored about half of that sentence. Your attempts to make people rely on disinformation that you provide rather than real evidence or the information of experts is dangerous. I'll not allow you to spread disinformation and I'm happy to push you until you backpedal until you're just trying to save face, as you're doing here.

That's not quid pro quo. What's the fancy latin term for turn about's fair play?
http://www.youtube.com/watch?v=teMlv3ripSM At any rate, I'm long over due for bed and I don't think I've actually accomplised much in the way of homework.

<snip>
Ah, you did read ahead, you just decided to bitch me out for no reason. :D

Not for no reason, no. It was done to make sure you understand what responses your misstatements elicit in others, in the hope that you will keep that mind going forward.

Where on earth did you get that?

It's quite easy for a doctor to creatively inform you that you're getting a placebo.

The way you're making it sound placebos are highly effective when in fact, there's many instances they aren't. It's hilarious that I'm the one accused of painting with a broad brush when you just spoke for the entire population of people with psychogenic illnesses.

A) You still have not answered my question. Are we or are we not permitted to alleviate our symptoms while we search for solutions to the root causes? Yes or no, and why?

B) And once again you are putting words in my mouth. Kindly show me where I said anything at all about the efficacy of placebos in general. Kindly show me how my argument has been anything but that, if a doctor believes a placebo will be the best way to help the patient, then it is ethical to prescribe one. Go quote me saying anything more than that about placebos and, in particular, anything about the efficacy of placebos. I'll wait.

Seriously, if you cannot argue without misrepresenting the other person's argument, I wonder how you can possibly judge truthfulness on the part of a doctor. If you only respond to your own words, rather that the other person's, how can you know anything about whether what they said was honest or not?

It's an interesting dilemma, to be sure. One the one hand, I don't know of many people who would disagree that purposely overcharging someone for medication is at the very least morally suspect. But on the other hand, there are demonstrable medical benefits TO overcharging. It's quite the quandry.Agreed.

Patients who know it's a placebo aren't given them. The value of the placebo is zero when you've undermined the point of them. They provide health benefits and those benefits give them a value. Incidentally, as you've noted, increasing their cost increasing that value. It's interesting that you'd like to undermine the health benefit they provide by quibbling over money.I realize that knowing something is a placebo makes it not work. This is why I was trying to figure out if doctors can give out the placebo at placebo prices but convince the patient that the placebo is a pharmaceutical. In some cases it would be difficult.
Money, especially when talking about the costs of medication is never a quibble.

The question, the true ethical question, is would a reasonable patient be willing to pay the cost of the pill and the visit in order to feel better and would that patient prefer to be prescribed a placebo if it made them feel better? If the answer is yes, there is no ethical dillemma. And if the patient is reasonable, I think there's no doubt that they actually DID pay the money and take the advice in order to feel better.It's hard to say. Some people might be fine either way, but others might be willing to pay for a pill if it's a pharmaceutical that makes them feel better but not be willing to pay for a placebo even if the placebo makes them feel better.

Well then perhaps this is where you and I diverge in our respective opinions of this discussion. I do not have a concern with deception being applied for the sake of the patient's health. I do have a problem with someone directly profitting from such deception. Someone is making a lot of extra money if a person is paying $20 a pill for a placebo that costs $0.25 a pill otherwise, simply because saying it costs more makes people heal themselves better. I don't agree with that. There have to be reasonable workarounds possible to allow the patient to still believe they're paying for an expensive brand-name drug without making them pay an obscene price for sugar pills.

I see where you're coming from, but I truly think one pays for the effect. Pills aren't that expensive to make in general (I've actually helped set up the manufacturing for several different medications for several different pharmaceuticals... you can write me privately if you'd like to talk about it. It was a company that gets hired to set up a line and produce one particular pill or another... a subcontractor.)

Pills just aren't that expensive. There is virtually no pressure to be efficient because they have huge margins. The only pressure is to make them pure and have good documentation per things like 21 CFR part 11.

I have a bit of issue with the size of the margin, but let's face it, people are paying for the effects, not the cost to manufacture. Otherwise, medication wouldn't be cheaper in Canada.

I see where you're coming from, but I truly think one pays for the effect. Pills aren't that expensive to make in general (I've actually helped set up the manufacturing for several different medications for several different pharmaceuticals... you can write me privately if you'd like to talk about it. It was a company that gets hired to set up a line and produce one particular pill or another... a subcontractor.)

Actually, my father is a mechanical engineer for a firm that designs and produces stamping and bottling lines for various clients.

Actually, my father is a mechanical engineer for a firm that designs and produces stamping and bottling lines for various clients.

Cool. I'd be interested to hear something about it. I'd also be happy to explain more to you about what I do. I find the pharma industry fascinating. I'm actually a little disappointed I'm not working in the industry right now.

We had a discussion, after reading what she wrote, I agreed with her. It's quite simple really.

I know you're attempting to piggyback on the respect we have for her in this arena, but if you think for a moment that Aerou doesn't think your argument isn't wildly uninformed, I suggest you ask her.

Obviously, I consider you a friend and I think you'd actually care not to come across like this. I genuinely suggest you ask her. Presenting claims like yours are dangerous.

I'm not still here to save face, I'm here for an argument.

You seem to be confusing yourself. Are you hear for a discussion or an argument? Hint: Come on, you have to laugh at that one.


Except I was talking about a patient who didn't know they had a placebo in that instance. In no way does that quote imply that a person must unknowinly take a placebo for it to be effective. I'd never ever say that.

Ah ha! I see what you did there. I guess I assumed we'd be talking about the patients like in the study. Those other than the 3% that were told it was a placebo.

Once again, you're confusing yourself. We're talking about the difference between those who know and those who don't. You've pretty clearly contradicted yourself there.



That's not quid pro quo. What's the fancy latin term for turn about's fair play?
http://www.youtube.com/watch?v=teMlv3ripSM At any rate, I'm long over due for bed and I don't think I've actually accomplised much in the way of homework.

The problem is that I'm not on my heals. You get me wrapped around the axle like you are right now and I'll hand it to you. I'm not because there is only one of us that putting forth claims that are unsupported and based on complete speculation that is contrary to evidence.

Not for no reason, no. It was done to make sure you understand what responses your misstatements elicit in others, in the hope that you will keep that mind going forward.
Only telling half the story had nothing at all to do with the misunderstanding at all. Nope.

A) You still have not answered my question. Are we or are we not permitted to alleviate our symptoms while we search for solutions to the root causes? Yes or no, and why?
Placebos work in only 30-40% of the cases. How fair is it for the 60% to not be given all the information to make an informed decision about their treatment? And for the love of God, stop saying "we". You aren't in that group by your own admission. You seem to be very keen on taking the choice away from the other 60%-70%.

B) And once again you are putting words in my mouth. Kindly show me where I said anything at all about the efficacy of placebos in general. Kindly show me how my argument has been anything but that, if a doctor believes a placebo will be the best way to help the patient, then it is ethical to prescribe one. Go quote me saying anything more than that about placebos and, in particular, anything about the efficacy of placebos. I'll wait.
I just told you how that last post of yours read. Notice I didn't say "this is what you said," I said "this is what it sounds like."

Seriously, if you cannot argue without misrepresenting the other person's argument, I wonder how you can possibly judge truthfulness on the part of a doctor. If you only respond to your own words, rather that the other person's, how can you know anything about whether what they said was honest or not?
Says the cherry picker.

I know you're attempting to piggyback on the respect we have for her in this arena, but if you think for a moment that Aerou doesn't think your argument isn't wildly uninformed, I suggest you ask her.
That's actually an interesting tactic I hadn't considered at all. No, you just seem content to lump my exchange with Aerou in with the exchange with you.

Obviously, I consider you a friend and I think you'd actually care not to come across like this. I genuinely suggest you ask her. Presenting claims like yours are dangerous.

I'll remember that when I see my patients on Monday. Oh wait....

I spam NSG and occasionally come here looking for an argument. No, I think I'm coming across exactly the way I intend.

You seem to be confusing yourself. Are you hear for a discussion or an argument? Hint: Come on, you have to laugh at that one.
I can get two different things from two different posters. I didn't know you were going to pop in and I was going to get the pleasure of an argument with you this evening, but you showed up so I ran with it.


Once again, you're confusing yourself. We're talking about the difference between those who know and those who don't. You've pretty clearly contradicted yourself there.
No, I'm just making the point that I'm not talking about people that know and never ever did. You seem to think that I was.





The problem is that I'm not on my heals. You get me wrapped around the axle like you are right now and I'll hand it to you. I'm not because there is only one of us that putting forth claims that are unsupported and based on complete speculation that is contrary to evidence.
Of course you will. That's what makes you a fantastic sparring partner. I can have a serious debate with you or just argue.

Only telling half the story had nothing at all to do with the misunderstanding at all. Nope.

She reasonably assumed that people wouldn't just fill in the holes with shit they made up. (Sorry, Mura, but I can't ever keep people's gender straight, so if you're male, just correct me.)


Of course you will. That's what makes you a fantastic sparring partner. I can have a serious debate with you or just argue.
Oh, good. Cuz I was just waiting for a flight, really. :tongue:

I see where you're coming from, but I truly think one pays for the effect. Pills aren't that expensive to make in general (I've actually helped set up the manufacturing for several different medications for several different pharmaceuticals... you can write me privately if you'd like to talk about it. It was a company that gets hired to set up a line and produce one particular pill or another... a subcontractor.)

Pills just aren't that expensive. There is virtually no pressure to be efficient because they have huge margins. The only pressure is to make them pure and have good documentation per things like 21 CFR part 11.

I have a bit of issue with the size of the margin, but let's face it, people are paying for the effects, not the cost to manufacture. Otherwise, medication wouldn't be cheaper in Canada.Supposedly part of the inflated cost is to make up some of the costs spent on research and development. Or some other such crap. But that's a different issue.

When I read the title I thought of Take Two Interactive.

Supposedly part of the inflated cost is to make up some of the costs spent on research and development. Or some other such crap. But that's a different issue.

Yeah, the research and development that universities do for them. Yup. That is an place where our system is CLEARLY broken.

Only telling half the story had nothing at all to do with the misunderstanding at all. Nope.
You would know about telling only half the story. You would also be the resident expert on promoting misunderstanding.


Placebos work in only 30-40% of the cases. How fair is it for the 60% to not be given all the information to make an informed decision about their treatment? And for the love of God, stop saying "we". You aren't in that group by your own admission. You seem to be very keen on taking the choice away from the other 60%-70%.


I just told you how that last post of yours read. Notice I didn't say "this is what you said," I said "this is what it sounds like."


Says the cherry picker.

And once again, you do not answer the question.

I have asked you point blank, "are people allowed to seek to alleviate their symptoms or not?" and three times you have dodged that point and tried to make it seems as if I am talking about something entirely different.

In other words, you misrepresent my argument while hiding from questions at the same time.

Jocabia may consider you a friend, but I don't know you and, at this point in the conversation, you have given me no reason to like, or even respect you. At this point, I am ready to call you intellectually dishonest. You have no answer to a straightforward question. You persistently misrepresent your opponent's argument. And now you resort to the trick of repeating my own criticisms of you back at me, without either (a) demonstrating how I've done what you accuse me of or (b) ceasing to do it yourself.

You're being a real piece of work on this topic, Snafturi, and you are not making yourself look good by your attacks on my comments.


She reasonably assumed that people wouldn't just fill in the holes with shit they made up. (Sorry, Mura, but I can't ever keep people's gender straight, so if you're male, just correct me.)
You're right.

You would know about telling only half the story. You would also be the resident expert on promoting misunderstanding.
Protip: Don't tell half the story then get angry when someone mistakes it for the entire story.



And once again, you do not answer the question.
And you never answered mine.

I have asked you point blank, "are people allowed to seek to alleviate their symptoms or not?" and three times you have dodged that point and tried to make it seems as if I am talking about something entirely different.
If they chose their treatment based on informed consent, then yes. Going to answer mine now?

In other words, you misrepresent my argument while hiding from questions at the same time.
And you attack my posts instead of actually responding to the content.

Jocabia may consider you a friend, but I don't know you and, at this point in the conversation, you have given me no reason to like, or even respect you.
Have I given you the impression I think of you as a "friend"? I apoligize if my posts have lead you to conclude that. l need no pseudo-relationships with online personas, nor do I clamor for their respect.

At this point, I am ready to call you intellectually dishonest. You have no answer to a straightforward question. You persistently misrepresent your opponent's argument. And now you resort to the trick of repeating my own criticisms of you back at me, without either (a) demonstrating how I've done what you accuse me of or (b) ceasing to do it yourself.
I ask you questions and you don't answer them. See, if you could actually demonstrate where you had, you'd have paraded out those quotes for me by now.

You're being a real piece of work on this topic, Snafturi, and you are not making yourself look good by your attacks on my comments.
Given how you've chosen to attack the poster and not the comments I find this comment hysterical.

Ahhhhh, my thread.

I think, perhaps that Snaf now has a better understanding of how the study worked and she is really only upset about a small portion of the doctors who responded to the survey.

I don't think that she believes that placebos are all bad, just that giving antibiotics as placebos are bad. Snaf is a proponent of therapy and, though I see how therapy can work for many patients, I believe that patients who have psychosomatic disorders are too often thrust into therapy which drags on for years.

Protip: Don't tell half the story then get angry when someone mistakes it for the entire story.

You didn't mistake it for the entire story. You filled in the gaps. That's not the same thing.

You: You said you were wearing purple.
Mura: I didn't say what I was wearing.
You: Well, then can you blame me for assuming you were wearing purple? If you don't want me to assume you're wearing purple then tell me you aren't.

Protip: Don't tell half the story then get angry when someone mistakes it for the entire story.
Protip: Read the thread. I told my whole story over a couple of posts and in the context of the posts I was referring/responding to.

Protip #2: If you're going to be condescending to someone, you should make an effort to actually know what you think you know better than them.


And you never answered mine.


If they chose their treatment based on informed consent, then yes. Going to answer mine now?
1) Wait, so unless they give informed consent to treatment they're NOT ALLOWED TO SEEK to alleviate their symptoms?

So, does that mean that people are not allowed to seek to alleviate back pain by seeing an acupuncturist, if they only do so because they've heard a few other people say it might help? That would not be an informed consent situation, so are you saying people should not be allowed to choose that way to try to alleviate their pain symptoms?

2) I did not see a question directed to me in your posts.


And you attack my posts instead of actually responding to the content.
Not true. I attacked their content as being false and misleading.

Have I given you the impression I think of you as a "friend"? I apoligize if my posts have lead you to conclude that. l need no pseudo-relationships with online personas, nor do I clamor for their respect.
Did I suggest that you did? But thanks for responding in a way that makes me feel better about dismissing you.

I ask you questions and you don't answer them. See, if you could actually demonstrate where you had, you'd have paraded out those quotes for me by now.
I have run out of polite responses, so I won't respond. I merely repeate that I did not see a question directed to me in your posts.

[Given how you've chosen to attack the poster and not the comments I find this comment hysterical.
More irony.

Ahhhhh, my thread.

I think, perhaps that Snaf now has a better understanding of how the study worked and she is really only upset about a small portion of the doctors who responded to the survey.

I don't think that she believes that placebos are all bad, just that giving antibiotics as placebos are bad. Snaf is a proponent of therapy and, though I see how therapy can work for many patients, I believe that patients who have psychosomatic disorders are too often thrust into therapy which drags on for years.
That is a perfect summary of my stance. Sorry making such a mess of your thread.:$ At least it looked like a reasonable side discussion took place while Jocabia and I filled the quarterly quota.

Protip: Read the thread. I told my whole story over a couple of posts and in the context of the posts I was referring/responding to.

Protip #2: If you're going to be condescending to someone, you should make an effort to actually know what you think you know better than them.
That would be true if I was the one who engaged you. You engaged me. Do you go back and reread an entire thread to ensure that someone responding to you gave you the whole story?



1) Wait, so unless they give informed consent to treatment they're NOT ALLOWED TO SEEK to alleviate their symptoms?
I'll refer to to the first time I answered your question. Seeing as how you think I gave no answer, I think it bears reposting.
It's quite easy for a doctor to creatively inform you that you're getting a placebo.

So, does that mean that people are not allowed to seek to alleviate back pain by seeing an acupuncturist, if they only do so because they've heard a few other people say it might help? That would not be an informed consent situation, so are you saying people should not be allowed to choose that way to try to alleviate their pain symptoms?
I think you're misunderstanding what I mean by informed consent. I'm talking about the legal definition within the realm of the physician-patient relationship. Informed consent simply means a pateint understands the treatment they are being given. If you call a vitamin, for example, a non-standard treatment, the patient can still render informed consent. It's true that it's a treatment, it's true that it's non-standard. A patient has all the information needed to either inquire more, accept or reject the treatment.


2) I did not see a question directed to me in your posts.
Placebos work in only 30-40% of the cases. How fair is it for the 60% to not be given all the information to make an informed decision about their treatment?



Not true. I attacked their content as being false and misleading.
No, we actually haven't gottent to that point due to the agressive nature of your posts. You've been more interested in attacking me than having a discussion.


Did I suggest that you did? But thanks for responding in a way that makes me feel better about dismissing you.
You brought up the friendship thing. So, unless you randomly put non-sequiters in your posts completely apropos of nothing it would stand to reason that there was confusion. You said, "Jocabia may consider you a friend, but I don't know you...." which is either a non-sequiter; or you reason that I think of you as a friend or I think that you think of me as one.


I have run out of polite responses, so I won't respond. I merely repeate that I did not see a question directed to me in your posts.
Well, I dug it out for you.

More irony.
If you don't want abrasive responses from me, don't blatantly ignore posts just so you can bitch at me. And I never attacked you as a person. Please, show me where I have.

You didn't mistake it for the entire story. You filled in the gaps. That's not the same thing.

You: You said you were wearing purple.
Mura: I didn't say what I was wearing.
You: Well, then can you blame me for assuming you were wearing purple? If you don't want me to assume you're wearing purple then tell me you aren't.

No, it's more like this.
X: I went shopping and bought food to make for dinner. We're having spaghetti.
Y: No, you didn't. You didn't buy the sauce.
X: I never said I did buy the sauce, you assumed I bought the sauce. On my way home I realized I didn't have it.
Y: When you said you bought spaghetti fixins' I thought that included the sauce. Okay, sorry I assumed.
X: How could you assume I bought the sauce from what I said? I just said I bought spaghetti fixins. You can make spaghetti without sauce. Why didn't you think of that? You say now that your sorry for assuming, but you shouldn't have made that assumption to begin with. How dare you.

No, it's more like this.
X: I went shopping and bought food to make for dinner. We're having spaghetti.
Y: No, you didn't. You didn't buy the sauce.
X: I never said I did buy the sauce, you assumed I bought the sauce. On my way home I realized I didn't have it.
Y: When you said you bought spaghetti fixins' I thought that included the sauce. Okay, sorry I assumed.
X: How could you assume I bought the sauce from what I said? I just said I bought spaghetti fixins. You can make spaghetti without sauce. Why didn't you think of that? You say now that your sorry for assuming, but you shouldn't have made that assumption to begin with. How dare you.

I'm confused, who's who? Do you know how to make spaghetti? I'm kinda hungry.

That is a perfect summary of my stance. Sorry making such a mess of your thread.:$ At least it looked like a reasonable side discussion took place while Jocabia and I filled the quarterly quota.


That would be true if I was the one who engaged you. You engaged me. Do you go back and reread an entire thread to ensure that someone responding to you gave you the whole story?
Yes, often.

I'll refer to to the first time I answered your question. Seeing as how you think I gave no answer, I think it bears reposting.



I think you're misunderstanding what I mean by informed consent. I'm talking about the legal definition within the realm of the physician-patient relationship. Informed consent simply means a pateint understands the treatment they are being given. If you call a vitamin, for example, a non-standard treatment, the patient can still render informed consent. It's true that it's a treatment, it's true that it's non-standard. A patient has all the information needed to either inquire more, accept or reject the treatment.
How does that answer my question about acupuncture and whether people are allowed to seek to alleviate symptoms?

Oh, that's right, it doesn't.


No, we actually haven't gottent to that point due to the agressive nature of your posts. You've been more interested in attacking me than having a discussion.



You brought up the friendship thing. So, unless you randomly put non-sequiters in your posts completely apropos of nothing it would stand to reason that there was confusion. You said, "Jocabia may consider you a friend, but I don't know you...." which is either a non-sequiter; or you reason that I think of you as a friend or I think that you think of me as one.
Do you don't like my manners. Well, that's okay, because I'm not trying to sell them to you.

Well, I dug it out for you.
Originally Posted by Snafturi
It's quite easy for a doctor to creatively inform you that you're getting a placebo.
How the fuck does this respond to the question I asked you? Answer: It doesn't.

If you don't want abrasive responses from me, don't blatantly ignore posts just so you can bitch at me. And I never attacked you as a person. Please, show me where I have.
You do it in the past three posts I've been responding to.

No, it's more like this.
X: I went shopping and bought food to make for dinner. We're having spaghetti.
Y: No, you didn't. You didn't buy the sauce.
X: I never said I did buy the sauce, you assumed I bought the sauce. On my way home I realized I didn't have it.
Y: When you said you bought spaghetti fixins' I thought that included the sauce. Okay, sorry I assumed.
X: How could you assume I bought the sauce from what I said? I just said I bought spaghetti fixins. You can make spaghetti without sauce. Why didn't you think of that? You say now that your sorry for assuming, but you shouldn't have made that assumption to begin with. How dare you.
Bullshit. And funniest part of your bullshit is that you include in your own example the same error I first called you out on -- putting words in the other person's mouth.

LINE 1 of the dialogue: You have me saying I bought dinner, and we're having spaghetti.

LINES 4 & 5: You've suddenly decided that I said I bought "spaghetti fixins". Only in your own opening scenario, the character representing me said no such thing.

So, tell us again how you're not just making shit up to claim that I said? Explain to us how this conflict is entirely of MY creation and has nothing to do with you creating confusion because you can't keep straight what people actually say and what they don't.

Also, since you could not be bothered to tell what question of yours I never answered, I went back and re-read the entire thread. I found only two questions from you to me, both of which were answered:

If it's not psychogenic and it's not biological, then what is it?
The above is a technical question, and was answered while I was offline by Jocabia and Aerou. You agreed with them as follows:
I am very sorry I gave the impression that I thought psychosomatic was anything but psychogenic. That wasn't my intent at all.
Are you going to blame me because, when I came back online and saw that, I did not repost the same answers that you had already accepted?

Your other question to me was:
And this is which somatoform disorder?
And Aerou pointed out to you that this is none of your business, a point to which you also agreed, as follows:
Of course not. She was the one who brought it up, I asked a question on her post. She's free to answer, not answer or make something up (not implying she would make something up).

So, are you now blaming me for not telling you something that you had already agreed I did not have to tell you?

Fine. You want answers to your questions:

1) Psychosomatic = psychogenic.

2) None of your damned business.

Happy now? Or did you have another question in mind, one that you did not actually post but still choose to blame me for not answering?

By the way, in post 66 you formally retracted your objections to my statements on the ground that you had misunderstood them but, after further discussion, found that you had no disagreement with me.

But in an exchange with Sdaeriji in post 65, you misrepresented my statements as follows:
She said her doctor told her he would have perscribed a "sugar pill" to her grandmother if she was seen for the same thing. That's discussing one patient with another and would indeed be a HIPAA violation.

I objected to that on the grounds that I had not said that, and reminded you of what I had actually said, and it was from that point on that you have been arguing with me about ME, not about the thread topic. If you find this exchange to be unpleasantly personal, you have no one to blame but yourself, as you are the one who decided to make a personal insult out being called out on a faulty statement.

You are the one hijacking this thread into a personal dispute over my manners, and you seem to be doing it for no reason other than you didn't like the style with which I corrected your mistake. Well, tough. If you don't like to be corrected, try not to make such obvious mistakes.

I'm confused, who's who? Do you know how to make spaghetti? I'm kinda hungry.
I make damned good spagetti. I make my sauce from scratch.
Yes, often.
Well I generally assume that people responding to a post of mine give me all the information I need to respond to them. Go figure.


How does that answer my question about acupuncture and whether people are allowed to seek to alleviate symptoms?


Oh, that's right, it doesn't.
Because we seem to be talking about two different things in regards to informed consent. I can't answer a question when we are talking past eachother. Let me try to expand on my first answer. An acupuncturist isn't an MD or an OD so I'm not seeing how informed consent applies in that instance. I'm completely unaware of how legal/ethical issues apply to acupuncturist, so it's hard for me to discuss informed consent in the context of their profession.

If you mean the MDs or ODs who also have certifications to practice acupuncture, than that would fall under informed consent in the manner I'm using it. In that case, if the doctor thought it was the best treatment, the same standards would have to apply in my mind that apply to any other procedure a doctor performs. S/he'd need to inform the patient of the risks/benifits and not decieve the patient.

Acupuncture is really something I can't even begin to comment on. I know there's been question in the past to it's effectiveness, but I don't know if the "final ruling" on what it is and isn't good for is in, so to speak.



Do you don't like my manners. Well, that's okay, because I'm not trying to sell them to you.
Hey, whatever. You seem to think I have some emotional investment in this. You post, I respond. Nothing more.



How the fuck does this respond to the question I asked you? Answer: It doesn't.
Yes. It does. If informed consent is rendered, I have no problem with it. I outlined in my answer how informed consent can be rendered. When you finally accepted the answer to your question it was the exact same thing, just rewritten.


You do it in the past three posts I've been responding to.
Oh, because you bring up some weirdness about friendships and I respond that no such friendship exists, I'm attacking you? No, no. Again, you brought it up. I gave you the three possible interpretations of your post I could come up with. If there's a misunderstanding, you're free to address it.

Read my responses again, I'm not attacking the poster.

Bullshit. And funniest part of your bullshit is that you include in your own example the same error I first called you out on -- putting words in the other person's mouth.

LINE 1 of the dialogue: You have me saying I bought dinner, and we're having spaghetti.

LINES 4 & 5: You've suddenly decided that I said I bought "spaghetti fixins". Only in your own opening scenario, the character representing me said no such thing.
No, the character just said they bought food for the other to make dinner and proclaimed the first character was going to make spagetti.

So, tell us again how you're not just making shit up to claim that I said? Explain to us how this conflict is entirely of MY creation and has nothing to do with you creating confusion because you can't keep straight what people actually say and what they don't.
Because you present a scenario where it seems like you've given all the relevant information, then you get mad because you didn't. I didn't read between any lines, I did the exact opposite. You said your doctor told you what he'd do for your grandma. I'm going on that information and that information alone.

Also, since you could not be bothered to tell what question of yours I never answered, I went back and re-read the entire thread. I found only two questions from you to me, both of which were answered:
I did dig it out for you. Shall I post it again? Okay:

Placebos work in only 30-40% of the cases. How fair is it for the 60% to not be given all the information to make an informed decision about their treatment?
^That was directly under the quote of yours that said "I see no question." I'm just going to snip the rest of the post pertaining to this issue. I can always respond if you'd like me to.


By the way, in post 66 you formally retracted your objections to my statements on the ground that you had misunderstood them but, after further discussion, found that you had no disagreement with me.
I mentioned that a few posts back, yes I'm aware. You were also aware of post 66, chose to blantantly ignore it just so you could bitch me out, then aknowledge the post in the same exchange. Which, whatever, you're free to behave as you wish. But I'm not going to extend common courtesy to someone who behaves in such a fashion.

But in an exchange with Sdaeriji in post 65, you misrepresented my statements as follows:
It was a summary of what you said. You said "That's what the doctor told me. He told me that because I was me -- a patient who routinely refused most medications. If he had given me a pill -- real or fake -- I would have tossed it and his advice together. If I had been my grandmother -- a patient who routinely refused non-medical treatments -- he would have included a sugar pill prescription as part of the advice in order to get her to use both."

Which was pretty close to my summary, "She said her doctor told her he would have perscribed a "sugar pill" to her grandmother if she was seen for the same thing. "

To make a longer summary; You said your doctor wouldn't have given you a pill because you dislike taking pills, but he would have given your grandmother a placebo.


I objected to that on the grounds that I had not said that, and reminded you of what I had actually said, and it was from that point on that you have been arguing with me about ME, not about the thread topic. If you find this exchange to be unpleasantly personal, you have no one to blame but yourself, as you are the one who decided to make a personal insult out being called out on a faulty statement.
Not a personal insult at all. I'm not going to delete something unless I completely screw up a post and others haven't responded to it yet. I don't think that's really conducive to the flow of the thread. After your clarification, I would have deated it if it hadn't already been a point of discussion by two other posters and so far back in a thread.

Firstly, you can't call someone out when they've already admitted fault. It ceases to be calling out and starts to be bitching out at that point.

You are the one hijacking this thread into a personal dispute over my manners, and you seem to be doing it for no reason other than you didn't like the style with which I corrected your mistake. Well, tough. If you don't like to be corrected, try not to make such obvious mistakes.
That's a very, very small part of our exchange. You're the one who insists on making it slowly bigger by ignoring the actual content of the posts for the explanations you demanded of me. I've been nice by giving you those explanations. If you like, I can go back through our last 5 exchanges and color code them so you can see for yourself. I'd do that now, but that will take up an awful amount of space.

I make damned good spagetti. I make my sauce from scratch.
So do I. And I make more than one kind of sauce and more than one kind of pasta dish.

<snip>

That's a very, very small part of our exchange. You're the one who insists on making it slowly bigger by ignoring the actual content of the posts for the explanations you demanded of me. I've been nice by giving you those explanations. If you like, I can go back through our last 5 exchanges and color code them so you can see for yourself. I'd do that now, but that will take up an awful amount of space.
I'm the one who just finished re-reading the entire thread. Your private war with me is approximately half of the exchange between you and me.

I will respond to the rest of your post later. I have a dinner to go to.

"Placebos work in only 30-40% of the cases. How fair is it for the 60% to not be given all the information to make an informed decision about their treatment?"

Why single out the other 60? The first 30-40 are -dependent- on not being given all the information, no?

So do I. And I make more than one kind of sauce and more than one kind of pasta dish.
Good for you. Not enough people do that. I make a variety of sauces as well, but I only put red sauce on spaghetti noodles. I save my white sauces for linguine and fettucine.


I'm the one who just finished re-reading the entire thread. Your private war with me is approximately half of the exchange between you and me.
I just responded to your posts, you're the one responsible for the ever increasing size. Like I said, I could have ignored all those. But then you would have criticized me for ignoring it, and besides, you posted it, I figured you wanted a response.

I will respond to the rest of your post later. I have a dinner to go to.
I'll probably be asleep by the time you get back, so you'll get my responses in the morning.

"Placebos work in only 30-40% of the cases. How fair is it for the 60% to not be given all the information to make an informed decision about their treatment?"

Why single out the other 60? The first 30-40 are -dependent- on not being given all the information, no?
The majority of doctors, including Aerou, inform their patients creatively. As Aerou pointed out, it's really a very small percentage of cases I take issue with. I misinterpreted the 18% (IIRC) of doctors that tell their patients the placebo is "medicine." I took it to mean the doctors were saying, "this is medicine designed to treat your condition." She gave an example of another way that exhange could have happened where they wouldn't have said that at all.

Again, a doctor doesn't have to say, "I'm giving you a placebo" or "I know you think Bengay is helping your muscle aches, but it's not. That's impossible." A doctor can say, "this is a medication not always used to treat your condition, but in your case, I think it might help."

I do roundly condemn the use of antibiotics as placebo, however. But as has been pointed out in this thread, and in the comments on the study, antibiotic perscribed when not indicated really are a seperate discussion.

But as has been pointed out in this thread, and in the comments on the study, antibiotic perscribed when not indicated really are a seperate discussion.

So....you're just having fun with Muravyets.

Sweet, catfight. :D

No, it's more like this.
X: I went shopping and bought food to make for dinner. We're having spaghetti.
Y: No, you didn't. You didn't buy the sauce.
X: I never said I did buy the sauce, you assumed I bought the sauce. On my way home I realized I didn't have it.
Y: When you said you bought spaghetti fixins' I thought that included the sauce. Okay, sorry I assumed.
X: How could you assume I bought the sauce from what I said? I just said I bought spaghetti fixins. You can make spaghetti without sauce. Why didn't you think of that? You say now that your sorry for assuming, but you shouldn't have made that assumption to begin with. How dare you.

Hehe. You confused yourself in your example.

The Y character suddenly decides that the person didn't buy sauce, then the person said they did, when they didn't. They never told anyone to make dinner and never said anything about fixing.

"I went shopping and bought food to make for dinner. We're having spaghetti."

Potential meanings:
A: I went shopping and picked up food. I bought a whole bunch of things including all the stuff for making spaghetti without sauce.
B: I went shopping and picked up food. I bought a whole bunch of things including all the stuff for making spaghetti with sauce.
C: I went shopping and bought a bunch of stuff include a spaghetti dish (already made.
D: I went shopping for food and I also made spaghetti for dinner.
E: I went shopping and bought some of the fixings for spaghetti that I was missing and then made spaghetti.

And several more...

It really depends on the context. Now you could assume one of the above if you like. Or you could only react to what was said and ask questions about the rest.

From the statement we know, that X went shopping and that spaghetti is for dinner. If there is not enough information one should ask for more info, not make it up.

Hey, remember when this thread was about the placebo effect and the ethics surrounding it? Back before you guys all started bickering like a bunch of children? Those sure were the days....

Perhaps they're discussing the use of spaghetti as a placebo?

"Patient n=155 gets a bowl of spaghetti, n=156 gets a little white sugar pill, n=157 gets the 'real deal'"

Hey, remember when this thread was about the placebo effect and the ethics surrounding it? Back before you guys all started bickering like a bunch of children? Those sure were the days....

Did you just find NSG?

<snip a bunch of stuff that is nothing but personal fighting with me, plus one dodging of a point yet again>

I did dig it out for you. Shall I post it again? Okay:
Originally Posted by Snafturi
Placebos work in only 30-40% of the cases. How fair is it for the 60% to not be given all the information to make an informed decision about their treatment?

^That was directly under the quote of yours that said "I see no question." I'm just going to snip the rest of the post pertaining to this issue. I can always respond if you'd like me to.

<snip a whole bunch of other stuff that is nothing but personal sniping at me>
Oh, THAT question? That was not the one you told me to go look for, but whatever. Here's your answer <ahem>:

Your question is bullshit, Snafturi, for the following reasons:

1) It has already been established, and agreed to by you, that FULL disclosure of absolutely everything about a drug (such as its chemical makeup, etc) is not required for informed consent by the patient. Therefore, you have no basis for assuming that the doctor has not given the patient enough information to give informed consent to a prescription that is for a placebo. By acknowledging the threshold of what it takes to allow informed consent, you yourself acknowledge that "This pill should alleviate your symptoms. It has no significant side effects. Follow these dosage instructions and call me in a few days to discuss how you are feeling. We can always adjust your medication later, if need be" IS telling the patient everything they need to know.

2) What possible difference can a 60% failure rate make? Many active drugs also fail to have any effect on a percentage of patients. Does that mean that, if a doctor prescribes such a drug, they are lying to their patients? Or does it mean that they record the lack of effect and try another drug? And that differs from a placebo prescription how, exactly?

3) So, in direct response, there is no unfairness because you have not established that the doctor has not given the 60% full information required for informed consent.

The rest of this post, and the whole of the previous post, contain only sniping at me and nothing that is on topic. For Sdaeriji's sake, I choose to ignore that content.

Perhaps they're discussing the use of spaghetti as a placebo?

"Patient n=155 gets a bowl of spaghetti, n=156 gets a little white sugar pill, n=157 gets the 'real deal'"
We've secretly replace patient n=156's spaghetti with a little white pill. Let's see if s/he notices.

Oh, THAT question? That was not the one you told me to go look for, but whatever. Here's your answer <ahem>:
I didn't tell you to go look for anything. I treposted the question for you. I didn't do it to be snarky, rude, or anything else, I posted it because you missed it and I was trying to save you from having to go read through a thread. I posted it a second time because you missed it the first time and it's a heck of a lot easier to get the thread back on track when one poster isn't sent on an easter egg hunt.

Your question is bullshit, Snafturi, for the following reasons:

1) It has already been established, and agreed to by you, that FULL disclosure of absolutely everything about a drug (such as its chemical makeup, etc) is not required for informed consent by the patient. Therefore, you have no basis for assuming that the doctor has not given the patient enough information to give informed consent to a prescription that is for a placebo. By acknowledging the threshold of what it takes to allow informed consent, you yourself acknowledge that "This pill should alleviate your symptoms. It has no significant side effects. Follow these dosage instructions and call me in a few days to discuss how you are feeling. We can always adjust your medication later, if need be" IS telling the patient everything they need to know.
And has already been established looooong prior in the thread, the doctors that aren't decieving their patients aren't the ones I have issue with. I've been saying that since my 3rd or 4th post in this thread. You've kept on asking if someone is "allowed" to seek treatment. People are allowed to swallow glass, throw tiki idols into volcanos, or dance around under the moonlight. I've never once said that someone wasn't "allowed" to anything. I'm talking about the physician's responsibility to be honest with his or her patient.

2) What possible difference can a 60% failure rate make? Many active drugs also fail to have any effect on a percentage of patients. Does that mean that, if a doctor prescribes such a drug, they are lying to their patients? Or does it mean that they record the lack of effect and try another drug? And that differs from a placebo prescription how, exactly?
There are drugs out there with a 60% failure rate? Geesh, no wonder people are pissed off at pharma companies.

If a doctor perscribes any drug, be it placebo or otherwise, and they tell their patient that it WILL work, they are lying. To my knowledge, there's no drug that is 100% effective, and even if there were, doctors aren't always 100% accurate with their diagnoses. To say "this will help" isn't accurate. To say "this could help, this should help, this drug is highly effective. let's try this" is accurate. And to my knowledge, this is how the vast majority of doctors present this information to their patients.

3) So, in direct response, there is no unfairness because you have not established that the doctor has not given the 60% full information required for informed consent.
And again, like I've been saying since post 65, it's not the doctors that explain the treatment to their patient (and no, not as in "this is a placebo and the only results are ones in your head") that I take issue with. It's the group, that I mistakenly attributed the 13% (IIRC) number to that I take issue with. As long as the words "this is a medication designed to treat the condition you are suffering from"(or something akin to that) I take no issue.

The rest of this post, and the whole of the previous post, contain only sniping at me and nothing that is on topic. For Sdaeriji's sake, I choose to ignore that content.
But what about Dina's sake? He's clearly enjoying this. Or maybe he's just waiting for us to settle this with a cook off.

We've secretly replace patient n=156's spaghetti with a little white pill. Let's see if s/he notices.
No, that's not what's happening with a placebo prescription. You persist in imagining that doctors are choosing to prescribe placebos even for conditions for which an active drug is warranted. There is no evidence that this is an issue in medicine. You have been told repeatedly by other posters that this is not what we are talking about when we talk about doctors prescribing placebos. You have been told repeatedly that we think that, if a doctor does do that, then that would be unethical and, possibly, a case of malpractice. And you yourself have, at various times, have acknowledged that this is our position and have agreed with us. Yet you continue to argue as if we have been defending malpractice.

It's very frustrating.

I didn't tell you to go look for anything. I treposted the question for you. I didn't do it to be snarky, rude, or anything else, I posted it because you missed it and I was trying to save you from having to go read through a thread. I posted it a second time because you missed it the first time and it's a heck of a lot easier to get the thread back on track when one poster isn't sent on an easter egg hunt.
Mm-hm.

And has already been established looooong prior in the thread, the doctors that aren't decieving their patients aren't the ones I have issue with. I've been saying that since my 3rd or 4th post in this thread. You've kept on asking if someone is "allowed" to seek treatment. People are allowed to swallow glass, throw tiki idols into volcanos, or dance around under the moonlight. I've never once said that someone wasn't "allowed" to anything. I'm talking about the physician's responsibility to be honest with his or her patient.
See my first paragraph above, and please consider: If you've been saying this all along, then why do you keep arguing with us after every time we tell you we've been saying the same thing?

There are drugs out there with a 60% failure rate? Geesh, no wonder people are pissed off at pharma companies.

If a doctor perscribes any drug, be it placebo or otherwise, and they tell their patient that it WILL work, they are lying. To my knowledge, there's no drug that is 100% effective, and even if there were, doctors aren't always 100% accurate with their diagnoses. To say "this will help" isn't accurate. To say "this could help, this should help, this drug is highly effective. let's try this" is accurate. And to my knowledge, this is how the vast majority of doctors present this information to their patients.
I'm sure of it, too. I was not quoting a physician in my post. And your point is?

And again, like I've been saying since post 65, it's not the doctors that explain the treatment to their patient (and no, not as in "this is a placebo and the only results are ones in your head") that I take issue with. It's the group, that I mistakenly attributed the 13% (IIRC) number to that I take issue with. As long as the words "this is a medication designed to treat the condition you are suffering from"(or something akin to that) I take no issue.
So, in other words, you take issue with malpractice. Well, good news! So does everyone in this thread and the AMA.

But what about Dina's sake? He's clearly enjoying this. Or maybe he's just waiting for us to settle this with a cook off.

He's just hungry, and since it was your metaphor, you get to do the cooking for him.

No, that's not what's happening with a placebo prescription. You persist in imagining that doctors are choosing to prescribe placebos even for conditions for which an active drug is warranted. There is no evidence that this is an issue in medicine. You have been told repeatedly by other posters that this is not what we are talking about when we talk about doctors prescribing placebos. You have been told repeatedly that we think that, if a doctor does do that, then that would be unethical and, possibly, a case of malpractice. And you yourself have, at various times, have acknowledged that this is our position and have agreed with us. Yet you continue to argue as if we have been defending malpractice.

It's very frustrating.
Uh, that was 100% a joke. Haven't you seen those commercials back in the 80's?


Mm-hm.


See my first paragraph above, and please consider: If you've been saying this all along, then why do you keep arguing with us after every time we tell you we've been saying the same thing?
Only you. Haven't argued with Aerou, Jocabia and I ceased to actually argue about anything thread related forever and a half ago. And you can look at the post if you don't believe me. I reapeated it over 9000 times.


I'm sure of it, too. I was not quoting a physician in my post. And your point is?
I was quoting a physician?


So, in other words, you take issue with malpractice. Well, good news! So does everyone in this thread and the AMA.
So there's no disagreement then.



He's just hungry, and since it was your metaphor, you get to do the cooking for him.
He'll have to settle for spaghetti with red sauce then.

Uh, that was 100% a joke. Haven't you seen those commercials back in the 80's?
I saw lots of commercials in the 80s. Poufed hair, giant shoulder pads, and pants that were fatter on top than at the ankles are all I remember of them.

Only you. Haven't argued with Aerou, Jocabia and I ceased to actually argue about anything thread related forever and a half ago. And you can look at the post if you don't believe me. I reapeated it over 9000 times.
That's an exaggeration. And if you've only been busting my chops, kindly cut it out. It has gotten boring.


I was quoting a physician?
Did I say you were?

No, I didn't.


So there's no disagreement then.
Good. Fine. Finally.


He'll have to settle for spaghetti with red sauce then.
Do you mean tomato sauce, or are you just going to pour paint over the pasta?

I make damned good spagetti. I make my sauce from scratch.


So do I. And I make more than one kind of sauce and more than one kind of pasta dish.


Good for you. Not enough people do that. I make a variety of sauces as well, but I only put red sauce on spaghetti noodles. I save my white sauces for linguine and fettucine.


This argument should be settled by a cook-off:rolleyes: