Placebos: Threat or Menace?
So there's an interesting dilemma been brewing in medicine for some while now, concerning placebos and the use of the placebo effect in clinical practice. A recent study indicates that the strength of the placebo effect can be augmented by "a supportive psychosocial context". Now, the study is for patients with irritable bowel syndrome, a syndrome with many symptoms, and a fairly clean definition, but no pathology per se, and no "bad outcome" in the sense of death or serious malfunction of body part; you don't get malnourished, you will not die of IBS, it's not contagious, etc. It is, as a neurologist colleague of mine phrases it, a disease with a lot of "functional augmentation", meaning that psychosocial factors play a larger than usual role in the disease process.
It has been a tenet of medical practice since before I was in school, though (no, Osler was not one of my classmates) that giving placebos violated the trust of the physician. You were giving a 'drug' you knew didn't work; in essence, you were lying to the patient. It's fine to be confident in your treatments and convey that to the patient, but another thing to be confident while giving something which isn't a drug and not telling the patient.
So, what do you think?
Poll Placebos: Threat or Menace?
Honestly, I'm a bit torn about this. I don't like the idea of lying to the patient; it smacks of a return to the paternalism of old, and I doubt we need that. But on the other hand, dammit, they seem to work, especially for diseases we have little else for, like IBS. There is no "scientifically effective treatment" for IBS. Treatment is supportive and dietary-eat high fiber, learn what sets you off symptom-wise and avoid it, and very limited pain medication when the disease flares up.
So right now I'm in the "study more" camp. For instance, does the placebo still work if you tell the patient "The effects of this medication are primarily psychological, it's not an active drug"? If it does, win! Do that; no lying to the patient, and still getting the benefit. If not, back to the old drawing board. But it's a nice problem.
It has been a tenet of medical practice since before I was in school, though (no, Osler was not one of my classmates) that giving placebos violated the trust of the physician. You were giving a 'drug' you knew didn't work; in essence, you were lying to the patient. It's fine to be confident in your treatments and convey that to the patient, but another thing to be confident while giving something which isn't a drug and not telling the patient.
So, what do you think?
Poll Placebos: Threat or Menace?
Honestly, I'm a bit torn about this. I don't like the idea of lying to the patient; it smacks of a return to the paternalism of old, and I doubt we need that. But on the other hand, dammit, they seem to work, especially for diseases we have little else for, like IBS. There is no "scientifically effective treatment" for IBS. Treatment is supportive and dietary-eat high fiber, learn what sets you off symptom-wise and avoid it, and very limited pain medication when the disease flares up.
So right now I'm in the "study more" camp. For instance, does the placebo still work if you tell the patient "The effects of this medication are primarily psychological, it's not an active drug"? If it does, win! Do that; no lying to the patient, and still getting the benefit. If not, back to the old drawing board. But it's a nice problem.