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Is your doctor prescribing sugar pills?

SteveGrenard

Philosopher
S
Joined
Oct 6, 2002
Messages
5,528
In this survey of 231 physicians in Chicagoland some 45% responded that they have prescribed placebos. This is much higher than I would've expected. With so many patients adept today on the internet drug information sources I am wondering how so many
actually "get away" with this practice. Today, would most of us take a prescription drug given to us by our doctor with promise of a cure without knowing exactly what it is and "looking it up"??

In a study published this week in the Journal of General Internal Medicine, a student-and-professor team at the University of Chicago surveyed 466 faculty physicians at Chicago-area medical schools. Almost half of the 231 respondents — 45% — said they had prescribed placebos in regular clinical practice and, of those, just over half had prescribed them in the previous year. Among the reasons the doctors gave: to calm a patient down, to respond to demands for medication that the doctor felt was unnecessary, or simply to do something after all other clinical treatment options had failed.
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http://www.time.com/time/health/article/0,8599,1700079,00.html
 
SteveGrenard said:
In this survey of 231 physicians in Chicagoland some 45% responded that they have prescribed placebos. This is much higher than I would've expected. With so many patients adept today on the internet drug information sources I am wondering how so many
actually "get away" with this practice. Today, would most of us take a prescription drug given to us by our doctor with promise of a cure without knowing exactly what it is and "looking it up"??
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You're confusing "placebo" with "sugar pill."

Most placebos that are prescribed are vitamin pills or something similar, and they're prescribed only when the patient won't shut the hell up and needs to be given something harmless to get them out of your office. People like that generally don't look up the drug information sources, and wouldn't recognize the clinical ineffectiveness of "niacin" for their condition if they did.

And, yes, I do take drugs without looking them up. I'm taking such a drug now. I had a boo-boo and the doctor prescribed antibiotic pills for it. Specifically, he prescribed Keflex, and the pharmacist gave me Cephalexin, which he (pharma) said was the equivalent generic. No, I didn't bother to look up if what he's really giving me is arsenic or something. If I didn't trust my doctor to get the scrip right, I'd use a different doctor. But I don't have three years to invest in medical school to double-check his work.
 
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I'd like to get a grasp on the actual numbers. It looks like 22% have 'prescribed' a placebo in the past year. Once? Twice? Maybe out of 5,000 visits? Let's say once out of 5,000 visits, one in five doctors, means patients are getting a placebo 1/25,000 visits.

Now, that's a minimum, of course, but without actual numbers, I don't know how to interpret this report.
 
I think this should be ENCOURAGED. Especially if this keeps people from demanding antibiotics they do not need.

Because, its is the deadly truth that we are entering the POST-antibiotic era faster each and every day. In 30 years there will be very, very few bacterial infections that will respond to antibiotics, and many infectious diseases will either have no practical treatment, or you will have to EXCIZE the infected tissues. "Nothing cures like cold steel." will again be the motto of the infectious diseases specialty.

VERY sad, really.
 
Sorry Sugar-Pill is an old fashioned way of saying not a real pill....er, a placebo. If a doctor gives someone a vitamin instead of an antibiotic and tells 'em he's giving them an antibiotic he is still giving them a real pill. In high priced placebo controlled drug studies they make special pills that are totally inert --- they sure don't give vitamins but I appreciate your take on the use of placebos in clinical situations. BTW if a doctor gives straight niacin he is apt to get a complaint in short order that it is causing hot flashes. It would be a bad choice.
 
SteveGrenard said:
Sorry Sugar-Pill is an old fashioned way of saying not a real pill....er, a placebo. If a doctor gives someone a vitamin instead of an antibiotic and tells 'em he's giving them an antibiotic he is still giving them a real pill. In high priced placebo controlled drug studies they make special pills that are totally inert --- they sure don't give vitamins but I appreciate your take on the use of placebos in clinical situations. BTW if a doctor gives straight niacin he is apt to get a complaint in short order that it is causing hot flashes. It would be a bad choice.
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Ahem to that! Large doses of niacin are not much fun.
 
jsfisher said:
Ahem to that! Large doses of niacin are not much fun.
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Niacin is available in a sustained-release form which, for most people, eliminates the hot flashes. Niacin is, in high doses, a potent agent for reducing HDL cholesterol, but may have and adverse effect on the liver for some people - do not use it without consulting your physician. :boxedin:
 
You know, it doesn't have to be sugar.

Sometimes people come in wanting morphine, or other addictive substances, claiming they are in "pain" and get really demanding. Someone comes in and gives them a shot. They don't say what it is, the patient *assumes* it is morphine, and calms down. Until the next time, these sorts of people show up on a regular basis - every other day or so, sometimes more often.

Not every patient is honest with the physician. Some of these people are actually simply addicted to pain meds or whatever. Giving them an addictive substance is irresponsible. Giving them an actual pain medication, one that is not addictive, is a great alternative. Now, if it is not morphine (or whatever they demand) does that make it a placebo?
 
jsfisher said:
Ahem to that! Large doses of niacin are not much fun.
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So give them small doses. It's available in 10mg pills. Take one of those a day and call me when you calm down. If you decide to take a bottle of 50 at once and then you hot flash, it's your own fault.
 
SteveGrenard said:
Sorry Sugar-Pill is an old fashioned way of saying not a real pill....er, a placebo. If a doctor gives someone a vitamin instead of an antibiotic and tells 'em he's giving them an antibiotic he is still giving them a real pill.
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Er, no. Most definitions of "placebo" are much broader -- for example "Placebo medication commonly operates through the administration of a substance, either pharmacologically active (a drug) or inert. The net effect of a given drug is thus the sum of the drug's pharmacological effects and the placebo effect associated with the act of treatment." "Placebos are generally control treatments with a similar appearance to the study treatments but without their specific activity." Et cetera, et cetera.

The point, of course, is that the vitamin has no useful specific action -- it will do nothing for the specific complaint, and the doctor knows it. That makes it a placebo, medically speaking.
 
drkitten said:
So give them small doses. It's available in 10mg pills. Take one of those a day and call me when you calm down. If you decide to take a bottle of 50 at once and then you hot flash, it's your own fault.
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Sure, I understand all that. It is just having been on the legitimate end of a Niacin prescription, I can attest to the discomfort the prescription caused.
 
BenBurch said:
I think this should be ENCOURAGED. Especially if this keeps people from demanding antibiotics they do not need.
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I think this is contradictory. Providing placebo will not discourage people from demanding antibiotics when contraindicated: it is encouraging it by capitulating.

I suggest educating the public about when antibiotics are contraindicated.

I'll recommend openness over deception any day.
 
blutoski said:
I think this is contradictory. Providing placebo will not discourage people from demanding antibiotics when contraindicated: it is encouraging it by capitulating.

I suggest educating the public about when antibiotics are contraindicated.

I'll recommend openness over deception any day.
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I quite agree. Stupid should not be encouraged.
 
Well, here is the deal; I simply do not believe the average patient has the patience or the intelligence to understand the issue of why Amoxicillin is not what they want for the sever cold they have. Given that, a physician will lose that patient and she will go to another doc who is less scrupulous about giving out needless antibiotics.
 
BenBurch said:
Well, here is the deal; I simply do not believe the average patient has the patience or the intelligence to understand the issue of why Amoxicillin is not what they want for the sever cold they have. Given that, a physician will lose that patient and she will go to another doc who is less scrupulous about giving out needless antibiotics.
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I understand the sentiment, but I do not agree. In the not to extreme, that would lead to an intellectual elite, caring for the poor stupid downtrodden who don't know any better.
 
jsfisher said:
I understand the sentiment, but I do not agree. In the not to extreme, that would lead to an intellectual elite, caring for the poor stupid downtrodden who don't know any better.
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My understanding is that "average" patients are not given placebos. They're far from routine (only 22% of the survey have given them in the past year, and fewer than half have ever given them).

I'm willing to believe there really is a group of patients out there so stupid that they must be protected from themselves, by deception if necessary. I do not think that this implies the existence of an intellectual elite as much as an intellectual, er, un-elite. In particular, doctor-shoppers are actively harmful to my health (they're part of the reason we're entering the post-antibiotic age) and I see no reason to allow them free rein to do so. I won't let them drive drunk and risk killing me -- why should I let them drive on unnecessary antibiotics and risk killing me through drug-resistant TB?
 
drkitten said:
My understanding is that "average" patients are not given placebos. They're far from routine (only 22% of the survey have given them in the past year, and fewer than half have ever given them).

I'm willing to believe there really is a group of patients out there so stupid that they must be protected from themselves, by deception if necessary. I do not think that this implies the existence of an intellectual elite as much as an intellectual, er, un-elite. In particular, doctor-shoppers are actively harmful to my health (they're part of the reason we're entering the post-antibiotic age) and I see no reason to allow them free rein to do so. I won't let them drive drunk and risk killing me -- why should I let them drive on unnecessary antibiotics and risk killing me through drug-resistant TB?
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If you intervene with potential drunk drivers, do you actually do so with dishonesty? If patients can doctor-shop to get the medical attention they think they deserve, then is the problem with the patient or with the doctor?
 
jsfisher said:
If you intervene with potential drunk drivers, do you actually do so with dishonesty? If patients can doctor-shop to get the medical attention they think they deserve, then is the problem with the patient or with the doctor?
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Yes. Just as when a burglar sells his goods to a fence, the problem is with both of them, and I see no reason not to treat both with equal contempt.
 
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