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Guess Which Country?
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Guess which country's national medical association, relying on findings from a new study, has advised its doctors to increase the use of placebos for patients complaining of asthma, chronic inflammatory problems, mild depression, chronic pain, and other such diseases with "subjective components." Under this country's medical ethics standards, doctors are not required to tell patients they are receiving placebos.

The link to the news story which reveals the answer follows: BUT TRY AND GUESS BEFORE CLICKING THIS LINK.

Just sayin.

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Just sayin what? You can't "just sayin" without sayin.

Hell No ma'am. No way am I go going there at all!

One is forced to wonder how much the objection to placebos is a principled objection to psychosomatic cures, and how much is because the pharmaceutical companies have a deep, deep interest in not having their pills discredited. The fact that placebos really do appear to work in some cases suggests we don't need to dope up the population on expensive pills, but that's not the answer that pharmaceutical companies want to hear (or for that matter, the doctors who get kickbacks from drug companies.)

I think the "right" thing to have done would be for the medical association to clarify when placebos may be prescribed, but leave it up to the doctor whether to do so or not.

I agree with everything you said and implied about the efficacy of placebos and the financial interest of those who prescribe and produce pharmaceuticals. But what I find troubling is the extreme paternalism being advocated here, the idea that doctors can willfully deceive their patients, or be any less than 100% forthcoming with them. And this goes double in a country with a still smoldering history of unethical and downright evil medical experimentation.

I realize the whole concept of placebo is based on deception, and that's why (in the U.S.) you must knowingly and competently consent to be in a medical study which might involve you getting them. To take away that consent requirement and allow, even encourage, placebos to be used in everyday practice is Bad Medicine.

Unfortunately, it's also bad practice to prescribe actual drugs to a patient that has nothing physically wrong. If the patient could be "cured" by the ritual of pill-taking even if it's just a sugar pill, should the doctor give him a placebo? Or should the doctor just leave the patient in pain and tell him it's "all in his head"? I don't know -- it seems like several ethically messy options when treating a patient who has something psychosomatic. That's why I think the medical association should issue clear guidelines on when/how a placebo might be recommended (if at all). A patient with a associated doctor would then have knowledge of if they might get a placebo. I agree deception of patients is never appropriate, though I don't know if deception is required -- even with chemically active drugs, most of the time doctors basically say "take this pill, it might help" which is a true statement for placebos. Moreover, for some maladies, it may be that a placebo really is the best cure, so it'd be foolish to ignore it as a treatment option.

I'm not well versed in medical ethics, so it's not clear to me what the 'best practices' should be. But I am troubled by the widespread chemical dependence that modern healthcare seems to promote (and the associated conflict between wellness and profits for pharma companies.) If there are conditions with effective treatment options that don't require drugs, I would think those treatments should be on the table, but I agree patients need to consent to their treatments. I think that's ethically reconcilable with placebos, though it is a tougher case than say, penicillin.

How about this for a reconciliation: if a doctor misprescribes a placebo and someone gets more sick, the doctor loses their license to practice medication.

I had a doctor tell me my chest pains were all in my head and then I almost died. I had a pocket of fluid in my heart the size of a tangerine *and* a staph infection of the blood. No placebo in the world would've put a dent in those things, but I'm sure the doctor who told me my problems would be better solved by a psychiatrist would've happily prescribed them to me.

I don't trust doctors enough to give them that power. Besides that in the US it's thankfully against the law for a physician to lie to his patients about the medications their prescribed, HIPAA states that medical records actually belong *to the patient* and it is illegal to deny a patient access/copies of their full medical history.

Everyone I know knows someone with a horror story like this, or has one themselves. Yet everyday calls for "tort reform" get louder. It's mind-boggling.

My actual psychiatrist was so pissed off at my old rheumatologist that she told me she'd help me make a formal complaint to the medical board. I wouldn't go as far as suing him just because that's not my thing. But that's before I had insurance. At that facility, there were feces on the walls in the bathroom and the toilet paper was sitting on the (wet) sink.

Nowadays, I merely mention I have chest pains and I'm referred to cardiology *the same day*.

I think if a doctor misprescribes anything and a patient gets more sick, the doctor's license should probably be revoked. Its the MD's job to figure out what's wrong and propose a solution based on medical knowledge and experience. Absent an unknown allergy, the doctor should know what a drug can do and its side effects. If there's a objectively diagnosable problem in a patient and the doctor misses or ignores it, choosing some pointless treatment (placebo or otherwise), I'd consider that a dereliction of duty. I'm glad you got an accurate diagnosis, that sounds terrible.

Then there wouldn't be any doctors left. As even the suggestion of using placebos shows, medicine is a *soft* science.

The most interesting part of this, to me anyhow, is how three different Western democracies approach the use of placebos. In Germany, it’s accepted that doctors can lie to patients and prescribe them sugar pills if, in the doctor’s sole discretion, the problem is judged to be in a patient’s head. In Britain, the idea is abhorrent, a clear violation of their concept of medical ethics. The U.S. is somewhere in the middle, acknowledging the value of placebos, but requiring a degree of consent and transparency. Out of those three countries, the one with the least regard for an individual’s autonomy over his or her body in this regard is also the one with a bad record for crimes against humanity. And it would be as simple as that, were it not for the fact that the U.S. and Britain have committed their own share of crimes against humanity in the medical context (e.g., Tuskegee syphilis experiments; nuclear and chemical weapons tests on unsuspecting soldiers and civilians, etc.).

You could further test the hypothesis by checking the medical practices of Japan, which had a pretty terrifying human experimentation program during WWII. I have no idea how placebos are treated there.

However, I think something to consider is the dichotomy with which a nation might regard the medical rights of its (privileged) citizens versus those that it considers "others". The examples here: Germany and the Jewish population, Japan and the Chinese, US and black sharecroppers or Puerto Rican women. Several other countries have had eugenics programs of some sort, including forced sterilization, which inevitably focused on already marginalized groups. Given that many countries have had some appalling medical practices in the past, I'm not sure there will be a straightforward correlation with current practices. That said, there does appear to be some connection to the strength of national identity (Nazi Germany & Imperial Japan both topping out in nationalism and racial exceptionalism.) Once you have a popular deference to authority, it would be easy for doctors to operate without much oversight.

What a great resource!


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