Placebo

[Chevalier]

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[splik]

It is unethical to give patients placebos without their knowledge. It does not happen routinely in the US and in fact would be grounds for disciplinary action. It is considered fundamentally dishonest and a deception. Interesting, some studies show placebos still work (though to a lesser extent) when patients know they are receiving a placebo.

FYI placebos are very powerful and if someone responds to it, it doesn't mean they are lying at all. Anxiety responds to placebo better than medications. Pain, even severe pain, can respond wonderfully to placebo. Beecher's studies found even 40%of patients with post-operative pain respond to placebos, and we know the placebo effect in pain can be blocked by opioid antagonists like naltrexone which is to say placebos still have powerful effects in the brain.

 

[wolfvgang22]

Yep, you would get in trouble for prescribing a placebo in modern times in the U.S. But it was common many years ago. Sometimes I wish I could prescribe drug seeking patients a placebo, but it wouldn't be the healthiest long term solution.

 

[Chevalier]

Yeah, I kinda felt that it was unethical.

But I've had patients that just straight up demand unneeded medication. Last month a manic patient just came straight up to me and told me to "give her a benzo because she was anxious" but clinically she was fine. Another patient asked for analgesics every hour for different types of pain. Sometimes it would be a headache, then a toothache 2 hours later, then her back or her hand hurt, etc. It's with these patients that we usually give placebo to, and it works. I've tried talking to them or just giving them relaxation techniques and whatnot but they always come back for meds.

The above cases are from the inpatient unit.

 

[birchswing]

I work at a psych only hospital and we often use placebo.

Our placebo capsules are filled with flour or sugar. We use them when a patient claims that he/she is anxious or has some sort of pain, but clinically you can tell that the patient is lying. Most patients swear that they work and come back for more every so often. We give them to avoid the over-usage of pain killers and anxiolitics when they aren't needed. If the patient is clinically anxious or in pain we obviously use the correct medication and we also switch to real meds when we notice that the placebo isn't working.

How ethical is this? and is this a common practice in the US?

If this isn't a joke, I'm not sure why you'd have to ask this.

You're asking if a person has a right to know what they are putting in their bodies. Yes, of course they do.

But the way this post was written leads me to believe it was not written by a physician.

"we also switch to real meds when we notice that the placebo isn't working."

So the patient then believes a higher dosage was needed—that's helpful.

But again, this seems fake to me.

Edit: If it's not fake, IMO you should report and IMO not reporting would be the same level of culpability as anyone committing this fraud.

 

[Chevalier]

It's not a joke. Psychiatry is handled way differently where I live than in the US. For starters patients are usually involuntarily admitted by family members. They have no say on their treatment and recieve oral/IM medication against their will. The placebo situation I brought up is common practice here. I recently graduated from med-school and wish to pursue a psych residency in the US, i'm just trying to grasp the differences between the systems and what we're doing wrongfully here. It's not like I'm the one inventing all this, it's the protocol of the hospital I work at. I'm just questioning the system.

 

[erg923]

I work at a psych only hospital and we often use placebo.

Our placebo capsules are filled with flour or sugar. We use them when a patient claims that he/she is anxious or has some sort of pain, but clinically you can tell that the patient is lying. Most patients swear that they work and come back for more every so often. We give them to avoid the over-usage of pain killers and anxiolitics when they aren't needed. If the patient is clinically anxious or in pain we obviously use the correct medication and we also switch to real meds when we notice that the placebo isn't working.

How ethical is this? and is this a common practice in the US?

That ****ed up if there is lack of actual treatment or addressing of their concerns. And of course, thats not really "psychiatry" (or the practice of medicine in anyway), right?

 

[birchswing]

It's not a joke. Psychiatry is handled way differently where I live than in the US. For starters patients are usually involuntarily admitted by family members. They have no say on their treatment and recieve oral/IM medication against their will. The placebo situation I brought up is common practice here. I recently graduated from med-school and wish to pursue a psych residency in the US, i'm just trying to grasp the differences between the systems and what we're doing wrongfully here.

My bad. I think it's often a default assumption of Americans that everyone on the Internet is in the US.

Also you should know I'm not a doctor or psychiatrist.

It's in my profile, but people don't always see it.

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In the US, it's pretty hard to involuntarily commit someone. Sounds like it might be easier where you are.

 

[thoffen]

Yeah, I kinda felt that it was unethical.

But I've had patients that just straight up demand unneeded medication. Last month a manic patient just came straight up to me and told me to "give her a benzo because she was anxious" but clinically she was fine. Another patient asked for analgesics every hour for different types of pain. Sometimes it would be a headache, then a toothache 2 hours later, then her back or her hand hurt, etc. It's with these patients that we usually give placebo to, and it works. I've tried talking to them or just giving them relaxation techniques and whatnot but they always come back for meds.

The above cases are from the inpatient unit.

No is a complete sentence.

 

[wolfvgang22]

To be fair, I see actual practicing psychiatrists in the U.S. prescribe low doses of medicines to such patients that may as well be placebo all the time. For example, hydroxyzine 5mg, gabapentin 100mg, lamotrigine 25mg, even Deplin, etc. They just don't have access to sugar pills.

 

[hamstergang]

I've tried talking to them or just giving them relaxation techniques and whatnot but they always come back for meds.

Are you not allowed to just not give medication? We can't fix everything.

 

[Crayola227]

I was trained that physicians in the US can actually prescribe placebos, BUT you can only do so if the patient is aware they are receiving a placebo (not discussing how this works in placebo controlled studies), which as pointed out, doesn't actually defeat the purpose

I think the key thing is that people conflate the concept of placebo with the idea that in order to be a placebo or to work, the patient must be blinded to what they are receiving

that is true for the purposes of a study but not for actually utilizing a placebo in a patient under ethical conditions

there are other examples where physicians essentially make use of the placebo effect in ways that are ethical

"try drinking more water and taking deep breaths and if your symptoms persist or worsen call me"

 

[thoffen]

I was trained that physicians in the US can actually prescribe placebos, BUT you can only do so if the patient is aware they are receiving a placebo (not discussing how this works in placebo controlled studies), which as pointed out, doesn't actually defeat the purpose

I think the key thing is that people conflate the concept of placebo with the idea that in order to be a placebo or to work, the patient must be blinded to what they are receiving

that is true for the purposes of a study but not for actually utilizing a placebo in a patient under ethical conditions

there are other examples where physicians essentially make use of the placebo effect in ways that are ethical

"try drinking more water and taking deep breaths and if your symptoms persist or worsen call me"

In clinical studies, the enrollees know that they might be receiving placebo instead of active drug before they start the trial. In reality, a good bit of unblinding goes on anyway.

But part of this, as you suggest, is that knowing something is a placebo doesn't necessarily render it ineffective.

Really, the meaning a person attaches to a particular treatment is often more important than the treatment itself, and often that's with parallel rational awareness that their response makes no biological sense. There really are people where alternative therapies (so long as medically safe) are still the best treatment even with them full knowing it's hogwash (degree of hogwashery depends on the treatment).

Of course, there are some illnesses where placebo just won't do.

 

[nitemagi]

This seems suspect to me. Where in the US are you?

 

[hamstergang]

This seems suspect to me. Where in the US are you?

Gutamala.

 

[whopper]

As written, placebos aren't supposed to be given in the US. There might be an argument if the patient has a guardian and the guardian is okay with it but even then medical ethics in this area aren't established.

 

[nitemagi]

Overall this goes against the ethical principles of informed consent (honesty, transparency), though an argument could be made that the other principles of beneficence, non-malfeasance, and justice are equally important and could override them. I don't necessarily believe that, but I could see someone constructing that argument in certain cases.