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BBC: 'Most family doctors' have given a patient a placebo drug

Discussion in 'General ME/CFS News' started by Firestormm, Mar 21, 2013.

  1. adreno

    adreno 3% neanderthal

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    Are you serious? You feel it is ok for doctors to withhold information about your health, because it is your opinion that people are too delicate to handle the truth? Well, I couldn't disagree more, and find the whole idea detestable. I will decide what information I can handle, thank you.
    ukxmrv, SOC and Valentijn like this.
  2. Hip

    Hip Senior Member

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    Well that is a very polarized view.

    I did not in fact give opinion, I just described the historical cultural practices of medicine — where the medical profession has come from — in order to open up debate.

    But if we are going to be scientific and factual here, then whether "judicious management of the facts" versus "the raw blunt truth" is the best approach, in terms of the health and wellbeing of the patient, can probably only be determined by a controlled study.
  3. adreno

    adreno 3% neanderthal

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    This is not about facts. It's about ethics. Of course, ethics cannot be agreed upon. You are welcome to your paternal romanticism. I'll take the blunt truth.

    Your logic is seriously faulty. On one hand you are arguing against putting faith in "omnipotent gods". This means taking responsibility for your own health. On the other hand you are arguing that it is okay for doctors to be discrete about information pertaining to your health. So in essence, taking responsibility becomes an impossibility. Information is power, and withholding information is withholding power. This puts the doctor in the "omnipotent god" position.
  4. Esther12

    Esther12 Senior Member

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    This is a complicated one. I think that a lot of senior medical professional are keen to play up the abilities of doctors, as it's helpful for their own prestige, for negotiations over budgets and salaries, etc. While front-line doctors generally seem to be more reasonable than the people who float up to positions of authority, there doesn't seem to be much of a desire to point out that society thinks too highly of doctors during pay negotiations, or discussions about self-regulation.

    Doctors are humans, and it's important to try to be understanding of the difficult situation that they are often in.... but they also tend to have rather more power over these matters than patients, and the social situation seems to be one which often favours the interests of doctors. If the majority of doctors were truly committed to changing the system in a way which would improve matters for patients, even if it harmed their own interests, then things would rapidly improve.

    It was not just in medicine: many different areas of social power were able to get away with treating others with disdain. As it becomes harder to control the flow of information, and people come to realise that they are being managed without their consent, disgust at this forces improvements in the way that people are treated.

    There are practical reasons which make it difficult for people to avoid being manipulated and managed, but I cannot think of an instance where there was an open discussion about whether people wanted to be, and the majority decided that they did.

    People like honesty in the long run. It can cause people short-term problems, but being able to trust one another brings long-term benefits. That includes discussing weight issues in a relationship imo - one can be honest and open while still being caring and gentle.

    Such a trial would be founded on an embrace of pragmatism which many reject. Even if we accept that this is a matter which should be assessed in pragmatic terms (I do not), in order to gather meaningful data we would need a trial which accounted for the long-run social impact of running the trial. eg: One would need to run one arm of the trial is a society which was intolerant of deception by doctors, and the other in a society which accepted such practices.

    What we commonly see, particularly with CFS, is poorly run trials by biased researchers which provided shoddy pragmatic justifications for treating patients in morally dubious ways. I think that the long-run affect of this has not been good, and that we would have been much better off if there were no studies, but instead just open and honest moral discussion and debate.
    sianrecovery, Valentijn and MeSci like this.
  5. Hip

    Hip Senior Member

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    And I am sure if you demanded it from your doctor, in no uncertain terms, he would give it to you.

    But others visiting their doctor may, just by their body language and personality, implicitly intimate to their doctor that they want the sanitized version of the truth. As humans, we often reveal our unconscious desires and requirements by our body language. I suspect a good doctor will posses the sensibility to judge just how much of the terrible truth the patient themselves wants to know. Ultimately, the doctor with such sensibility is giving the patient exactly what they want. Some patients probably want the cold truth; others may want a more sanitized version.

    Consider that some people have committed suicide on being told they have cancer. These medical truths can be very hard to bear, depending on the temperament of the person.

    I know several people that are so frightened of a possible terrible disease diagnosis, that they will not even visit a doctor at all, no matter how bad their symptoms become. Doctors deal with a huge variety of patients all with very differing temperaments.

    You are just judging the situation in relation to what you want, and in relation to your personality and requirements.
  6. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Interesting that Gerada says "...seeing the GP is sometimes the placebo when the patient walks out feeling better than they walked in thankfully..."

    In my case, it takes something like wild horses to drag me to the doctor's due to so many bad experiences and very few good ones, and it's a very rare occasion that I don't leave the surgery feeling worse than before, almost tearing my hair out in frustration and with blood pressure probably soaring due to anger.

    Now I don't know his views on ME, but assuming that he doesn't espouse psycho-quackery, this is the kind of doctor I would like:

    http://drphilhammond.com/
    jimells, Shell and allyb like this.
  7. PhoenixBurger

    PhoenixBurger Senior Member

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    Haha. That's rich.
    jimells likes this.
  8. Esther12

    Esther12 Senior Member

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    She wouldn't have dressed like that if she didn't want it. Her mouth said 'no', but her body said 'Y-E-S'... [I can't think of any more clichés now. Darn, I was enjoying that].

    I'm a bit uncomfortable with that sort of mind-reading.

    I think that you're side stepping important moral aspects of this. A commitment to truth and honesty is not just about personal preferences in the way that preferring chocolate cake to coffee cake is. Personal preferences and informed consent do come in to it, but there are also wider issues with regard to human being's moral responsibility to an honest pursuit of truth, and honest discussion and debate.

    He got fired a while back, and I think he now works at Crawley's CFS clinic, and cited a book by Andrew Malleson when mentioning it (on Countdown). I'd assume that his decision not to speak out about how results are often spun with CFS is a concious one.
    Valentijn likes this.
  9. SOC

    SOC Moderator and Senior Member

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    No. Being an adult means taking responsibility for yourself, including the hard stuff. That's not just a personality characteristic. While I grant you there are some people who still want to behave like children and turn their responsibility for self-management over to others, it is neither adult nor psychologically healthy. It is not an attitude to encourage or enable in our adult population.

    No one should decide for others what degree of truth they can handle. That's playing god. Or Mommy/Daddy. It's an obnoxiously paternalistic attitude. Adults need to deal with the reality of their lives, even when it's tough.

    There are better ways and worse ways to give bad news. Doctors should learn the better ways, so that the trauma of bad news is not exacerbated by poor social skills on the part of the doctor. They should not deceive the patient because it's easier than telling the truth, or because the doctors decides, with very little knowledge of the patient, that the patient can't cope with the truth.

    Who chooses, by the way, the people that get to be the parent/god figures who decide for other people whether they can be told the truth? Should we allow a medical degree to automatically give people the elite status of "truth knowers" who decide how much truth other people are allowed to know? What about teachers? Do they get to deceive parents about their children "for their own good"? How about your plumber? Is s/he elite enough to be entitled to lie to you about the condition of your plumbing because s/he thinks you can't handle the reality that it's going to need a major overhaul?

    I have to ask, Hip, if your GP knows you well enough to make life decisions for you. I know mine doesn't. No GP I've had in the last 15 years would even know me if we passed on the street. I don't even think my siblings know me well enough to make serious decisions for me, why would I want someone I'm paying for information to decide what I'm allowed to know (or not)?
  10. Hip

    Hip Senior Member

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    No, you are misinterpreting what I wrote. I already mentioned that I am not really arguing any strong points of view. I am simply describing things as they are, and having a go at explaining why they are that way. I am attempting a de facto description of the psychology of the doctor–patient interaction.

    Ideally patients would be mentally strong and self-reliant, so that they would not have this sometimes childlike reliance on a doctor; and if patients were strong like this, then doctors could then just speak the sometimes harsh medical truth.

    But like it or not, a lot of patients are not strong and self-reliant, and in response, doctors may be more judicious in terms of what they tell the patient. This is de a facto description of the doctor–patient relation. I am not getting into an argument; I am getting into the psychology.
    wdb and MeSci like this.
  11. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    I didn't know about him being fired. I just did some searching and info seems to be conflicting, with one site saying he is still currently a part-time GP in Bristol and another saying he's a hospital doctor.

    But he appears to be the most candid, outspoken and honest doctor I have ever come across, and his Twitter feed and Private Eye column reflect that. I have difficulty imagining him standing for any bad practice and not speaking out.

    I'd be very interested to hear of any evidence of this. Maybe someone who is on Twitter could ask him:

    https://twitter.com/drphilhammond
  12. Esther12

    Esther12 Senior Member

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    I saw him talking about it on Coutdown. There was a discussion about it somewhere. A google for him and Crawley brought up this: https://twitter.com/drphilhammond/status/270128196484202496

    I was disappointed, as I'd been a fan of his work in Private Eye too. When people need a job, that will affect how they see things. I think that a lot of doctors think that different standards apply for CFS patients than others.
  13. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Maybe he needs some more correspondence on Twitter from people with ME/CFS...
  14. Esther12

    Esther12 Senior Member

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    Maybe. I'm not sure CFS is the ideal topic for twitter discussions! I'm not a twitter fan though.
  15. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Regarding him being fired (if he was) I would not be at all surprised, and it would not necessarily indicate any wrongdoing by him - indeed it could indicate the opposite. I have recently been watching the UK Health Select Committee proceedings on the BBC Parliament channel about hospital trusts imposing gagging clauses on senior staff and forcing them out of their jobs through bullying, etc. It is truly shocking. These were staff trying to expose the fact that patients were in danger.

    Dr Phil would be a powerful person to have on our side, as he is renowned for exposing nonsense and wrongdoing in the health service and empowering patients.

    If he is not prepared to take an interest in what is being done to ME/CFS patients by psychoquackery, he should be reminded of the first three items of his recipe for NHS reform(on the page I linked to above):


    1. Stop killing patients
    2. Harm patients as little as possible
    3. Before doing anything, ask not just ‘is it likely to work?’ but ‘is it humane?’
    sianrecovery likes this.
  16. biophile

    biophile Places I'd rather be.

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    Talking about CFS on TV. Perhaps next time Gerada et al complain that their digital TV breaks up sometimes in stormy weather, instead of investigating the antenna and cabling, or informing them when nothing much can be done, for hundreds of dollars "Mr Antenna" can just install a dummy amplifier that does nothing, a passthrough box with a pretty blinking light on it, and re-assure them that reception will be significantly improved or even the PACE style of "back to normal"?
    PhoenixDown, ukxmrv, SOC and 5 others like this.
  17. Esther12

    Esther12 Senior Member

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    Just to be clear - I didn't mean to imply that there was any wrongdoing by him. I did read something about it by him I think, but cannot remember the details - budget cuts? Or a change in services? I think that he was a GP for a walk-in centre? I can't really remember.

    Who knows? Maybe his role in the media was one reason he was given his new job? The BPS lot have always paid attention to media presentations of CFS, and there has been a big media push post-PACE.

    I've not seen anything from Hammond about anything like allowing patients access to data on the outcome measures laid out in PACE's protocol.

    I don't want to sound like I'm generally anti-Hammond though. As I said, I was (and am) a fan of his Private Eye stuff. I just don't have much faith that he would be condemning of the spin about efficacy which surrounds the service which employs him and may be no more effective than placebo intervention.
  18. adreno

    adreno 3% neanderthal

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    The thing is, you can't claim neutrality in an ethical discussion. Ethics is about values. What are yours? Moot observations that some patients are more fragile than others, and there are differences in the way doctors dispense information to patients are hardly surprising. The interesting question here is whether doctors should withhold information that is vital to decisionmaking for the patient.

    Everyone is responsible for themselves. Individual decisions are based upon the knowledge available. Human decisionmaking is a heuristic function, weighing in costs and benefits. No one has all information pertaining to their situation available to them, but I argue that humans always make the best decision given the available information (barring cognitive defects). So withholding vital information will seriously impair patients ability to make the best decision for themselves. In any case you can't know the outcome of your actions. Giving someone a true diagnosis might enable them to take action that will save their lifes, make their peace with God, or give them time to settle their affairs and say goodbye to their loved ones. No one is a mind reader, and there is no way you can predict the reaction of a patient. Giving them no information is giving them no choice.

    You mention people commiting suicide after getting a diagnosis. This is not the doctor's responsibility. If someone (who is mentally sane) decides to kill themselves based on their situation, then who are we to say they are wrong? Life can be too unbearable, and whether someone wants to live out their life to it's "natural" end (which in this case might be an agonizing slow death), or end it at their own choice is entirely an adult decision in my view.

    I am aware that there are patients who are mentally insane, depressed and/or suicidal, who might not be in a position to make the best decision for themselves. In that case, it is not the responsibility of the doctor to send them home with a "your result came back negative, you're fine", but rather to acknowledge and treat their mental disorder. Advice them to see a counselor, prescribe medication or even commit them to hospital if they are obviously suicidal (this is a very fine line to walk, though). Just handing someone a HIV diagnosis and sending them straight home without any support is very irresponsible, and not what I'm arguing for here.
    SOC and Valentijn like this.
  19. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    I agree with some of what you say and disagree with some. I agree that doctors should give as much info as possible, but it must be done in a careful way where it is apparent that it could cause harm when given in the wrong way.

    But it is not necessarily possible for a busy doctor to know whether a patient is depressed or suicidal, or how vulnerable the patient is to becoming so. The precautionary principle must be applied where appropriate.

    I disagree with your statement that people committing suicide after getting a diagnosis is not the doctor's responsibility. People exist in society, and we are responsible for each other to varying extents. In the case of a doctor, this responsibility is considerable. For example, they need to be careful not to prescribe a large number of sedatives to a patient who is in a temporarily distressed state. It would be irresponsible to do so. But I do also agree that people should be able to commit suicide if they are rational and life is unbearable with no likelihood of improving. Indeed, I think that it should be legal for other people, including health professionals, to help them to do so in the easiest, most peaceful way possible.

    But I know that it is common for doctors to operate on the other extreme of even refusing to give patients info to which they have a right, and which they demand repeatedly. I have been on the receiving end of such behaviour when demanding test results so that I could work out what was wrong with me as the docs clearly hadn't a clue. This is not just unacceptable - it is crazy and outrageous.

    Re the original topic, I know that the placebo effect can be powerful but suspect that placebos may often be prescribed erroneously, when doctors just haven't identified the real problem. I am very uncomfortable with the concept of these being prescribed by an accredited practitioner, but am not sure that it is always wrong.
  20. Living Dead

    Living Dead

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    I remember this episode. The man claimed to have CFS because of "waking up tired in the morning". House did not think he had CFS. Now you can all sleep in peace. :)
    Jarod and Valentijn like this.

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