• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

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

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
21 March 2013

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

Most family doctors have given a placebo to at least one of their patients, survey findings suggest.

In a poll, 97% of 783 GPs admitted that they had recommended a sugar pill or a treatment with no established efficacy for the ailment their patient came in with.

The PLOS One study authors say this may not be a bad thing - doctors are doing it to help, not to deceive patients.

The Royal College of GPs [Gerada] says there is a place for placebos in medicine.

But they warn that some sham treatments may be inappropriate and could cause side effects or issues such as drug resistance.

For example, one of the placebo treatments identified in the study was antibiotics for suspected viral infections.

"This is not about doctors deceiving patients” Dr Jeremy Howick the study's co-author.

Antibiotics are powerless against viruses and doctors are told not to use them.

About one in 10 of the GPs in the study said they had given a patient a sugar pill or an injection of salty water rather than a real medicine at some time in their career.

One in 100 of them said they did this at least once a week.

'Offering reassurance'

Almost all of the GPs said they had provided patients with treatments, like supplements, probiotics and complementary medicines, that were unproven for their medical condition. Three-quarters said they offered unproven treatments on a daily or weekly basis.

Dr Jeremy Howick, co-author of the study that was carried out by the University of Oxford and the University of Southampton, said: "This is not about doctors deceiving patients.

"The study shows that placebo use is widespread in the UK, and doctors clearly believe that placebos can help patients."

The GPs in the study said they used placebos either because patients requested treatment or to reassure patients.

Half said they told their patients that the therapy had helped other patients without specifically telling them that they were prescribing a placebo.

Dr Clare Gerada, chairwoman of the Royal College of GPs, said it was perfectly acceptable to use a placebo as long as it did not cause harm and was not expensive.

"Lots of doctors use them and they can help people.

"If you think about it, a kiss on the cheek when you fall over is a placebo.

"But there are risks. Not all of the placebo treatments that the researchers looked at in this study are inert. If you take too many vitamins, for example, some can cause harm."

She said fobbing off patients with an ineffectual treatment was never acceptable. "But admitting to your patient that you do not know exactly what is going on, but that a therapy might help is."

Gerada was on the BBC Today programme this morning (Radio), and happened to mention she had also prescribed a placebo for 'fatigue'. The other doctor (a long time GP) claimed she had never prescribed a placebo feeling to do so was deceptive.

There is I think something to be said about any medicine (even active ones) being at least in part placebo, but I think the focus here might be whether or not 'therapies' relating to CFS/ME as well as prescribed treatments (drugs), off-label and speculative, as well as supplements and unapproved treatments - are more placebo than not.

How can you really tell? Anyway. It was an interesting mini-debate on the Radio and I think Gerada performed poorly. The interviewer kept laughing. I mean. Medicine in this day and age prescribing (knowingly) a placebo - well, it just sucks.
 

user9876

Senior Member
Messages
4,556
Its not just about diseaving patients. A placebo can lead to patients feeling their symptoms are less but without having a physical change. So without doing any diagnostics and giving a patient a placebo for say fatigue could simply delay any real diagnosis and treatment.

The interviews should have been asking what process did you go through before prescribing a placebo.
 

snowathlete

Senior Member
Messages
5,374
Location
UK
it just breaks down patient-doctor trust, and really what it is is the doctor fobbing you off because he doesn't know what to do with you, or worse, doesn't believe you. I think it's shocking.
 

wdb

Senior Member
Messages
1,392
Location
London
I think the BBC have somewhat sensationalised that story, there is a better article here

In fact only 12% have used 'pure' placebos such as sugar pills.

The 97% figure includes treatments that are unproven, such as antibiotics for suspected viral infections, or more commonly non-essential physical examinations and blood tests performed to reassure patients.
 
Messages
13,774
Thanks for mentioning this.

I've tried to find audio of the Gerada audio but haven't been able to.

It starts at 1:52: http://www.bbc.co.uk/programmes/b01r9rxp

I think that this is a really important part of the problems which surround CFS, and the matters of dishonesty, informed consent, paternalism, etc. I think that in this area the British establishment is a long way behind the British public, and also many front-line GPs. I've also noticed that those keen on biopsychosocial management tend to be those who believe that placebos are particularly effective treatments, while those sceptical about the claims of placebos leading to dramatic medical benefits also tend to be more committed to treating patients honestly.
 

biophile

Places I'd rather be.
Messages
8,977
Dr Clare Gerada, chairwoman of the Royal College of GPs, said it was perfectly acceptable to use a placebo as long as it did not cause harm and was not expensive.

"Lots of doctors use them and they can help people.

"If you think about it, a kiss on the cheek when you fall over is a placebo.

"But there are risks. Not all of the placebo treatments that the researchers looked at in this study are inert. If you take too many vitamins, for example, some can cause harm."

She said fobbing off patients with an ineffectual treatment was never acceptable. "But admitting to your patient that you do not know exactly what is going on, but that a therapy might help is."

So according to Gerada, "fobbing off patients with an ineffectual treatment was never acceptable", but it is "perfectly acceptable to use a placebo as long as it did not cause harm and was not expensive"? Placebos are ineffective in the majority of people, and the supposed benefits of placebo are questionable.
 

Little Bluestem

All Good Things Must Come to an End
Messages
4,930
Almost all of the GPs said they had provided patients with treatments, like supplements, probiotics and complementary medicines, that were unproven for their medical condition. Three-quarters said they offered unproven treatments on a daily or weekly basis.
I am disturbed that these doctors consider complementary medicines to be the same as a placebo. While they may be unproven in the sense of not having medical trials to back them, they often have a long history of successful use. If the doctor is not familiar with that history and considers them ineffective, he may use them inappropriately and harmfully.
 
Messages
15,786
The snippet is less than 5 minutes long, so worth listening to. But here's a transcript (no guarantees I didn't miss a word or two).

Host: Clare Gerada, have you knowingly prescribed a real placebo?

Clare: Uh, Yes I have. Uh, I have uh been a GP for twenty-five years and I have knowingly prescribed placebos. I have knowingly prescribed vitamin tablets. I have knowingly prescribed things like Simple Linctus which is a cough mixture, it's got no active ingredient in it. But I agree, I agree

Host: (laughs) Wait wait wait! What did you tell the patient when you did it?

Clare: Oh, it's a very difficult issue. Because on the one hand what Margeret's saying, which is that placebos do involve a form of deception. But at the same time placebos are part of medicine. Now there is a dividing line, you clearly can't cure a broken bone with a placebo, or cure cancer, but you can relieve distress. Placebos also work if you know they're placebos, which seems to me quite bizarre.

Host: Ah, now hang on, is that really the case? Because I assumed that the arguement in favor of deception is that it's not gonna work if you tell them it's not doing anything.

Clare: No, there's a number of studies that show that if you actually tell people, if you write on the box "this is a placebo" you still get a positive effect. (host laughs) The other thing is, most of us, so if I took a paracetamol for a headache, you tend to get relief almost immediately, well, clearly it hasn't gone through the body and done its work by then, so that's a placebo. Most medicines we take, even real medicines if there's such a thing, have a 50% placebo effect.

(Margaret says patient care is the first concern patients can get care by being listened to and seeing the doctor during their illness, and it's unethical to deceive them. Objects to "care" being entirely pill-based.)

Clare: I fundamentally and totally agree with you, Margaret, and I think all of those are what makes a good GP, and I suspect what makes you a brilliant GP. But sometimes part of medicine also, and I've said to patients look I really don't know what's going on, patients with fatigue, patients with odd symptoms, which actually sometimes part of that treatment would be to give a placebo, but I take your point: if we have more time, I mean seeing the GP is sometimes the placebo whene the patient walks out feeling better than they walked in thankfully, whereas what we're doing as you say is imparting care.

Host: You know there is a placebo effect, right? Because it's built into the double-blind studies.

Clare: Oh, of course there is a massive placebo effect with lots of studies, every study, every good study involves a placebo to a certain extent, and we know placebos not just can cause positive effects but they can cause harmful effects.

Host: Am I not right in thinking that loads of stuff you buy off the shelf at the chemist is basically placebo?

Clare: I suspect so. I suspect there will be things that people are going to put in their mouths today that will be found to actually have a massive placebo effect. Maybe some food supplements, vitamins, all sorts of things that we walk into a pharmacist and take.

(Margaret says a 2002 cochrane shows that we overstate the value of placebos - since placebos have not been compared to no treatment.)
Yup, you heard it ... vitamins are placebo! I'd like to see how good she'd be feeling if she was deficient in some vitamins :cautious:
 

Jarod

Senior Member
Messages
784
Location
planet earth
I think the BBC have somewhat sensationalised that story, there is a better article here

In fact only 12% have used 'pure' placebos such as sugar pills.

The 97% figure includes treatments that are unproven, such as antibiotics for suspected viral infections, or more commonly non-essential physical examinations and blood tests performed to reassure patients.

Good one. Don't want anybody to get any funny ideas.

The 12% is still shocking though. My girlfriend watches this show called "house" on TV. House is a doctor (with a drug habit) who is an expert at diagnosing tough and unusual illnesses.

House had a CFS patient propaganda episode one time that showed the Dr diagnosing a CFS patient. Dr House determined the best treatment for the CFS patient was placibos. He obtained some heavy pain killers from the pharmacy and immediately emptied the painkillers in his pocket.He then goes to the vending machine to buy skittles to refill the prescription bottle with skittles for the CFS patient.....

Makes my stomach turn when I see my girlfriend watching those shows. Later I try to explain how something in the real world works and she tells me she "knows" because she watches another show called CSI......:ill:
 
Messages
15,786
House had a CFS patient propaganda episode one time that showed the Dr diagnosing a CFS patient. Dr House determined the best treatment for the CFS patient was placibos. He obtained some heavy pain killers from the pharmacy and immediately emptied the painkillers in his pocket.He then goes to the vending machine to buy skittles to refill the prescription bottle with skittles for the CFS patient....
Not to get too off track, but the "CFS patient" was self-diagnosed based feeling a bit tired out. So probably not someone with ME/CFS.

Though the aspect of getting rid of someone by using a placebo was still quite nasty. And if I got to choose the context in which ME/CFS was mentioned on House, I would have chosen a rather different scenario :rolleyes: But if your girlfriend is into the doctor shows, "Royal Pains" has an episode where CFS is briefly mentioned as a potential diagnosis for someone acknowledged to be seriously ill ... and ruled out in the context of "good news, your life isn't over."
 

Hip

Senior Member
Messages
17,824
Patients are just as much to blame here, as patients often mistakenly believe that doctors are some kind of omniscient and omnipotent gods. We go to doctors not just for medical advice and consultation, but because we want the assurance and support of an all-knowing medical authority figure in times of personal medical crisis and sickness. I am just as much to blame in this respect as everyone else. I admit that sickness does create psychological vulnerability, and the psychological need for a supportive medical authority.

This is not unlike the human need for a supportive religious figure. And just as Nietzsche told us that "God is dead" (what he meant was that the era in which we had a childlike reliance on a divine father or authority figure was over), likewise, we as patients need to develop maturity, and dispense with the childlike need for an all-knowing medical figure. Then doctors will not feel the need to prescribe placebos, just to create hope, and to cultivate an aura of capability.

Because patients have this childlike psychological need, that is why we get placebos. We have got to come to terms with the fact that often doctors can do very little in the case of many diseases.
 
Messages
13,774
I think that informed consent is the important thing here. I never wanted reassurance or emotional support, I wanted, and want, to be able to trust that my doctor will try to communicate honestly and respectfully with me. The biopsychosocial approach to CFS makes that impossible, and this is a burden.

If some patients want paternalism, they need to provide informed consent for it. It should not be inflicted routinely upon people without their consent.
 

Jarod

Senior Member
Messages
784
Location
planet earth
Patients are just as much to blame here, as patients often mistakenly believe that doctors are some kind of omniscient and omnipotent gods. .

Agree doctors are people too. They have a tough job.

I think the patients and society in general are heavily trained to consider doctors as gods. Every tool imaginable is used to do this no doubt; Including, but not limited to television.

This puts tremendous burden on the doctors, and probably serves as a useful tool to keep the majority if doctors strickly following the official CDC treatment consensus. The CDC consensus being; treat physical disease as a mental illness for all practical purposes.

Frustrating, but the system is changing. People are becoming more informed and this should help IMO.
 

Jarod

Senior Member
Messages
784
Location
planet earth
And if I got to choose the context in which ME/CFS was mentioned on House, I would have chosen a rather different scenario :rolleyes: But if your girlfriend is into the doctor shows, "Royal Pains" has an episode where CFS is briefly mentioned as a potential diagnosis for someone acknowledged to be seriously ill ... and ruled out in the context of "good news, your life isn't over."

Oh no there's another one. o_O Maybe I should disconnect cable so she doesn't get anymore wrong ideas. :O)
 

Hip

Senior Member
Messages
17,824
I think that informed consent is the important thing here. I never wanted reassurance or emotional support, I wanted, and want, to be able to trust that my doctor will try to communicate honestly and respectfully with me. The biopsychosocial approach to CFS makes that impossible, and this is a burden.

If some patients want paternalism, they need to provide informed consent for it. It should not be inflicted routinely upon people without their consent.

It is interesting that not so many decades ago, the tact often taken by doctors was to be very judicious with the truth, when it was perceived that the truth might be too much to bear for a given patient.

For example, certain patients who had incurable fatal diseases might not be told of the diagnosis themselves, the facts of the matter only given to some other family member. Similarly, many a person told by their doctor that they had say a fatal cancer would keep this fact to themselves, and not inform their family, because they considered it too much to bear for their family.

Being judicious with the truth — truth management, if you like — was a very common approach to dealing with things, not only in medicine, but in many walks of life.

It is only in recent decades that we have begun to slowly bring everything above board, making the facts of all sorts of areas of life much more visible and available. It is all part of the Information Age we have entered into. But this approach is a brave new world, and, coming back to medicine, whether it is wise to go for a "total truth" approach in medicine, or whether is wise to still keep certain details confidential, is a matter for debate.

Perhaps sometimes certain facts are best not brought up. Nobody tells their girlfriend that their backside looks fat, even if it does.