Placebo ethics.
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02-01-2013, 12:32 AM
RE: Placebo ethics.
(02-01-2013 12:19 AM)Bucky Ball Wrote:  Handing out "placebo antibiotics" is one of the reasons "super-bugs" are growing out, and resistance to some of the usual ones has increased.

Couldn't agree with you more about this. I understand that patients can be difficult at times, but to simply give active medications to pacify a patient when the physician knows the medication will do nothing for the condition is a cop out on the physicians part.

Quote:It's wrong, and in general is bad for the world. I say total honesty is best.

Patient pacification notwithstanding, how about if there is a demonstrable clinical benefit to the patient in question and their condition?
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02-01-2013, 12:36 AM
RE: Placebo ethics.
(02-01-2013 12:32 AM)BioPsychMS Wrote:  
(02-01-2013 12:19 AM)Bucky Ball Wrote:  Handing out "placebo antibiotics" is one of the reasons "super-bugs" are growing out, and resistance to some of the usual ones has increased.

Couldn't agree with you more about this. I understand that patients can be difficult at times, but to simply give active medications to pacify a patient when the physician knows the medication will do nothing for the condition is a cop out on the physicians part.

Quote:It's wrong, and in general is bad for the world. I say total honesty is best.

Patient pacification notwithstanding, how about if there is a demonstrable clinical benefit to the patient in question and their condition?
How about giving a specific example.

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02-01-2013, 01:01 AM
RE: Placebo ethics.
Ok, how about this for a hypothetical example. Let's say a patient is being treated for chronic pain, perhaps fibromyalgia. The doctor in this scenario has tried a variety of standard pain treatments and in the end has found that a high opioid dosage is the only relief the patient is getting and that relief is minimal. The doctor believes that the patient is a good candidate for placebo response.

Now let's say the doctor has the option of providing a "prescription" of inert pills or an occasional injection at the clinic. The doctor tells the patient that this "drug" has been demonstrated to be effective for patients suffering from their condition when combined with the therapy they are currently on.

So in this example the doctor in no way stops the active treatment but is offering a choice of a supplemental treatment.
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02-01-2013, 02:13 AM (This post was last modified: 02-01-2013 02:34 AM by Bucky Ball.)
RE: Placebo ethics.
(02-01-2013 01:01 AM)BioPsychMS Wrote:  Ok, how about this for a hypothetical example. Let's say a patient is being treated for chronic pain, perhaps fibromyalgia. The doctor in this scenario has tried a variety of standard pain treatments and in the end has found that a high opioid dosage is the only relief the patient is getting and that relief is minimal. The doctor believes that the patient is a good candidate for placebo response.

Now let's say the doctor has the option of providing a "prescription" of inert pills or an occasional injection at the clinic. The doctor tells the patient that this "drug" has been demonstrated to be effective for patients suffering from their condition when combined with the therapy they are currently on.

So in this example the doctor in no way stops the active treatment but is offering a choice of a supplemental treatment.
Not gonna happen. If the patient asks what it was, or decided to file, eventually an action, and a lawyer asked to know what exactly it was, the doc would be screwed. They can't charge for a fake medication, or treatment, that has not been proven to be safe and effective. There is the principle of the "standard of care, (for the particular community). You can't breach that or you are legally vulnerable. The example is totally unrealistic.

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02-01-2013, 08:24 AM
RE: Placebo ethics.
(02-01-2013 02:13 AM)Bucky Ball Wrote:  
(02-01-2013 01:01 AM)BioPsychMS Wrote:  Ok, how about this for a hypothetical example. Let's say a patient is being treated for chronic pain, perhaps fibromyalgia. The doctor in this scenario has tried a variety of standard pain treatments and in the end has found that a high opioid dosage is the only relief the patient is getting and that relief is minimal. The doctor believes that the patient is a good candidate for placebo response.

Now let's say the doctor has the option of providing a "prescription" of inert pills or an occasional injection at the clinic. The doctor tells the patient that this "drug" has been demonstrated to be effective for patients suffering from their condition when combined with the therapy they are currently on.

So in this example the doctor in no way stops the active treatment but is offering a choice of a supplemental treatment.
Not gonna happen. If the patient asks what it was, or decided to file, eventually an action, and a lawyer asked to know what exactly it was, the doc would be screwed. They can't charge for a fake medication, or treatment, that has not been proven to be safe and effective. There is the principle of the "standard of care, (for the particular community). You can't breach that or you are legally vulnerable. The example is totally unrealistic.
The situation is not that far fetched, change inert substance to one of a mild compound if you wish. This doesn't change the underlying question about whether it is ethical to deceive in a situation like this. Nothing in the scenario was unsafe. The question of efficacy is assumed to be true just perhaps not true for all patients, which is a true statement for nearly any treatment.

Given that assertion, is your objection then one of being charged for an inert compound or mildly active compound? or the deception? or perhaps both?
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02-01-2013, 08:55 AM
RE: Placebo ethics.
(02-01-2013 08:24 AM)BioPsychMS Wrote:  
(02-01-2013 02:13 AM)Bucky Ball Wrote:  Not gonna happen. If the patient asks what it was, or decided to file, eventually an action, and a lawyer asked to know what exactly it was, the doc would be screwed. They can't charge for a fake medication, or treatment, that has not been proven to be safe and effective. There is the principle of the "standard of care, (for the particular community). You can't breach that or you are legally vulnerable. The example is totally unrealistic.
The situation is not that far fetched, change inert substance to one of a mild compound if you wish. This doesn't change the underlying question about whether it is ethical to deceive in a situation like this. Nothing in the scenario was unsafe. The question of efficacy is assumed to be true just perhaps not true for all patients, which is a true statement for nearly any treatment.

Given that assertion, is your objection then one of being charged for an inert compound or mildly active compound? or the deception? or perhaps both?

Yes it is far fetched on a practical basis. Any practitioner has malpractice insurance. They are also trained re the standard of practice for a given situation. No one is going to prescribe "inert substances', and make their patients pay for things that are not proven effective. You must have no practical experience in the field. They maybe can "suggest" things, (from the health foods store), but any patient in that situation has likely investigated these things for themselves.

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02-01-2013, 09:12 AM
RE: Placebo ethics.
(02-01-2013 08:55 AM)Bucky Ball Wrote:  
(02-01-2013 08:24 AM)BioPsychMS Wrote:  The situation is not that far fetched, change inert substance to one of a mild compound if you wish. This doesn't change the underlying question about whether it is ethical to deceive in a situation like this. Nothing in the scenario was unsafe. The question of efficacy is assumed to be true just perhaps not true for all patients, which is a true statement for nearly any treatment.

Given that assertion, is your objection then one of being charged for an inert compound or mildly active compound? or the deception? or perhaps both?

Yes it is far fetched on a practical basis. Any practitioner has malpractice insurance. They are also trained re the standard of practice for a given situation. No one is going to prescribe "inert substances', and make their patients pay for things that are not proven effective. You must have no practical experience in the field. They maybe can "suggest" things, (from the health foods store), but any patient in that situation has likely investigated these things for themselves.
You are right that I am not a field practitioner, however, I am aware of malpractice insurance and standards of practice. I am also aware that it is not uncommon to prescribe drugs for off label purposes. I am also aware that some physicians will give inert shots to placate difficult to deal with patients. To be fair I don't know whether they are billed for that service or not. I am interested in the ethics of the deception itself not the billing practices, though I recognize that would have to be addressed. Don't mistake me either, I am not asking about whether a doctor should recommend some sort of homeopathic regimen or some other sort of unsubstantiated claim. I am asserting a question of ethics about deception when that deception is perhaps a central component of a treatment that would, hypothetically, have an efficacy claim.
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02-01-2013, 09:38 AM
RE: Placebo ethics.
If the intent is to lessen pain, which is the specific medical issue here in the OP, I think that is different from treating an infection or a presumed infection. Many people just don't want to hear that the doctor can't make them better because they have a virus and not an infection that can be treated with antibiotics. Patients get insistent, doctors give out a Zpac which is basically worthless and the patient "gets better", they would have anyway, in time. Everybody goes home happy even the bugs that are now more resistent to treatment.
As for pain management, and as a sufferer of chronic pain, I say let them lie to me....if it works, they can tell me just about anything they want to. Opiods do not work on nerve pain, lucky me. I have tried Lyrica and Cymbalta which are supposed to work but with Cymbalta there was no relief at all. With Lyrica, they started me on a really low dose that wasn't working. So they said I could up the dosage...if I took a second one in a 24 hour period, I slept for hours and hours and was basically useless for anything else. I was told I could take up to EIGHTEEN times the dosage I was prescibed! Hell's Bells, I would have been in the fetal position drooling on myself and needing a diaper. My oncologist said that Lyrica did the same thing to her...if she took two in a day, she was done.
It is mentally and physcially exhausting to trudge through every day in pain and I don't care what they say or do...if someone has something that works or that I think will work...I am in!

See here they are, the bruises, some were self-inflicted and some showed up along the way. - JF
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02-01-2013, 12:16 PM
RE: Placebo ethics.
(02-01-2013 09:38 AM)Anjele Wrote:  If the intent is to lessen pain, which is the specific medical issue here in the OP, I think that is different from treating an infection or a presumed infection. Many people just don't want to hear that the doctor can't make them better because they have a virus and not an infection that can be treated with antibiotics. Patients get insistent, doctors give out a Zpac which is basically worthless and the patient "gets better", they would have anyway, in time. Everybody goes home happy even the bugs that are now more resistent to treatment.
As for pain management, and as a sufferer of chronic pain, I say let them lie to me....if it works, they can tell me just about anything they want to. Opiods do not work on nerve pain, lucky me. I have tried Lyrica and Cymbalta which are supposed to work but with Cymbalta there was no relief at all. With Lyrica, they started me on a really low dose that wasn't working. So they said I could up the dosage...if I took a second one in a 24 hour period, I slept for hours and hours and was basically useless for anything else. I was told I could take up to EIGHTEEN times the dosage I was prescibed! Hell's Bells, I would have been in the fetal position drooling on myself and needing a diaper. My oncologist said that Lyrica did the same thing to her...if she took two in a day, she was done.
It is mentally and physcially exhausting to trudge through every day in pain and I don't care what they say or do...if someone has something that works or that I think will work...I am in!
So I will butt out. However a "Z Pack" (Azithromycin), is incredibly effective, if one actually has an infection by a bug that is sensitive to it. All I can say, is, I would not want anyone, especially a practicioner, to lie to me. Eventually, the truth will out.

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02-01-2013, 12:22 PM
RE: Placebo ethics.
I wasn't clear Bucky, sorry...it's worthless if you are treating a virus, but many patients don't feel like they got their money's worth of the doctor doesn't give them some kind of antibiotic.
I ran into so many half-truths with the medical profession (and that's a little generous) but after all this time, if someone could make the pain stop so I could sleep in a bed and not a recliner and sleep all night, I would take even a BIG lie.

(And happily pay for it.)

See here they are, the bruises, some were self-inflicted and some showed up along the way. - JF
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