Over 97% of British doctors prescribe fake medicine

[MarxSchmarx]

I couldn't believe this figure when I read this:

http://www.bbc.co.uk/news/health-21834440

just how often placebos are given in some incredibly paternalistic and elitist sense to "assuage" patients. They don't want patients to worry their pretty little heads over a lie. It's not clear how often the doctors tell the patients it's a placebo, or clarify what they are prescribing isn't known to have any effect on the illness.

This reliance on the placebo effect is the exact opposite of informed consent and modern scientific practice. I mean, maybe in cases where the illness is terminal you could give it a try. In the same way you might as well give crystal healing a try.

Honestly, this is just sorcery by any other name.

[Sperm-Doll Setsuna]

And how often do they proscribe placebos masquerading as medicine in the form of Homoeopathic and "holistic" treatments and other useless "alternative medicine"? I bet that too is at a disturbing frequency, even excluding the types bought in those quack-haven "health-food shops".

[Kenco Smooth]

It's not to "assuage" patients. Placebo's are proven as efficient interventions. Nor is the 97% figure shocking given that it's a figure of have you ever. There's nothing shocking about 97% of doctors at one time or another having undertaken common medical practice at least once (even then the criteria they use for 'placebo' are wide). The only thing worth taking from it is that the majority of doctors giving out homeopathic treatment believe it to be a placebo. Other than that I fail to see why this is getting the attention it is.

[Danielle Ni Dhighe]

This is deception, pure and simple.

[Kenco Smooth]

This is deception, pure and simple.

It's medical treatment. How much info does your doctor give you when prescribing something? I've always simply got a "here's a prescription for that see how it works", whether or not it was a placebo I don't know or care. If it really rankles you for some reason express that you don't want any placebos and you won't get given any (but you may just be limiting the treatment you can receive).

[Sperm-Doll Setsuna]

It's medical treatment. How much info does your doctor give you when prescribing something? I've always simply got a "here's a prescription for that see how it works", whether or not it was a placebo I don't know or care. If it really rankles you for some reason express that you don't want any placebos and you won't get given any (but you may just be limiting the treatment you can receive).

Proscribing antibiotics where they aren't effective is quite a serious problem though, whatwith all the extra exposure giving rise to growing resistance.

[GiantMonkeyMan]

Part of me thinks that maybe doctors get a lot of patients who seem overly worried about something that they shouldn't really worry about and so they give the patients something that won't effect them either way just to make the patient less stressed. Every time the BBC has some news story about some new killer flu, I'm sure a host of middle-class toffs head straight for their GP.

[hatzel]

As Kenco says, calling all placebos 'fake medicine' is pretty misleading, because it's not necessarily 'fake medicine,' it's simply 'medicine.' If somebody comes in complaining about...I dunno, erectile dysfunction or something like this, and you suspect it has a psychological rather than physiological origin, you might give them a placebo and then they may be able to achieve erection again; that certainly doesn't deserve to be called 'fake medicine,' because it's standard medicinal practice achieving the desired results, that is to say it's medicating the patient...

Considering the article only mentions one specific case ('antibiotics for suspected viral infections') and doesn't even give any indication of how widespread that is - if even one isolated person did this in one isolated case, it would still be enough to call it 'one of the placebo treatments identified in the study' - I don't really feel there's enough information to decide either way whether or not this is worthy of public outrage or whatever else people might use this for. To be honest these cases usually only show that the general population is still at least partially enthralled by some largely outdated medical ideology that those working in the field itself dropped decades ago when it became apparent that it was inaccurate and kinda chauvinistic sometimes (anybody with a passing knowledge of medical anthropology may be able to explain this to you), not to mention potentially damaging...or maybe I've just read too much Illich, who knows?

Random point of comparison: I remember seeing a documentary a little while ago about that town in New York State where a bunch of girls developed Tourette-like ticks (perhaps you remember the story). The reason I bring this up is because when a doctor suggested it was psychosomatic and could be tackled with therapy, the mother of one of the girls got pretty indignant and started saying stuff like 'you think she's pretending? This is real, she needs drugs, give her drugs and injections to cure her!' and so on. Two issues should instantly jump out here: 1) the idea (long since discredited, if in fact it was ever really credible) that medical complaints must necessarily have a purely physiological basis, must be the direct result of some infection or virus or so on, with psychological causes considered as somehow less legitimate, 'made-up,' 'imaginary' etc., thereby making light of psychological and mental illnesses; and 2) the idea that these ailments - perhaps because of their (supposedly) physiological nature, perhaps not - must be cured by the direct intervention of various chemicals, drugs to fight the virus and so on, which - it could be argued - is a direct outcome of the process of increased medicalisation through the 19th and 20th centuries, but which is no longer adhered to by doctors, and rightly so. People - for some reason or another - tend to demand pills and injections for everything, therefore medical professionals have very little choice but to give them, so that the patients do not feel un-/undertreated, hindering their recovery in cases where there is (potentially) a psychosomatic origin. But that's a problem with medical ideology and the position of medicine in society, not necessarily with the individual doctors themselves working within it...

(By the way if you happen to have forgotten the ending of the Tourette's story: eventually the girls were largely cured, some through therapy, others by the administration of medicine which is widely considered to have actually had its effect as a placebo, given the fact that the others saw similar results without the drugs)

[Kenco Smooth]

Proscribing antibiotics where they aren't effective is quite a serious problem though, whatwith all the extra exposure giving rise to growing resistance.

It's an extremely serious problem and one which I think people need to be a lot more worried about. But it's essentially a different issue from the one of placebos. Antibiotics should be given out sparingly, end of. The fact that they are being used as placebos is a serious issue from this position, but the fact that placebos of some sort are being employed is not an issue in itself.

I hadn't read the linked bbc article and so did not know that it is the only placebo example listed. Shoddy journalism picking out the most dangerous potential practice. Here's the full (broad) list provided in the PLOS article.



Positive suggestions
Nutritional supplements for conditions unlikely to benefit from this therapy (such as vitamin C for cancer)
Probiotics for diarrhea
Peppermint pills for pharyngitis
Antibiotics for suspected viral infections [5] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-Fassler2)
Sub-clinical doses of otherwise effective therapies [32] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-deJong1)
Off-label uses of potentially effective therapies
Complementary and Alternative medicine (CAM) whose effectiveness is not evidence-based [33] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-Kaptchuk1), [34] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-Ernst1)
Conventional medicine whose effectiveness is not evidence-based [35] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-Smith1), [36] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-Ellis1), [37] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-Gill1), [38] (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058247#pone.0 058247-Imrie1)
Diagnostic practices based on the patient's request or to calm the patient such as

Non-essential physical examinations
Non-essential technical examinations of the patient (blood tests, X-rays)

[Tenka]

As Kenco says, calling all placebos 'fake medicine' is pretty misleading, because it's not necessarily 'fake medicine,' it's simply 'medicine.' If somebody comes in complaining about...I dunno, erectile dysfunction or something like this, and you suspect it has a psychological rather than physiological origin, you might give them a placebo and then they may be able to achieve erection again; that certainly doesn't deserve to be called 'fake medicine,' because it's standard medicinal practice achieving the desired results, that is to say it's medicating the patient...


Placebos can indeed be helpful for psychosomatic illness. Things like erectile dysfunction can have such origin. But placebos prescribed to, for example, patients with illness of a pathogenic origin, deserve to be called "fake medicine". Antibiotics for viral infection? Fake medicine, and contributing to a growing problem of antibiotic resistance among bacteria.

If it's known to be useless to treat something, but used anyway, it is in that case fake medicine. Prescribing things that you know have zero efficacy vis-à-vis the thing for which they're prescribed should cost you your license.


Complementary and Alternative medicine (CAM) whose effectiveness is not evidence-based [33], [34]

As should that! NCCAM is a joke and should have been dismantled in the 90s, along with whatever is the equivalent British organisation for giving quackery the state sanction.

[MarxSchmarx]

Placebo's are proven as efficient interventions.

I think it's important to note the qualifier "efficient". Not "optimal", much less "just" or "correct".


Part of me thinks that maybe doctors get a lot of patients who seem overly worried about something that they shouldn't really worry about and so they give the patients something that won't effect them either way just to make the patient less stressed.



Nor is the 97% figure shocking given that it's a figure of have you ever. There's nothing shocking about 97% of doctors at one time or another having undertaken common medical practice at least once (even then the criteria they use for 'placebo' are wide). The only thing worth taking from it is that the majority of doctors giving out homeopathic treatment believe it to be a placebo. Other than that I fail to see why this is getting the attention it is.

Well so the antibiotics for viral infections is one very real problem.

Even if we were to take something potentially more benign like homeopathy, however, I don't think this solves the problem at all. Even there, it seems the doc might as well tell the patients: "I'll sacrifice a chicken. This should appease Akatosh, who will right your illness".

But more than either of these scenarios, I think the most problematic part of this is that the medical doctors feel they can use the considerable respect and authority we as a society give to them to, as best I gather, mislead patients. This would be interpreted as usurping the bodily autonomy of patients in any other context; it is no more acceptable because the Royal College of Medicine or what have you feels the ignorant masses can be kept in the dark for their own good.

[Orange Juche]

It's not to "assuage" patients. Placebo's are proven as efficient interventions.

Huh? Any studies I've heard of indicate that placebos are equally as effective as if the patient was given nothing.

[Kenco Smooth]

Huh? Any studies I've heard of indicate that placebos are equally as effective as if the patient was given nothing.

Then you've not heard accurately of any studies. There's a reason clinical trials have to compare treatments against placebo rather than a non-treatment base rate.


I think it's important to note the qualifier "efficient". Not "optimal", much less "just" or "correct".

If you have any evidence that practitioners have been giving out placebos instead of better proven treatments then that'd be an issue. As it is there's no evidence of this and in the spirit of innocent till proven guilty I think it's fair to assume not the case, making placebos both efficient and "optimal".



Well so the antibiotics for viral infections is one very real problem.

Yes but not for the reason that it's a placebo treatment.



But more than either of these scenarios, I think the most problematic part of this is that the medical doctors feel they can use the considerable respect and authority we as a society give to them to, as best I gather, mislead patients. This would be interpreted as usurping the bodily autonomy of patients in any other context; it is no more acceptable because the Royal College of Medicine or what have you feels the ignorant masses can be kept in the dark for their own good.

Without an eye into the GP's room we can't know if this constitutes deception but I doubt it in the majority of cases. Not explicitly spelling out what a treatment consists of and the mechanism by which it works is typical and not in anyway a case of deception. If a patient asks for details and is then lied to that would be deception. If the patient doesn;t ask they've accepted the treatment within the bounds of ethical behaviour (which placebo treatments fall into).

[black magick hustla]

a doctor once gave me antibiotics for a virial infection....

he didnt realize i have an internet connection tho lmao