There is a reason that I use the term Placebo in my "brand" of products (journal, gazette, blog, television, book). There is a lot of power in the placebo. It means "to give pleasure to". I don't, however, knowingly give placebos to my patients. A new survey, which is getting a lot of headlines lately, states that 60% of U.S. physicians think that prescribing placebos is ethically permissible. This Boston Globe piece, one of many articles written about placebos in local papers, was able to throw the terms "not honest", "disturbing", "if doctors just spent more time", "not trust the doctor" and much more around in another attempt to bad mouth physicians. We are in a pessimistic time in our country so I guess I will have to try and defend against "doctor bashing" some more. Sorry. Four years ago I wrote about doctors in Israel using placebos. The numbers were strikingly similar to this study. Let me highlight what I wrote then:
- "up to 60% of Israeli doctors often give inactive "placebo" pills to their patients and, in most cases, tell them they're getting a real drug"
- "94 % of placebo users found the inactive agents to be generally or occasionally effective"
- "I would love to be able to use placebos here in the United States but I just know a dozen or so of my patients would become addicted to them."
The truth is that I still don't use placebos but I can see why doctors do. As explained in the study, some doctors give antibiotics for viruses just to make the patients feel like they have been treated. Supposedly, as some other studies have show, if doctors would just explain the pathophysiology of why these medications don't work, then patients would understand and this practice of over prescribing antibiotics would stop. Maybe. I recently had a patient, who was trained to be on antibiotics for past viruses, come in for a cold. The exam was stone cold normal but she needed something because of an engagement out of town later in the week. I spent 10 more minutes explaining how this was a virus, how a virus differs from bacteria, how antibiotic resistance is a growing problem and how some OTC meds and even herbal remedies would be cheaper and better in the long run. She was not satisfied. I dug in my heels and apologized for not meeting her needs. Through my EMR I found out that she went to another doctor two days later and got some Zithromax.