Tuesday, January 29, 2008

When is a Painkiller Not a Painkiller? A Patient's Right To Choose

Most patients trust their doctors. If prescribed a treatment, therapy or drug, many would not question the necessity, or authenticity of the physician's advice or prescribing strategy.

Indeed. In a study published this month in the Journal of General Internal Medicine, of 466 physicians surveyed at medical schools in the Chicago-area, 45% admitted to prescribing placebos to patients without the patient's knowledge, a practice striking at the very heart of Western medical ethics: informed consent.

Even more startling, one in five doctors admitted to actually lying to patients, claiming the placebos were medication, in clear violation of American Medical Association (AMA) guidelines, which directs its members to use placebos only if the patient is aware of and agrees to it.

Perhaps some might argue that the issue is not that significant--since placebos are viewed as harmless--but just how important is it? Particularly in terms of the doctor-patient relationship? Others might argue it raises major trust issues, and even a violation of patient rights.

See the full Time.com article here.

11 comments:

Sue Trinidad said...

This *is* an interesting report--but I'm not sure I agree with your analysis. The trick about placebos is that, in order for them to work, the patient must believe that she (or he) is receiving treatment. Placebo has shown to relieve patients' subjective symptoms in certain cases, and it's unclear to me that physicians should be barred from using this strategy in situations where conventional treatment has been ineffective.

Kevin B. O'Reilly said...

AMA policy is that the placebo effect can still be achieved by obtaining patients' consent to use placebos ahead of time but then varying the time of administration. For more information, see my article about this study in American Medical News (http://tinyurl.com/382qpb).

Sue Trinidad said...

Kevin, thanks for the info and link. Isn't there still disagreement about this, though, in the broader community? I'm trying to remember what Howard Brody's book on the placebo effect argues....

Kelly Hills said...

Oi.
Oi.

As someone who suffers from a severe, debilitating and degenerative chronic pain problem, if I found out that during the diagnose process I'd been assigned placebo when I could have been out of pain that much sooner, I'd... I'd get on the phone with my back pocket lawyer and see what options were available to me.

I do understand the feeling that you might need a sugar pill to give a kid with the flu who's parent is insisting on antibiotics, and those sorts of things - but if someone is genuinely having issues,.. yeah, it makes me see red.

(And I realize that it was a study that showed the pain/placebo thing, and recognize a study is valid - people were given a choice. People who are going to their doctor in order to be cured, however, are going there on a trust that should not be violated - especially when it turns out the doctor is wrong in their diagnosis.)

Wanda Reese said...

Sue,
Not sure what you mean by not agreeing with my "analysis". I took no position on the issue, just put questions on the table for consideration or argument for those reading the post, and possible arguments that may or may not be raised by those either advocating or against placebos or their use.

Like anyone I do have my own personal opinions on the value of placebos, but I can't and don't speculate for the purposes of this blog on the right or "wrong" for other patients, or the value judgments made by the doctors involved in the survey. As a former journalist, I avoid taking personal positions on these issues, but see myself as trying to stimulate thought and discourse on a topic.

I worked with Howard Brody during my tenure at Michigan State University, and can't recall either all of the points from his book.

Daniel Goldberg said...

Dr. Brody (the Director of the Institute for Medical Humanities, where I am a graduate student )was recently profiled on NPR regarding placebos:

http://www.npr.org/templates/story/story.php?storyId=17792517

Also, for those who are interested, Adam Kolber has an excellent article critiquing the AMA's position and arguing that benevolent deception can be ethical:

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=967563

Sue Trinidad said...

Wanda, sorry--didn't mean to offend! You're absolutely right: your post just reports what the Time article said, without additional commentary. That said, I don't think there's anything wrong with taking a position on ethical issues, here or elsewhere. Making and defending arguments is what it's all about, as far as I can tell. Anyway, my apologies.

But on to the placebo question! Kelly, I agree with you, but I'd want to say that placebo in research (as in a control group vs intervention group) is a completely different deal from placebo as treatment (ie, when no other solution has worked for the patient).

And I'll have to check out the Kolber article--thanks for the ref, Daniel.

And, finally, let's hear it for Howard Brody! Full disclosure: I studied with him too, at Michigan State. It's like old home week ... ;-)

Kelly Hills said...

Sue - the problem I have with placebo when "nothing else has worked for the patient" is that doctor's often jump to this conclusion without trying every drug combination, or by trying to "prove" that their patient is just drug-seeking, a problem that a lot of people with complicated chronic illnesses have. It's hard enough to fight the stereotype that I'm really just a smart junkie - to find out my doctor bought into that to the degree of trying to fool me to catch me just... really irritates me, even in thought.

Sue Trinidad said...

Ahh, gotcha. Yes, right--that would clearly be a derelict practice.

It makes me wonder how often this kind of thing happens, and how we would ever get that data...

Wanda Reese said...

Sue,
No offense taken. Simply making the point that I take no public position on these issues as a poster/blogger.

My comments were also not meant to be critical of those who do choose to take a side in their posts. It's a free country. I simply choose to take a more neutral position here, and allow the readers to make and express their own judgments. Personal conversations are a different matter. Old (journalistic)habits die hard.

Yes, kudos to Howard. It was a pleasure to be a colleague, especially being an MSU alum. Very knowledgeable scholar.

Kevin B. O'Reilly said...

Ms. Trinidad, you're right that there's debate within the physician community about whether the deceptive use of placebos is acceptable. The survey results demonstrate that very well.