Placebos

[USS Monitor]

Ahoy NSG.

Here's a question for you: Is it ever ethical for doctors to prescribe placebos?

Obviously, if you have a medication that works better than placebo, you should use that. But what if your patient has a condition for which there is no effective treatment? Or what if they are suffering from a problem that appears to be psychosomatic? Do you prescribe them sugar pills under some fake name, on the theory that the placebo effect might make them feel better? There is a chance that it could help them.

Or is honesty more important than whatever benefit the patient might get in this scenario?

This is a tough one for me because it has the potential to improve the patient's quality of life, but it also has the potential to undermine trust and it could backfire if you've misdiagnosed someone.

[Kilobugya]

I understand the desire to help the patient even if it's by lying, but I think in the long-term it's more important to keep the trust between the doctor and patient, both at the individual level and at society level.

The only exceptions might be some cases of mentally ill patients who can't really tell reality from fiction anymore, but even then it just feels wrong.

[Bombadil]

I went to a doctor once who said I've found The Cure for you, turns out he was lying and it was just Placebo.

..because isn't laughter the best medicine..?

[USS Monitor]

I went to a doctor once who said I've found The Cure for you, turns out he was lying and it was just Placebo.

..because isn't laughter the best medicine..?

You mean the bands? I actually like Placebo better. The Cure was the band that every music recommendation algorithm always thought I would like, but most of their songs just grate on my nerves.

[The Hazar Amisnery]

paracetamol is technically a placebo because it doesn't isn't very strong and it is only really useful in stuff like post surgery pain. It doesn't really work on headaches or migraines alone but people still sell it and buy it a lot. People overdose and die because they aren't effective. Something like Aspirin or Ibuprofen works better.

[Dofelkvic]

aren't they bound to do their best to treat a person's illness, if so then placebo would appear to be the right choice. I assume that they are undergoing placebo treatment because recent data from their medical chart or something suggests that it works for them if no then the doctor is just being stupid continuing this treatment even though medical data suggests otherwise.

[Kilobugya]

paracetamol is technically a placebo because it doesn't isn't very strong and it is only really useful in stuff like post surgery pain. It doesn't really work on headaches or migraines alone but people still sell it and buy it a lot. People overdose and die because they aren't effective. Something like Aspirin or Ibuprofen works better.

Paracetamol is a relatively efficient painkiller and works much better than a placebo for alleviating the symptoms of a mild cold, altitude sickness and some headaches (but not all of them, depends a lot of the person and the root cause). It is dangerous for the liver if you abuse of it, an adult should never take more than one gram every 6 hours (less for a child).

Aspirin is an anticoagulant and you should be very careful with it. I for example cannot take it or I get my nose bleeding.

Ibuprofen is stronger than paracetamol, but tends to have stronger side effects, especially on the digestive system. It's recommended to only take it during a meal.

[Bombadil]

I went to a doctor once who said I've found The Cure for you, turns out he was lying and it was just Placebo.

..because isn't laughter the best medicine..?

You mean the bands? I actually like Placebo better. The Cure was the band that every music recommendation algorithm always thought I would like, but most of their songs just grate on my nerves.

*tries to think of joke along the lines of 'The Cure is worse than the disease..*

I think you have to be careful about where you're using placebos, and certainly not use them because you think it's a psychosomatic issue when it's not - I vaguely read through something on the shockingly low diagnoses of something called.. endo *goes to google* metriosis - where..

The severe pain and bleeding and other incapacitating symptoms that often accompany endometriosis mean that the life quality of those who live with this condition is impacted in serious ways.

Despite this, it can take anywhere between 4 and 11 years for women to receive the correct diagnosis, and as many as six out of every 10 cases of endometriosis may remain undiagnosed.

I had a recurring foot pain when young, and doing a lot of sports, for which the doctor gave me pills that did nothing in the idea that it was overblown, turned out after going to a specialist it was a fairly serious spine issue.

So I'd be really wary of using placebos despite the evidence they do clearly work on perception issues - for example the brain perceives pain in its own way to some extent - I snapped a bone out of my finger and felt absolutely nothing at all.. clearly my brain went 'woah, TMI, shut down nerves..', but stubb my toe and it's 'inject the morphine stat!'.

Long story short, fine but be really wary and use for one or two times alone because if the condition persists then probably worth looking more deeply at the issue.

[Chan Island]

I think it's ethical to prescribe placebos in some scenarios. For example, there are some "diseases" that are entirely imaginary (even though they create real symptoms... humans are weird) and a placebo is a quick & harmless way to "cure" them.

My real thought is about hypochondriacs. Would it be ethical to prescribe them placebo medication? Since their whole issue is worrying about being sick when they are not, giving them a placebo may help sooth that anxiety, but on the other hand equally may feed into their paranoid delusions. This one I don't know, and I'm curious to see what NSG makes of it.

[USS Monitor]

paracetamol is technically a placebo because it doesn't isn't very strong and it is only really useful in stuff like post surgery pain. It doesn't really work on headaches or migraines alone but people still sell it and buy it a lot. People overdose and die because they aren't effective. Something like Aspirin or Ibuprofen works better.

Paracetamol is a relatively efficient painkiller and works much better than a placebo for alleviating the symptoms of a mild cold, altitude sickness and some headaches (but not all of them, depends a lot of the person and the root cause). It is dangerous for the liver if you abuse of it, an adult should never take more than one gram every 6 hours (less for a child).

Aspirin is an anticoagulant and you should be very careful with it. I for example cannot take it or I get my nose bleeding.

Ibuprofen is stronger than paracetamol, but tends to have stronger side effects, especially on the digestive system. It's recommended to only take it during a meal.

You know what else alleviates altitude sickness and won't mess up your liver? Coca. We should legalize that.

I gotta be careful with aspirin too.

[USS Monitor]

You mean the bands? I actually like Placebo better. The Cure was the band that every music recommendation algorithm always thought I would like, but most of their songs just grate on my nerves.

*tries to think of joke along the lines of 'The Cure is worse than the disease..*

I think you have to be careful about where you're using placebos, and certainly not use them because you think it's a psychosomatic issue when it's not - I vaguely read through something on the shockingly low diagnoses of something called.. endo *goes to google* metriosis - where..

The severe pain and bleeding and other incapacitating symptoms that often accompany endometriosis mean that the life quality of those who live with this condition is impacted in serious ways.

Despite this, it can take anywhere between 4 and 11 years for women to receive the correct diagnosis, and as many as six out of every 10 cases of endometriosis may remain undiagnosed.

I had a recurring foot pain when young, and doing a lot of sports, for which the doctor gave me pills that did nothing in the idea that it was overblown, turned out after going to a specialist it was a fairly serious spine issue.

So I'd be really wary of using placebos despite the evidence they do clearly work on perception issues - for example the brain perceives pain in its own way to some extent - I snapped a bone out of my finger and felt absolutely nothing at all.. clearly my brain went 'woah, TMI, shut down nerves..', but stubb my toe and it's 'inject the morphine stat!'.

Long story short, fine but be really wary and use for one or two times alone because if the condition persists then probably worth looking more deeply at the issue.

Yeah, if the placebo doesn't work, you should go back to the drawing board and see if there is something you missed or another treatment you can try. That's a good idea with any treatment that doesn't work.

[Kilobugya]

You know what else alleviates altitude sickness and won't mess up your liver? Coca. We should legalize that.

Indeed, I do use coca leaves (as tea mostly) when I go to the Andes in Ecuador, Bolivia or Peru where they are legal. But when I do a sudden Paris-La Paz (50 to 3900 m) or even Paris-Quito (50 - 2900 m) sometimes I use both coca leaves and a bit of paracetamol.

[Risottia]

Ahoy NSG.

Here's a question for you: Is it ever ethical for doctors to prescribe placebos?

Yes.
The placebo effect is a well-documented and well-known phenomenon. If a patient can be cured without the need for actual drugs, why not?

[Australian rePublic]

Tough one, you don't want to errode trust, but at the same time, you don't want to give someone medication that they don't need. This is especially true if the person is a hypercondriac who is wary of taking tablets, the former would be the most likely to suffer from psychosomatic illnesses in the first place

[Kilobugya]

The placebo effect is a well-documented and well-known phenomenon. If a patient can be cured without the need for actual drugs, why not?

Because it'll damage the trust between the doctor and the patient if the patient ever figures it out and it'll globally damage the trust the people have in the medical establishment, and feed all kind of conspiracy theory and legitimate "alternative medicine" (such as hemeopathy) quacks.

So on the long term it's likely to do damages both at individual level and at society level.

[An Alan Smithee Nation]

How much do they charge for a placebo? I'm guessing expensive placebos work better than free ones.

[Dogmeat]

In the case of sugar deficiency, a sugar pill would be acceptable.

[Xmara]

I would say it’s ethical. In fact I know of an example.

My uncle had to go to the cardiologist and had to have some kind of scan (I think it was an MRI). However, my uncle was severely claustrophobic and could not handle being put into a tiny tube like that. So, the cardiologist told him that he could give him a mild sedative to relax him long enough to have the scan. He gave my uncle the pill, and my uncle was able to have the scan without having a panic attack. After the scan, the cardiologist revealed that the pill he gave my uncle was just a sugar pill, and the sedative effects were all in my uncle’s head.

[Kilobugya]

I would say it’s ethical. In fact I know of an example.

My uncle had to go to the cardiologist and had to have some kind of scan (I think it was an MRI). However, my uncle was severely claustrophobic and could not handle being put into a tiny tube like that. So, the cardiologist told him that he could give him a mild sedative to relax him long enough to have the scan. He gave my uncle the pill, and my uncle was able to have the scan without having a panic attack. After the scan, the cardiologist revealed that the pill he gave my uncle was just a sugar pill, and the sedative effects were all in my uncle’s head.

But the problem is that later on your uncle is much less likely to trust whatever the doctor says, which can rank from mild consequences (no placebo effect next time) to much more serious issues, like the uncle not taking a really needed drug believing that it's a placebo too. Trust is easy to damage, hard to repair, and the consequences of damaged trust can be very bad.

[Unstoppable Empire of Doom]

I have a friend who had a patient years ago. A kid maybe 7 or 8 years old. His mother took him to see my friend once a week with a new phantom ailment. So he would occasionally prescribe a placebo. The reason was he could run scans and tests over and over again. Poking the kid with needles seemed cruel though and repeated x-rays could cause cancer.

[Kilobugya]

I have a friend who had a patient years ago. A kid maybe 7 or 8 years old. His mother took him to see my friend once a week with a new phantom ailment. So he would occasionally prescribe a placebo. The reason was he could run scans and tests over and over again. Poking the kid with needles seemed cruel though and repeated x-rays could cause cancer.

Ah yes, in this case it's probably justified. But I would report the mother to social services, such attitude will likely harm the child, and might actually be the sign of some even bigger problem in the household.

[Xmara]

I would say it’s ethical. In fact I know of an example.

My uncle had to go to the cardiologist and had to have some kind of scan (I think it was an MRI). However, my uncle was severely claustrophobic and could not handle being put into a tiny tube like that. So, the cardiologist told him that he could give him a mild sedative to relax him long enough to have the scan. He gave my uncle the pill, and my uncle was able to have the scan without having a panic attack. After the scan, the cardiologist revealed that the pill he gave my uncle was just a sugar pill, and the sedative effects were all in my uncle’s head.

But the problem is that later on your uncle is much less likely to trust whatever the doctor says, which can rank from mild consequences (no placebo effect next time) to much more serious issues, like the uncle not taking a really needed drug believing that it's a placebo too. Trust is easy to damage, hard to repair, and the consequences of damaged trust can be very bad.

I think it’s a little late for that. He died in 2019 from pneumonia.

[Page]

I'm a consequentialist so as to a question of whether it is ethical to prescribe a placebo, like the question of whether it's acceptable to torture someone in a ticking time bomb scenario, my answer is yes it is ethical within the confines of this thought experiment but not necessarily ethical in the real world.

If tricking the patient by prescribing a placebo improves the patient's quality of life, then it is the right thing to do BUT there are implications for the wider world and undesirable consequences. Such a thing being common would greatly increase distrust in medicine and if everyone becomes vigilant of the fact that the drug they are taking is a placebo, then placebos will be much less effective and their utility is lost.

I would also note that if a person is paying for the placebo, the fraud becomes more of a transgression transgression than if the placebo was given for free. And how would it really work? Would people actually be picking up placebos at Walgreens, is the pharmaceutical industry manufacturing inactive pills? It's bad enough that these parasites profit from sickness, we don't want to let them make even more money selling fake drugs. Although I don't think it is ethical to make people pay for real medicine anyway, but my point is that under capitalism, selling placebos is worse.

[USS Monitor]

I'm a consequentialist so as to a question of whether it is ethical to prescribe a placebo, like the question of whether it's acceptable to torture someone in a ticking time bomb scenario, my answer is yes it is ethical within the confines of this thought experiment but not necessarily ethical in the real world.

If tricking the patient by prescribing a placebo improves the patient's quality of life, then it is the right thing to do BUT there are implications for the wider world and undesirable consequences. Such a thing being common would greatly increase distrust in medicine and if everyone becomes vigilant of the fact that the drug they are taking is a placebo, then placebos will be much less effective and their utility is lost.

I would also note that if a person is paying for the placebo, the fraud becomes more of a transgression transgression than if the placebo was given for free. And how would it really work? Would people actually be picking up placebos at Walgreens, is the pharmaceutical industry manufacturing inactive pills? It's bad enough that these parasites profit from sickness, we don't want to let them make even more money selling fake drugs. Although I don't think it is ethical to make people pay for real medicine anyway, but my point is that under capitalism, selling placebos is worse.

How much do they charge for a placebo? I'm guessing expensive placebos work better than free ones.

There might be some situations where you need to charge money to make it convincing, but there is no reason to charge large sums of money. It should always be cheap or free. If it was something like Xmara's claustrophobic uncle, then there's no reason to bill him. The cardiologist already fessed up after doing the scan.

I'm not sure how much it would affect people's trust. It might have an effect, and that's a legitimate concern, but a lot of people seem to believe what they want to believe, regardless of what is actually going on. Some people would still trust doctors regardless. Some people will never trust doctors no matter what. And then there's a spectrum in between where people have varying levels of trust, and I don't know how many people are in the middle of the spectrum where the use of placebos could change their minds. The abuse of opioids doesn't seem like it inspired people to be very cautious about prescription pills.

[Krasny-Volny]

Ahoy NSG.

Here's a question for you: Is it ever ethical for doctors to prescribe placebos?

Obviously, if you have a medication that works better than placebo, you should use that. But what if your patient has a condition for which there is no effective treatment? Or what if they are suffering from a problem that appears to be psychosomatic? Do you prescribe them sugar pills under some fake name, on the theory that the placebo effect might make them feel better? There is a chance that it could help them.

Or is honesty more important than whatever benefit the patient might get in this scenario?

This is a tough one for me because it has the potential to improve the patient's quality of life, but it also has the potential to undermine trust and it could backfire if you've misdiagnosed someone.

The use of placebos, I feel, is acceptable among laymen who are not physicians. You don't go to a physician to get a placebo; in fact, by the very act of visiting a physician you're declaring that you don't want any kind of placebo, you want frank, professional advice from a licensed professional qualified to give that medical advice.

I have my own little remedies for various things that I'm 99% sure no documented evidence exists to prove they have an effect one way or another on whatever they're being used to remedy. There's no telling how much of it is chalked up to placebo effect, and I really don't want to know.

For example: Granny used to make this dark, bitter, concoction she called "medicine soup" for the common cold. Don't know what she put in it, but if I drank a couple bowls of the stuff my cold symptoms went away within 8-9 hours. It had the same effect as taking commercial acetaminophen. I'll swear by that horrible stuff until the day I die, but it could've been a placebo (at least in part). I don't care if it is or not, because Granny wasn't a doctor.

It's worth noting my mother knew the recipe too, but generally prefers to see a doctor and get professional advice and/or medication if she's feeling poorly.