Are The Placebos That Doctors Give Us Dangerous?

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Are The Placebos That Doctors Give Us Dangerous?
Are The Placebos That Doctors Give Us Dangerous?

Video: Are The Placebos That Doctors Give Us Dangerous?

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Video: Should Doctors Prescribe Placebos? 2023, January
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Are the placebos that doctors give us dangerous?

All over the world, doctors are giving placebos to their patients. We figured out how often and why they do it, how correct it is from the point of view of ethics and what are the potential benefits and harms of such appointments.

Are the placebos that doctors give us dangerous?
Are the placebos that doctors give us dangerous?

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All over the world, doctors are giving placebos to their patients. We figured out how often and why they do it, how correct it is from the point of view of ethics and what are the potential benefits and harms of such appointments.

What is a placebo

Placebos (pacifiers) are substances and interventions that have no therapeutic effect. An inert placebo does not “work” from a pharmacological point of view. But it can have an effect that is associated with the patient's expectations of the treatment. The placebo effect, however, does not exist only in the imagination. Instrumental methods have shown that taking a pacifier can induce various neurobiological responses in the body. For example, with placebo pain relief, opioid receptors in the brain respond, dopamine is produced, and there is a decrease in the activity of structures that are responsible for the perception of pain.

An active placebo is a drug that may work for certain diseases but are prescribed for conditions that they cannot treat. Prescribing antibiotics for viral infections is a typical example of this type of pacifier.

Placebo is only approved for clinical trials of drug efficacy and safety. It is not recommended in any treatment guide for any disease. But in real life, it is very often prescribed in one form or another.

How often do doctors prescribe a placebo

There are many studies that focus on the use of placebos by healthcare professionals. In 2010, their analysis showed that it is periodically prescribed by 17-80% of doctors and 51-100% of nurses.

USA

In the United States, according to surveys, about half of interns, rheumatologists and family doctors regularly give patients placebos, including over-the-counter medications, antibiotics, and sedatives.

Germany

In 2012, it became known that 88% of German doctors had used a placebo at least once. More often these were active placebos. On average, each of them did it 20 times a year.

Great Britain

A 2013 British study found that 97% of physicians had ever used an active placebo. 77% of doctors did it on average once a week.

Australia

In Australia, a survey found that 39% of general practitioners prescribed inert placebos at least once. Active placebos were used by three quarters of the specialists. 42% of these prescriptions were for antibiotics.

Russia

Yaroslav Ashikhmin, candidate of medical sciences, believes that Russian doctors often prescribe placebos, but does not provide data. There are reasons to think so. In response to regular prescriptions of drugs without proven efficacy (ie, active placebos) by doctors, Evidence-Based Medicine advocates created a Drug Firing List.

Why do doctors prescribe a placebo

According to various studies, doctors prescribe placebos in response to patients' unreasonable demands for a certain drug, in an attempt to meet the patient's expectations and calm him down to avoid conflict. Medical reasons are also possible: hope for a placebo effect (that is, a positive effect), prescribing pacifiers for vague complaints, use for diagnostic purposes. When prescribing active placebos, doctors can simply trust that these drugs will be effective.

When and how a placebo works

Doctors have tried differently to adapt the placebo effect to benefit people. There were regular reports of its effectiveness in various branches of medicine: surgery, cardiology, psychiatry, primary care. The number of diseases and symptoms for which scientists have tested placebos is in the tens.

Placebo usually acts on conditions in which a person's perception of them (pain, nausea) plays an important role. But there are exceptions: it has shown some effectiveness in improving motor (motor) function in Parkinson's disease.

The effects that placebos have shown in scientific papers have been regularly questioned. Some scientists point out that in studies it is very difficult to separate the placebo effect from the natural course of the disease, in which moments of relief may occur.

A 2001 Cochrane Fellowship Review reports that scientists found "little evidence that placebos overall have strong clinical effects." The exception was "significant effects" on people's perception of pain. According to the Cocrane team, placebo cannot be recommended for use in medical practice.

Subsequent reviews, in 2003 and 2010, repeated these findings. But since then, a lot of new scientific information has accumulated. It should also be noted that the methods of analysis used by the leading authors of the Cochrane reviews have been criticized. It is believed that their data underestimates the effects of placebo.

Is it ethical to use a placebo

Despite the de facto widespread use of placebos in medical practice, it is practically not regulated by anything. The American Medical Association provides ethical guidance. They say that the doctor, when prescribing a placebo, must explain why he is resorting to this measure and obtain the patient's informed consent. After that, the doctor may not say exactly when he gives the placebo. It is not recommended to give placebo for the purpose of sedation of severe patients. The document indicates that such an action may put the doctor's comfort ahead of the patient's benefit.

Israeli scientists note that the use of a placebo may be justified. They emphasize that the physician's material interest in such an appointment should be excluded. It is also wrong to give a placebo instead of the likely effective real drug, and it is unethical to withdraw it if it helped the patient.

A placebo can act when we know about it

The ethical prescription of a placebo involves informing the patient. Will a placebo effect occur if a person knows they are being treated with a dummy? In some cases, yes.

"Fair" use of placebos has shown some effectiveness in certain conditions. In experiments, it eased the manifestations of irritable bowel syndrome, lumbago, and chronic back pain.

By prescribing a placebo, a doctor may violate the oldest principle of medical ethics: simply harm. Active pacifiers can have side effects and interact with other medications. The unnecessary use of antibiotics is one of the most important reasons for the development of antibiotic resistance.

Placebo use in clinical practice can be both beneficial and harmful. The rules that govern its administration will increase patient safety.

Nocebo

Completely neutral and safe substances can also cause undesirable reactions, they can make people worse. This is the so-called nocebo effect. It develops in patients who expect treatment to make them worse

In an experiment, 50 people with chronic back pain were divided into two groups. Half of the patients received a placebo with a warning that the pain might get worse, the other half were given a pacifier and said that it would not affect the pain. Pain scores in the first group were significantly higher.

The effect of nocebo is varied: it can cause side effects of drugs and even withdrawal symptoms.

As with the placebo effect, the nocebo effect is not the result of the pharmacological action of the prescribed substance. Scientists have discovered some of the physiological mechanisms behind it. For example, they were able to identify a neurotransmitter responsible for increasing pain in the nocebo effect and were even able to block it.

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