week 11 assignments

Last class we discussed the article, 'Most family doctors' have given a patient a placebo drug’ written by Michelle Roberts. The article discusses the practice of family doctors giving placebos to their patients. The article stated that, “in a poll, 97% of 783 GPs admitted that they had recommended a sugar pill or a treatment with no established efficacy for the ailment their patient came in with.”

This article elicited various responses from the class. I felt like the conversation was hampered by our superficial understanding of the definition of placebo and our willingness to distill the various ethical issues associated with the practice of prescribing placebo down to a simple dichotomy of ‘good or bad.’

A placebo, by definition, is intended to deceive the recipient. In drug trial studies the participant consents to being given either the active form of the drug or an inactive sugar pill. Physicians also have the authority to prescribe prescription medication or sugar pills as placebos to their patients with, or without the consent. On occasion, participants in drug efficacy studies or patients given a placebo treatment will have a perceived, subjective or actual improvement in a medical condition, a phenomenon commonly called the placebo effect.

Like many of my classmates I believe that the power of thought greatly influences our capacity to heal. However, I believe that it is ethically problematic to mislead, manipulate or fool patients. Deceiving a patient disempowers them from having agency in their own health. The argument against this may be that they then may not heal, and while this may be true, health care providers still should not exercise this type of control/ power.

Additionally, (though I agree with neither) there is a significant difference between prescribing a sugar pill and prescribing an antibiotic. A sugar pill has little consequences compared to an antibiotic, which indiscriminately kills intestinal flora and weakens the immune system.

The story in class regarding the small child being given ice cream after being injured/ traumatized, illustrated good medicine and proper care- not a placebo or placebo effect.  This example illustrated exactly what good care should look like- the treatment met the physical and physiological needs of the patient and the patient consented to the care.

Biomedicine as practiced in the west, relies heavily on pharmaceuticals even when the function and total effect on the body is often unknown. The mechanism of action of most of the psychiatric drugs being prescribed in the u.s. is unclear and yet one in five adults is now taking at least one psychiatric drug such as antidepressants, antipsychotics and anti-anxiety medications.

Because it is normalized to prescribe and consume drugs that are not fully understood, the practice of prescribing placebos is logical and rational within the western paradigm of healthcare. However, this is not to say that this practice is ethical. In the clinical setting, the use of a placebo without the patient’s knowledge compromises the patient-physician relationship and may result in medical harm to the patient.

This is not to say that placebos should never be used, instead physicians may use placebos for diagnosis or treatment if the patient is informed of and consents to its use. It is always the healthcare providers responsibility to respect the autonomy of their patients.