Tuesday, September 11th 2012

Who Cares About The Physiology

Long before I read this excellent post from Dr. Karen Rommelfanger, I’ve also wondered about the lack of intentional use of placebos in patient treatment. Not that in clinical practice the prescription of placebos doesn’t happen, because it does. Maybe not with maliciousness or whole intention, but I can think of situations where say a patient with poorly controlled, poorly explained symptoms requests a therapy with low harm but low or no efficacy just as a matter of appeasement. Studies certainly back up the idea that physicians use placebos.

While the ethical arguments against the intentional use of placebos are well spoken, I think the issue is becoming less and less black and white within the bioethics community. Beyond Dr. Rommelfanger’s piece, here is a piece by Michael Brooks in The Guardian.

Giving a placebo is not the same as doing nothing, which means that sometimes prescribing a placebo is better than doing nothing. People are not biochemical versions of computer programs, where a particular input will give a particular output. Being a doctor isn’t about being handcuffed by evidence-based medicine, it’s about using skilled judgement in tandem with the best available evidence – including evidence about the efficacy of placebos.

Placebos are not without there downsides for sure. There is a level of deception in adding legitimacy to patient’s with psychosomatic symptoms. Considering the lack of success in strategies that attempt to convince Conversion disorder victims they are not sick however, placebo therapies deserve a consideration. I think there is a way to describe potential placebo treatments to patients so that they understand risk-benefits, the key element in making an informed decision, without describing the strategy as a placebo.

Intentional placebo therapies deserve consideration in some scenarios and shouldn’t be painted off as completely unethical.