I should have one of those counters on my blog that reflects how many days I have gone without reading more than 1-2 medblogs a day, except the ones on Bloglines, which aren't as fun because I can't read the comments. A side effect of not reading the medblogs is that I write more, which explains the sudden appearance of more posts on my blog.
One of my favorite Andy Griffith episodes is the one where the new pharmacist (Andy asks her if Ph.G means pharmacy gal) won’t give a little old lady her “medicine” without a prescription. The medicine costs a dime and the lady goes downhill quickly when she can’t get it. Of course, it turns out it was only a sugar pill, the little old lady gets her medicine and everyone lives happily ever after (except for the pharmacy gal, I think Andy must have eventually dumped her for Helen Crump).
I’m supposed to be working tonight, but I stumbled onto this little article by accident and now I can’t let it go. I’ve heard of the “placebo effect” and I know placebos are used in drug studies. I don't doubt the power of a placebo, I was just surprised to learn that, according to this article, doctors really used placebos in the treatment of their patients.
BACKGROUND: The placebo and the placebo effect are often investigated in the context of clinical trials. Little data exist on the use of placebos in the course of routine health care. OBJECTIVE: The aim of this study is to describe a group of academic physicians' use of placebos and their knowledge, attitudes, and beliefs about placebos and the placebo effect. DESIGN: A 16-question anonymous web-based survey of physicians from Internal Medicine departments of 3 Chicago-area medical schools was used. RESULTS: There were 231/466 (50%) physicians who responded; of these, 45% reported they had used a placebo in clinical practice. The most common reasons for placebo use were to calm the patient and as supplemental treatment. Physicians did not widely agree on the definition of a placebo and had a variety of explanations for its mechanism of action. Ninety-six percent of the respondents believed that placebos can have therapeutic effects, and up to 40% of the physicians reported that placebos could benefit patients physiologically for certain health problems. Only 12% of the respondents said that placebo use in routine medical care should be categorically prohibited. Regarding "placebo-like" treatment, 48% of respondents reported giving at least 1 type of treatment in a situation where there was no evidence of clinical efficacy. CONCLUSION: Nearly half of the respondents use placebos in clinical practice and most believe in the mind-body connection. The results of this study, based on retrospective self-reported behavior, are subject to recall bias and may not be representative of American physicians. PMID: 17994270 [PubMed - in process].
I don't know, though. I think I would be pissed if I found out a doctor gave me a placebo, especially if I had to pay more than a dime for it. [What? No one asked me why I would be pissed, since I was "cured"? and, if I were cured, why would cost matter?] So now, instead of researching “lien stripping”, I want to research placebos. If physicians use placebos in their medical practices, then that must mean there is a placebo industry. Do the pharmaceutical companies manufacture placebo pills or does the pharmacist just go to the backroom and break open a box of TicTacs? Is there an official name (or better yet, a secret code name) for placebos, or does the doctor write “sugar pill” in Latin? How much do the pills cost? Or do doctors just hand them out as "samples." Do doctors ever openly admit to prescribing placebos or is this one of those deep dark doctor secrets? What do the medical schools teach about placebos? Can they use Splenda instead of sugar? Liability issues?