Doctors prescribe drugs that don't work ("But what surprised us was the most commonly prescribed placebos were antibiotics ...)


Doctors prescribe drugs that don't work
By RUTH HILL - The Dominion Post Last updated 05:00 04/07/2009

Three out of four New Zealand doctors have prescribed placebo
medications to patients, new research suggests.

Medical researcher Shaun Holt said the practice could be costing the
taxpayer several million dollars.

Of 157 doctors surveyed, 72 per cent admitted dishing out placebos,
including vitamins, herbal supplements, "harmless" medications, salt
water injections and sugar pills.

"But what surprised us was the most commonly prescribed placebos were antibiotics, which is obviously a concern because of the rise of
antibiotic resistance and potential side-effects for patients," Dr
Holt said.

A placebo is an inert medicine intended to lead the recipient to
believe that it may improve their condition.

Patients' unjustified demands for medication was cited as the most
common reason for prescribing placebos (34 per cent), followed by non-
specific complaints (25 per cent), and exhausting other treatment
options (24 per cent).

Dr Holt, who co-authored the paper in The New Zealand Medical Journal
with Massey University psychologist Andrew Gilbey, said he believed
placebos were ethical "as long as the doctor considers them to be in
the best interests of the patient". "The placebo effect is quite
powerful," he said.

A recent New Zealand survey suggested patients accept placebo use, at
least when there is no available alternative. However, given the
deception involved, it has been suggested that placebo use could harm
the doctor-patient relationship. The American Medical Association
warns that placebos are unethical and could expose doctors to
malpractice suits.

Other medical authorities claim placebos are bad because they
condition patients to believe that pills fix every ailment.

Dr Holt, who is calling on the Medical Council to issue guidelines on
placebos, said the total cost to taxpayers from placebos could be
"several million dollars" in subsidised GP visits, medicines and
pharmacy charges. "There could be an argument for bringing back sugar
pills, which are safer, just as effective and certainly cheaper."

Wellington Independent Practice Association chairman Richard Tyler, a Johnsonville GP, said it was "not what you give, it's how you give
it".

"A doctor that hands something over with a couple of grunts is not
going to get the same result as someone who listens to the patient,
explains the illness and the treatment. You can't separate that from
the placebo effect."

Pharmac medical director Peter Moodie said data showed doctors were
prescribing antibiotics responsibly. He agreed it was not acceptable
to waste money prescribing medicines with no effect.

Both the Health Ministry and the College of General Practitioners
declined to comment.

Ad Feedback PLACEBO EFFECT

A placebo is a sham medical intervention, such as a pill or even an
operation, intended to make patients believe it will help. If someone
thinks something will make them better, it sometimes does a phenomenon
known as "the placebo effect".

HOW DOES IT WORK?

Placebos are associated with the release of natural painkillers in the
brain, including dopamine. Taking a placebo creates a "self-
reinforcing feedback loop" in the brain: during pain an individual
recalls having taken the placebo and reduced pain reinforces its
status as a painkiller. About one-in-three people appear susceptible
to placebo effects.

NEGATIVE EFFECTS

The so-called "nocebo effect" occurs when patients taking placebos
develop side-effects associated with real treatment. Some patients
suffer withdrawal symptoms when they stop taking placebos.

http://i.stuff.co.nz/national/health/2564342/Doctors-prescribe-drugs-that-don-t-work

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