What do the experts say...

The following seven quotes are supportive to my thesis that doctors should not use placebos. They collaborate with my subtopics regarding the ethics of using them, the dangers of using them, the price issue and the fact that there are alternatives to their use.

In the health section of the Los Angeles Times it was published that "placebos treatments, as defined by the researchers and the doctors they surveyed, go well beyond the popular notion of placebo as a 'sugar pill'."

In the USA Today "Health and Behavior" section, studies show that "most doctors used actual medicines as a placebo treatment. 41% used painkillers, 38% used vitamins, 13% used antibotics, 13% used sedatives, 3% used saline injections and 2% used sugar pills."

Ebsco's article "Placebo Gives Brain Emotional Break" claims that "according to a new study of placebo-induced reduction of anxiety, such expectations trigger a decline in the brain's emotional responsiveness and marshal pain-numbing neural activity."

Dr. Howard Brody, a medical ethicist and family physician at the University of Texas agrees that it creates a dependance on drugs and causes "kids to grow up thinking that the only way to get better is by taking a pill..."
He then furthers his argument by saying "some doctors worry that giving children 'medicine' for every ache and pain teaches that every ailment has a cure in a bottle."

In a New York Times article, reporter Benedict Carey reflects on an experiment where two groups of people were given the same placebo, one more expensive than the other ($2.50, $0.10). He reported that "85% of those using the expensive pills reported significant pain relief, compared with 61% on the cheaper pills." This is an easy way for doctors and companies to make quick money.

From the American Medical Association handbook and website, there is a copy of the princples of medical ethics that all doctors must abide by. Some of them state that "a physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities...a physician shall, while caring for a patient, regard responsibiility to the patient as paramount...a physician shall...make relevant information available to patients, collegagues and the public..."

Doctors quote in the Chicago Tribune that "the harm comes when antibiotics are dispensed needlessly, heightening the risk that bacteria will develop antibiotic resistance, on of the most dangerous medical phenomenons of our time."

Developing the Argument

In addition to arguing that placebos are dangerous to the patient in many different ways, my other subtopics include that prescribing them is morally and ethically wrong, it makes patients pay money for these medications when the pills themselves have no effect, there are alternative options that could achieve the same effects, and it creates a strong dependence on drugs.

> Prescribing Placebos is Morally/Ethically Wrong
*Composed of three different parts (the AMA Council on Ethical and Judicial Affairs, the AMA Ethics Resource Center, and the AMA Institute for Ethics), the American Medical Association is responsible for establishing policies and guidelines that ensure professionalism and ethical practices.
*Before becoming a doctor, one must agree to follow all of the laws listed under this Association.
*A few include, always putting the patients’ health and well being first, being honest in all professional interactions, reporting a physicians misconduct whether it be engaging in fraud, deception, etc., respecting the law, safeguarding patient confidences
*The use of placebos undermines these laws and if pursued, could be taken to the AMA Ethics Court
* The use of placebos gets in the way of the doctor – patient relationship. It significantly blocks open lines of communication and can lead to mistrust.
> To develop this argument I will further research the AMA and provide a counter act and argument for each law with the use of placebos.

>Patients Are Paying For These Inert Medications
*NYT, there was a study where two different groups of people were given placebos (which they thought to be actual medication) of different costs. One was $2.50 while the other was $0.10.
*More people from the group who paid $2.50 experienced results that were significantly stronger
*When doctors prescribe placebos, they are causing patients to pay for medication that they do not need.
*This can even cause issues with insurance companies if patients are covered because they are unknowingly filing claims for medication that is not necessary. The company is paying for something they could do without, especially in this tight economy.

>There Are Alertnatives
*The placebo effect is described as giving patients “inert” substances as a means to produce results that would usually only result in medically active ingredients
*Giving patients fake medications and making them believe cause the brain to secrete opioids, chemicals used for pain relief
*If the mind/body relationship is really that powerful, then there really is no need for the pills. The pills represent assurance, something in which the doctor could give with no health risks or cost if they just talked to their patients.
*Other methods could convince and calm the patient enough to secrete the opiods without the pills.

>Dependance on Drugs
*Placebos just feed in to the whole misconception that everything can be cured with a drug – for every pain, there is a pill.
*It can easily create a dependence and addiction.
*Doctor's take the easy way out.

Subtopic: The Dangers of Placebos

I plan to argue that placebos can be harmful to the patient and are becoming more dangerous with every use. The act of prescribing placebos has existed for years but is just recently become so widely used. The treatment, which years ago used to be strictly sugar pills, has now evolved into a much broader pool of possibilities like sedatives, vitamins, antibiotics, saline, analgesics and even what is called sham surgery. In fact, studies show that the percentage of doctors who prescribe antibiotics, over the counter pain killers, sedatives and analgesics is much higher than those who continue to use saline and vitamins. Placebos are defined as not having any specific effect on the patient’s illness but there is never a guarantee for this. It is proven that mixing medications that should not be combined can cause serious problems, including death. If a doctor prescribes low doses of actual drugs to their patient, he/she is putting them at serious risk. Even if the doctor were to research their other medications, what if at home they were to accidentally take this “harmless placebo” with another medication? Once the patient is at home, there is no doctor to guide them in taking the right combinations of medication. In addition to there being the potential of mixing medications, just using these sedatives or antibiotics alone is dangerous. For example, over time the body can develop a resistance to the “placebo” which can cause serious problems later on for the body. In following years, if there is an illness that requires a medication with the same ingredient as their “placebo”, the body could have developed a defense against it causing it to be in-effective for the illness. Finally, there is always the chance that any one of these placebos could alone react poorly with the body even if it is just a low dose. Sham surgeries are much rarer, however do occur. For incurable illnesses or those that have a very low chance of being cured, like Parkinson’s, patients often undergo these surgeries under the impression that it could pro-long their life or fix trivial matters. Again, the chance of coming across a problem while making incisions into the head during a surgery is putting the patient at risk.

Pro/Con

What does the pro side say/think/believe? What does the con side say/think/believe? Which side will you be arguing? Why?

Pro: Those in favor of doctors prescribing placebos for patients to use feel that there is no harm to the practice. The job of a doctor is to help cure a patient and instill hope in them, not to leave them with no suggestions or alternatives when problems arise. By prescribing placebos, which those in favor define as treatments that do not directly cause any physiological changes to the body, the doctors are doing their job by pleasing the patient. If there is any chance at all that the placebos will cause the patients to mentally feel comforted, there is no reason not to use them. Statistics seem to be supporting that when children and adults are given these "pretend" medicine pills, the brain seems to take over and convince them that they are feeling better. Basically, it is a way to satisfy needs without causing any harm that could result in unecessary medication.

Con: For as many people that are for the use of Placebos, there are just as many that feel it is unethical. Patients that were surveyed felt that the relationships that they have with their doctors are vital in feeling comfortable and safe. It is morally wrong for a doctor to prescribe these pills because they are being decietfull and hiding information from their patients. Not only does it create a false sense of trust between the patients and doctors, but when doctors give the pills to parents for their kids the practice of lying continues. Also, recently the definition of placebos has changed. Rather than being strictly sugar pills or vitamins that truly are harmless, stimulants and extremely low doses of medicine that usually have no effect on the body are becoming more popular. This crosses the line completley, putting the patients at risk. Finally, instituting the practice of placebos furthers the latest trends of relience on drugs to fix everything. It creates a dependance even among young children when in reality, letting a cold run its course could be the simple solution.

As of know, I think that I am going to defend those against the practice of placebos however I am still undecided at this point until I research the mind/body relationship more.

Placebo Topic

The topic I am going to research is Placebos and their effect. Placebos are sugar pills or other look a -like medications that have no active medical ingredient but are often used and prescribed to patients to give them the impression that they are being treated. The question of whether it is ethical for doctors to use them has grown increasingly debatable over the years. Not only is the doctor-patient relationship to be considered, but the effects that these “harmless” placebos have is an important aspect as well. Although some patients feel cheated and deceived by being given these pills that they think to be helping them when they really are not, there are some who feel that they have a positive affect on the mind and body and that is a good enough reason for doctors to use them. In addition, over the years the definition of Placebos has been ever changing. The most common placebos the American doctors reported using were headache pills, vitamins and sugar pills but recently, a large number has admitted to using antibiotics and sedatives which do have affects on the body. I will be taking a stance on whether it is ethical and healthy for doctors to use placebos.