Placebos and ethics

Would you give a placebo to somebody who has a minor headache? A stomach infection? Been hit by a bus?

How would you feel if you discovered your doctor had given you fake medicine?

We discussed these questions today, in our first session for two weeks and last session for three. With public holidays, school holidays and camps we haven’t been able to meet as often as we’d like but the kids made a good show by turning up today.

Last week we chatted about placebos. What they are, how they work and what can they do. During the discussion I asked the question “is it ethical to prescribe placebos to patients” and was suddenly assailed by hands in the air and comments being called out. Not wanting to skim over the issue I took a few comments and told them that we’d spend an entire session discussion next time.

We had a quick recap to refresh students of the nature of placebos and got a few questions out of the way. Placebos can be sugar pills, but aren’t vitamin tablets sort of placebos too? Yes actually, a type known as an ‘impure placebo’. Still containing an active substance, but one that isn’t really going to do anything.

We talked about endorphins and how their production can aid the body with pain relief. If smiling can produce them then surely a placebo can too. This takes the placebo effect out the purely psychological realm and implies a physiological response. Doesn’t this mean that placebos can actually change things in the body?

(Clearly, I am not a doctor. If any medical-type people notice that I’ve made a mistake, please pull me up on it.)

I asked them how they’d feel if they discovered that a doctor had given them a placebo. The response was varied.

“I’d be angry at first, but I think I’d get over it if it had actually worked.”

“I’d only be angry if it didn’t work at all.”

“I wouldn’t trust that doctor and would stop seeing them”

Most of them didn’t seem too bothered about the idea. Ultimately, they seemed to feel that as long as it worked it was ok to do.

A few other comments came up about this. One girl suggested that it would be ethical if it was for treating a minor problem, but only if it was a minor problem. She didn’t like the idea of  a pure placebo being given to somebody who needed real medicine. Another student felt that it was probably ok if it was a last resort. If the doctor that there was legitimately nothing else that could be done then a placebo would be fine just to make the patient feel hopeful. Some other students disagreed though and thought that false hope was worse than no hope at all because it prevents people from truly dealing with their illness.

One of my regulars girls thought that it would be fine to give to kids or hypochondriacs, just to shut them up for a while. I couldn’t really disagree with this.

We only had minutes to go before the bell rang so I asked them what they thought would happen if the public found out that doctors all over the country were using placebos. Most of the responses involved rioting, revolution and mass litigation but a calmer student prevailed and suggested that perhaps people would stop going to doctors altogether and instead get absorbed into the world of CAM.

A horrible thought, but fortunately the bell rang before they time to see my tears.

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2 Comments

Filed under McKinnon Secondary Sceptical Society

2 responses to “Placebos and ethics

  1. Rylee Scott

    Medical student here. You were absolutely right about the physiological effects of placebos. You’ve probably already seen it, but there’s a great TED talk about many nuances of placebos (http://www.ted.com/talks/eric_mead_the_magic_of_the_placebo.html), including that more and brightly colored capsules are more effective placebos! More expensive placebos are also more effective (http://www.medicalnewstoday.com/releases/99532.php). Evidence for real physiological effects can be seen in placebo-opiates depressing respiratory rate (http://www.sciencedirect.com/science/article/pii/S0304395998000104) and in patients undergoing withdrawal symptoms after removal of placebo (http://jama.ama-assn.org/content/294/2/183.full.pdf+html).

    On a less academic note, thank you so much for educating your students on this incredibly important topic. Good luck on the upcoming homeopath visit – with your training, I think your kids will do just fine.

  2. Adam vanLangenberg

    Thanks for the links, I will be devouring those over the weekend 🙂

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