The science news of the day is that nearly half of the practicing doctors today prescribe placebos to their patients at some time. A placebo is a medicine that medical science believes has no curative powers for the symptoms or disease involved. Common placebos are sugar pills, or saline solution injections. Also common are prescriptions for common pain killers in complex symptom sets such as fibromyalgia. The doctors prescribe these medications, knowing that according to their science of medicine there is no reason for the treatment to work. Yet, according to the New York Times (October 22, 2008), “Some 30 percent to 40 percent of depressed patients who are given placebos get better, a treatment effect that antidepressants barely top. Placebos have also proved effective against hypertension.”
There is significant controversy in the medical community as to the ethics involved in prescribing placebos to patients.
I think there is a problem with the ethics of prescribing any medication. Most medicines that doctors prescribe have lists and lists of side effects. Some of these side effects are dangerous. In extreme examples, the “cure” can kill you! Here are some treatments for cancer:
Radiation therapy: This treatment kills cancer cells. It also kills good cells. Its side effects include nausea, diarrhea, hair loss (sometimes permanent), earaches, sexual dysfunction and more. It MAY cure cancer, but I don’t think anyone will guarantee that it will.
Chemotherapy: This treatment also kills cancer cells. It is poison. Its side effects include hair loss, esophagitis, nausea, diarrhea, constipation, infertility, changes in the way food tastes, cognitive impairment, liver damage, heart damage, nerve damage, lung damage and more.
Medical treatments (prescription drugs) for all kinds of disease carry side effects that can kill. Aspirin given to the wrong patient can kill.
And so, with a doctor’s prescription, the pharmacist will warn you of the side effects. Your doctor will tell you that the drug may help you. Of course, it may not. It may instead cause side effects. It may cause side effects and help you at the same time.
What is the ethics involved in treating patients with drugs that also harm? This has become an acceptable practice.
So why is it unethical to prescribe placebos? The word placebo has a negative connotation in today’s language. It is looked down upon, and the practice of using them is labeled as unethical.
But a placebo may or may not cure the disease. It may cause side effects, although usually a placebo does not. Remember that placebos are usually harmless medicines or practices that should have “no” effect, accept that they do.
So which would you rather have, a drug that may cure you and will probably cause side effects, or a product that may cure you and will probably have NO side effects?
I think it is more ethical to do as little harm as possible, and therefore think that the judicious use of placebos is ethical and called for in many situations. What is unethical in the use of placebos is the practice of lying. Telling a patient that a sugar pill is really an antibiotic would be lying. Telling a patient that a sugar pill is a non-standard treatment that has proven to work in illnesses, has no side effects, and may be all the patient needs is telling the truth.
And who knows? Maybe a sugar pill has more healing effect than we all know. After all, one of the world’s best curatives for colds is a remedy known to many Jewish mothers, but is still being investigated because we really don’t know why it works! And like the answer to the old Jewish joke, at least the placebo “couldn’t hurt!”
“I think this man is dead!”
“Give him some chicken soup!”
“But this man is dead! It couldn’t possibly help!”
“Well, it couldn’t hurt!”
Stay tuned, in the near future I will address the power of the mind to heal the body, without “drugs.” Is it another version of the placebo effect?