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> Is it okay for doctors to lie about placebo treatments if it actually helps? I mean, their oath is to help people, not to tell the truth, the whole truth, an

• joshgel 8y ago
  Oh, no. It’s much more complicated than that. The ethical principle you describe might more clearly be defined as beneficence: acting in best interest of the patient. But what about when it conflicts with another ethical principle,namely autonomy: the right to decide what happens to your own body and what treatments you don’t get. To my mind, there isn’t an obvious answer, but the conflict between these two is why there is debate about “using” the placebo effect as a treatment.
  • TheCapn 8y ago
    I figure the ethical debate extends into our societal issue of greed as well. Certain institutions would love to be able to give you no medication/treatment, charge you as though you had received it and you're none the wiser.
    • nkrisc 8y ago
      Which is interesting because presumably if they didn't charge you it would shatter the placebo effect. I wonder if cost of the procedure actually impacts the efficacy of the placebo?
      • CiPHPerCoder 8y ago
        Sane middleground: "We did procedure X, but your insurance covered all of it."
        • InitialLastName 8y ago
          Nobody sane would ever believe that.
          • dragonwriter 8y ago
            Anyone with a decent HMO would, for broad classes of procedures.
          • yesenadam 8y ago
            I'm guessing you're in the US.
          • soperj 8y ago
            Nobody in the Western world outside the US would have any reason to question it.
      • wlesieutre 8y ago
        https://www.marketplace.org/2015/03/03/health-care/how-cost-drug-impacts-placebo-effect https://www.marketplace.org/2015/03/03/health-care/how-cost-...
      • viggity 8y ago
        this is a small study - but yes, it appears that way https://www.ncbi.nlm.nih.gov/pubmed/25632091 https://www.ncbi.nlm.nih.gov/pubmed/25632091
      • njarboe 8y ago
        They are still providing a service and even pills with starch in them cost something to make. I don't see any reason the doctor and hospital shouldn't charge.
    • OscarCunningham 8y ago
      If they're just administering placebos do you still have to pay for real doctors?
      • goldfeld 8y ago
        But then we go deeper into what placebo is. If the patient needs the psychological comfort of being seen and OK'd by real doctors, staying home mentalizing their own well-being won't do much. It's about taking responsibility for self-care--to the extent possible, of course--as opposed to externalizing any ill state to a sanctioned (sacred?) pill.
        • ulucs 8y ago
          You could train actors to give out placebos for a fraction of price. Less work for doctors and more jobs for actors. It's a win-win.
        • bambax 8y ago
          I think placebo can be self-administered. I can make many pains decrease in intensity (or sometimes go away) just by thinking about it. Last year I fell while mountain skiing and was in great pain at first (could barely move, standing up from lying down was excruciating, etc.) The first day I didn't take any pain killer; the second day I did but it didn't really help. The third day I stopped taking the pills and just kind of "decided" I wouldn't suffer that much. The pain didn't disappear completely, and it still hurt too much to get back on skis, but it stopped being so intense. When I got back home I did an x-ray exam and MRI and found I had broken a vertebra in two, that had lost 25% of its height. The doctor was super surprised I could walk normally and said: "do you not feel pain". I said I did but it was very manageable. She didn't investigate and just said "ok then, good for you!" Also, I used to get hiccups that lasted a long time (30 minutes); and then I discovered you can make them stop very fast by being super calm and concentrating. Not only that, but since I found this out, I barely get hiccups at all anymore. I think we can consciously control much more of our own body than we think, and we're only scratching the surface.
          • deleted 8y ago
    • JoeAltmaier 8y ago
      If it works, its treatment, even the right treatment. Would you know when its safe to give a placebo? That takes diagnostic skill.
    • collyw 8y ago
      Homoeopathy comes to mind. I am in two minds about it. On the one hand it would appear pretty ridiculous and there is no way that it should be paid for. On the other hand if it works via the placebo effect in a cost effective manner, is that a bad thing?
      • hobs 8y ago
        The placebo effect isnt bad, lying about the effects (homeopathy) charging much more than the cure is worth (homeopathy), and outright selling poison to people (homeopathy) is not ok.
        • icebraining 8y ago
          But isn't the lying necessary to be a placebo? And what is the cure worth? How do you measure that?
          • hapidjus 8y ago
            Not necessary apparently, https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn...
        • Udik 8y ago
          How is it supposed to work as a placebo if you're told "hey, this is a glass of fresh water: drink it. And by the way, it's free'. In other words the lie is integral to the working of the placebo. This is the whole source of the issue.
          • svachalek 8y ago
            It does work even without deception, which makes it all the weirder. It's covered in the article.
            • PhasmaFelis 8y ago
  • closed 8y ago
    I suspect that much of this issue is resolved by looking at how they sought consent for their study, since they had to inform participants about what they were going to do to them (though they could have phrased it as, I may do A, or I may do B). Now, they can say, "I may do A, and I may do B, and there is evidence that both are effective"
  • yomly 8y ago
    A very interesting ethical discussion I had with a doctor friend recently is that in some cases where a doctor identifies that amputation is the right/only course of action, they will only present that as a soft option to the patient, if at all. This is because studies have since found that amputations can cause a great deal of psychological harm and it can be better for the patient if they arrive at the conclusion to amputate of their own volition - even if that takes months of excrutiating agony spent realizing not having the limb is better than the pain. It was an interesting additional dimension to consider - even if the doctor knows much better than the patient, sometimes the patient feeling a sense of autonomy could be important for their wellbeing, and that short term pain could be beneficial.
    • joshgel 8y ago
      In some ways this applies to everything we do that we think might be helpful. Sure we could get patients to loose weight by locking them up and only feeding them 1300 calories of veggies, but for some obvious reasons that isn't really an option. We can encourage them to take medications, but they still have to take them. Atul Gawande talks about how much we have discovered in medicine in the last century, but that the next century is going to be about how to effectively implement that knowledge to help people. This applies to both the first world and to the developing world, though the challenges in both are different. (also we probably wont stop discovering new treatments that we will them have to deploy...)
      • derefr 8y ago
        > Sure we could get patients to loose weight by locking them up and only feeding them 1300 calories of veggies, but for some obvious reasons that isn't really an option. Yeah, but a lot of patients would consent to an offered treatment plan where they're locked up (and unable to sign themselves out!) and fed only 1300 calories of veggies. The weird thing is, there are private businesses willing to provide exactly that kind of service (see: de-tox centers.) But doctors and hospitals generally don't see this as a valid form of in-patient medical treatment. Why is that? Do doctors think that patients have an inalienable right to bodily autonomy? (If so, how would surgery ever work?) (The annoying point about this difference, to me, is that if a doctor were to diagnose you with X thing that keeps you at the hospital for a month, unable to leave—then your insurance would likely pay for that, and your employer would likely consider you on sick leave. But if a private business like a detox center keeps you for a month, then you have to pay for that out-of-pocket and you're likely to be fired from your job if you don't have the requisite vacation days saved up. From what I can see, it is in the patient's long-term interest if doctors get into this business!)
  • 794CD01 8y ago
    Autonomy isn't a meaningful principle when it comes to medicine. Even patients who are doctors can't really give informed consent since they won't necessarily be knowledgeable in the specialty relevant to their treatment. And the vast majority of patients aren't doctors.
    • delecti 8y ago
      Not to invoke a slippery slope argument, but there are a lot of really horrible things that have been done without giving patients autonomy. We as a society need to consider it extremely carefully before any instance of acting against a patient's bodily autonomy.
      • 794CD01 8y ago
        It would be interesting to compare that against the horrible things people do because they do have autonomy.
        • delecti 8y ago
          If horrible things are being done to people, I'd pick the ones those people are doing to themselves almost every time over the ones being done to others in violation of their bodily autonomy.
        • snowwrestler 8y ago
          The whole point of autonomy is that there is an ethical difference between doing something to yourself, vs. doing something to someone else.
          • 794CD01 8y ago
            Yes. Obviously you'd narrow things down and compare like to like. Anti-vaxers being the hot example of the day. Sometimes it's so obvious that we act on it, like with secondhand smoking, but I bet there's a lot more to dig into.
    • 8y ago
  • Spooky23 8y ago
    IMO the power of the mind and attitude is really key to how people perceive and function with pain. I don't think that we adequately understand it. We see that all of the time... I recall working in a bakery in the mall in high school and chatting with a Vietnam veteran with chronic pain from a lung issue and a missing leg who would walk 8-10 miles on crutches every day at 5AM and sometimes do push-ups in our cafe area. He was the most positive person that I have ever met, which was striking when you'd see other folks with very minor issues grouse and complain and be visibly ill. My mom was taught "therapeutic touch" in the 1960s in nursing school, which I believe isn't considered pseudoscience today. For certain types of patients, it was helpful, but the technique was mostly placebo. Fundamentally, changing how people think is ethically problematic if it becomes manipulative, but it's a key factor for our well being as well.
    • projektir 8y ago
      > We see that all of the time... I recall working in a bakery in the mall in high school and chatting with a Vietnam veteran with chronic pain from a lung issue and a missing leg who would walk 8-10 miles on crutches every day at 5AM and sometimes do push-ups in our cafe area. He was the most positive person that I have ever met, which was striking when you'd see other folks with very minor issues grouse and complain and be visibly ill. This might simply be that the Vietnam veteran happens to have much better and more stable chemistry than people with, say, depression. It seems one danger with this placebo discussion is that we may end up at square one, blaming depressed/anxious/ADHD/BPD people for their problems...
      • Spooky23 8y ago
        Absolutely... every question seems to open up a minefield of ethical problems, fraught with unknowns.
• vanattab 8y ago
  What about pricing and marketing? Is it ok for a doctor to create a new "placibo treatment" and market it as the real deal on late night tv just because some non zero percentage of people will mark that they had improved symtopms. What is the fair price for a sugar pill that the doctors and compaines are empowered to lie about. Ones mind and mindset play a big role in healing the body and we have far more powerful tools for effecting the mind then future doctor's lies and sugar pills. We have therapy, counseling and the love of family and friends. In my mind its all about hope which doctors can deliver to patients far better with smiles and compassion then sugar pills.
  • CiPHPerCoder 8y ago
    > What is the fair price for a sugar pill that the doctors and compaines are empowered to lie about. $0. Health care costs have ruined many, and that's frankly unethical. I don't see a point treating the unethical American health care system as a premise in these ethical debates.
    • justsomedood 8y ago
      What if it being $0 reduces to placebo effect so that it no longer is effective?
      • CiPHPerCoder 8y ago
        What if the opposite effect happens? https://www.marketplace.org/2015/03/03/health-care/how-cost-drug-impacts-placebo-effect https://www.marketplace.org/2015/03/03/health-care/how-cost-...
    • njarboe 8y ago
      Why would you think manufacturing and distributing a sugar pill should cost $0? Many drugs are basically the same cost as sugar and those aren't free. How about $5 for a bottle of 100.
      • pishpash 8y ago
• conanbatt 8y ago
  The practice of medicine is at the service of the patient: the doctor should not make decisions for the patients unless he has to: the final say is always from the patient. If the doctor lies to the patient, the patient cannot make a proper decision for himself. So yes, it truly is an ethical dilemma.
  • deleted 8y ago
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