5 ms·

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, ch

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

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