Au Revoir

The survey final results will be my last post for a while. The time has come to polish my research paper and compile my powerpoint presentation. I will give a final summary of my project later in May. I hope to see some of you at my presentation! Thank you for your readership. As of now, I'm not sure who reads this, if anyone does, but I hope I provided an informative overview of the antidepressant controversy.

-Savannah

Survey Finale

 

The third question: In a typical doctor-patient relationship, would it be ethical for a doctor to prescribe a patient a pill that is a placebo but represent that pill as an actual medicine?

Now, the most important ethical point has been reached. Can a doctor give a patient a placebo and call it medicine? Can they lie in an attempt to produce a benefit? Is a placebo a reasonable treatment plan?

This time 67.9% of responders said it was unethical while 24.5% said it was ethical. 7.5% of people were unsure.

The final question: If you answered no to the previous question, please mark the answers below that best explain why.

58.3% of people said it was unethical because doctors should not lie to their patients.

83.3% of people said it was unethical because patients have a right to know what they are being prescribed.

69.4% of people said it was unethical because it is not medically safe for a patient to be in the dark about the prescription(s) he is on.

13.9% of people said they did not think inducing placebo effect is an effective medical treatment.

The last option was to write a unique reason that the responder thought it was unethical. I received five.

1. "The only case a placebo may be effective is if the patient is a hypochondriac, but even then its a very subjective thing to describe. Also, if the patient is actually experiencing symptoms that prompt the doctor to prescribe something, I'd prefer the doctor to actually prescribe a REAL drug then just test his own theories on me (giving me placebo instead of a real drug for his own reasons). I would feel like a lab rat."

This response takes into consideration the risk of doctors "experimenting" on their patients by giving them non-drugs without being clear about the treatment plan. However, valid as that observation is, it is not correct to claim that only hypochondriacs would be positively affected by a placebo. Perhaps, it is unlikely anyone but a hypochondriac would be completely cured by a placebo, but even that is not certain.

2. "I think that the patient should be informed that it COULD be a placebo, but maybe it's not."

This is a good idea. It gives the patient much more control over their treatment. If they objected to the possibility of receiving a placebo, they would be able to express that to their doctor.

3. "Patients has a right to know the medication prescribed by a doctor-name of medication, purpose, side effects, etc. A placebo is to be used only in a study to benefit the medical community, not support drug company study or misguide a patient."

This objection seems to focus primarily on the patient's right and need to have all the information about their prescriptions. The mention of supporting drug company study is interesting. One could argue that the use of placebos in clinical trials helps protect against drug company manipulation of success rates by providing a standard of efficacy.

4. "At that stage of the of the doctor-patient relationship, the doctor is a well-schooled and trained expert in his/her field. He/she is well-aware of all the treatments that would undoubtedly cure the patient permanently or temporarily of their problem. Thus, if any medical doctor who is trained to administer medicine or perform typical doctoral procedure even considers giving his/he patient a placebo to see if it builds patient confidence, then THAT doctor is merely treating a genuine, hurting patient as an essential "lab-rat" to see if the placebo actually works. The patient is paying a lot of money to be treated properly with proper medicine that will properly and safely cure his/her illness. A placebo would be unethical and unfair to the patient in this sense."

This responder brings up the factor of paying for treatment and not receiving genuine medicine as a problem. He or she also brings up the issue of unauthorized doctor-patient experimentation as being unethical.

5. "In a double-blind study, patients know that there is a chance that they are receiving a placebo, but this understanding is not part of the doctor-patient relationship."

This response also addresses the concept that the placebo administration would be more acceptable if the patient was aware of the possibility.

This review of placebo ethics is relevant to the efficacy of antidepressants because it is important to consider whether or not taking the  side effect risks of the current medications is superior to administering placebo in order to cure what many people view as a problem "in the patient's head."

However, it is clear that placebo treatment is ethically questionable in many cases as well as less effective than antidepressants. There are biological symptoms to be treated in the case of depression and it is unlikely that a placebo would be enough to seriously treat the condition.

A link to the survey is provided in the sidebar.

Survey Says

After my last posts about placebos, I was interested in what the general opinion of placebo ethics might be. It seemed that my opinions and those of majority of doctors did not match up based on the following image.

For this reason, I created and distributed a survey to gauge the opinions of my peers. Fifty-three people responded to the survey. I will examine the results of the survey in my final two posts before my conclusion post due to their relevance to the superiority of antidepressants over other treatments namely placebos.

The first question: Placebos are used to determine the effectiveness of medicine in many studies. A double blind study involves a group of patients with a condition who will be administered either a placebo or the actual medicine. Neither the doctors nor the patients know who is being given medicine and who is being given placebo until the end of the trial. The placebo effect successful responses and the actual medicine successful responses are compared to determine the clinical worth of the actual medicine. Do you consider this an ethical use of the placebo effect?

The majority of people (83%) considered this ethical, including me. The rest of the people either considered it unethical (7.5%) or did not have an opinion (9.4%). I thought these results were unsurprising and I asked the question mainly to present how placebos are usually used.

The second question: Now consider a basic doctor-patient relationship completely separate from clinical trials. Would it be ethical for a doctor to promote a treatment primarily to increase the patient's confidence in that treatment and thus the likelihood that the patient will experience a helpful placebo effect?

This is a more interesting question. A doctor's positive presentation of a procedure or treatment can seriously affect a patient's confidence, and thus possibly the placebo effect the patient experiences. What can that hurt? The answer is less clear. This is especially relevant in the case of depression, in which many patients are consistently hopeless and demoralized. Should the doctor be getting the patient's hopes up or is it worth the benefit to over-represent the possibility for success? I would even argue that in prescribing any treatment the doctor must advocate it to a certain extent so where do you draw the line?

This was still voted ethical though by a smaller margin (only 62.3%). 34% of survey takers considered this unethical and 3.8% were unsure.

A link to the survey is provided in the sidebar. More information will be provided in my next post.