Use of Placebos Justifiable?

The first meeting minutes, curiously of the third meeting, of the Students’ Medical Society 05/06, hereafter known as the SMS (copyright royalties owed to the many telecommunications companies and a CERTAIN house in college notwithstanding), well attended by the jungle villagers of Lembah Beringin.

Notes taken by the local town scribe, Kenrick Ng, of PJ birth.

Topic: Is the use of placebos justifiable?

Justifiably, we started off with an esteemed pharmacy-bound student defining placebo. Placebos are generally drugs administered on patients, but have no effect on the patient’s biological system whatsoever. These drugs serve as ‘psychological-healing-substances’; the doctor somewhat deceiving the patient that what he/she has received is medicine. With the mental strength and false belief that the medicine will heal, hopefully, the patient will recover.

Under what circumstances do we use placebos? Why don’t we just give them real medicine?

1. When the patient is not really ill

There are situations where a patient believes: that he/she is ill, but is in fact, not. Some of the more profound opinions from the floor included

- Determining whether the patient is emotionally stable or in a condition of hysteria
If the patient is emotionally stable and appears rational, a doctor should reason to the patient that he/she is actually suffering from some form of self-deception, and is not actually ill. Another member suggested that doctors should sharpen their motivational skills and ways of convincing a patient, rather than merely lying.

If the patient is seen to be hysterical, the doctor is quite justified at giving the patient some form of a placebo (to instill a greater degree of emotional stability) before anything else is done to the patient

- It is also important to realise the consequences of giving ‘fake medicine’ to a patient. Some participants cited cases in the past where doctors were sued by their patients (with respect to this matter) after the patients discovered that they have been cheated. The doctor’s defense? : The placebo is a form of psychological medicine. Valid?

2. When the patient is really ill
Popular examples in this category included influenza and cancer. For the sake of those who know little about biology: Viruses which cause influenza mutate so rapidly that there is hardly any form of effective medication for it.

Members of the floor acknowledged the fact that most patients do not know much about medicine and health, and have a preconceived idea that he/she must have received medication upon exiting a clinic/hospital.

Do doctors charge for the placebos they prescribe? Well, there appears to be no definite answer. Some say doctors prescribe the medicine and the pharmacists sell the medicine/placebo. Others have the opinion that placebos should be given for free, and a ‘trial period’ for the patient allowed. Wouldn’t that affect the credibility of the doctor and the patient’s trust of the doctor’s ability to cure, and reflect that the doctor is indecisive?

A member of the floor shared his experience of not receiving any drugs from the doctor he visited and recovered from constipation after taking note of the doctor’s advice: Proper sleeping hours, diet etc. This individual was an advocate of not prescribing placebos.

The first individual who supported the usage of placebos backed up her argument by mentioning that some articles actually criticise over-prescription of antibiotics to patients, as this act will result in their immune systems being too dependent on medication-in other words, not producing sufficient antibodies. Another suggestion was to only prescribe placebos to waiting patients with the hope that the drug will comfort them, at least during the period of time spent waiting to see the doctor.

The heart of the topic was the role of a doctor and ethics. Some kept on the virtuous path of telling the truth, the truth and nothing but the truth. These members explained that we should return to the basics-that a doctor’s credibility is of utmost importance. A debate of ethics- Is it more important to provide emotional care to patient in the form of placebos and risk having to appear in court; or is it more important to practise the virtues of a doctor by redirecting the patient to a psychiatrist if all else fails?

Many feel that placebos should be used as last resorts, and that a doctor should not risk having to tell lies. Others feel that there is nothing wrong with using placebos-they are not harmful and the patient will probably gather enough emotional strength to free himself/herself from self-deception.

Well, this was an interesting forum, which blended a little knowledge of medicine, a lot about a doctor’s values, ethics etc. A note of thanks to all who attended and participated.