In medicine, there are those who think a traditional approach is best. They believe that medical problems should be treated with proven medical treatments. However, within the past few decades, there has been an increase in the use of placebos, which are treatments with no supposed medical benefits, in attempts to provide aid to the patient. In the reading by Lichtenberg, there were several cases in which placebos were used with different results. I will be drawing from the cases presented in order to formulate a case for why placebos should be considered ethical in medicine.
One concern surrounding placebos is the issue of effectiveness. There are concerns that placebos should not be used, because they provide little to no medical benefit to the patient. This claim can be argued against in Case 3 of the Lichtenberg reading, where a woman was treated for depression using a placebo. “Although a placebo was not intended to be used, it had substantial benefits to the patient, to the point where discontinuing use of the placebo would be considered unethical, and may even harm the patient in bringing about symptoms of depression” (Lichtenberg 553).
Questions have also been asked about the morality of placebos. A general rule of placebos is that in order for them to work, the patient has to be deceived into believing the medicine that they are being treated with is conventional medicine and has a proven medical benefit. This is one area where placebos fall short, as their effect is largely unknown to researchers, and many trials are being done to study why placebos work (Feinberg, harvardmagazine.com). However, the claim of deception may vary from case to case, as there have been cases where placebos have been openly discussed. Although this may be seen as counterproductive to the use of placebos, disclosing that a treatment is a placebo may not necessarily diminish its effectiveness (Lichtenberg 552). In the case with the 42-year-old man who had a case of gastroenteritis, the husband and wife asked the doctor for a placebo, after the doctor had already expressed his opinion that the issue would resolve itself in a couple of days (Lichtenberg 552-553). In some cases, even if a physician states a treatment is unnecessary, that does not mean the patient will not want to receive it in hopes of a better recovery.
The effect of disclosing treatment methods to the patient was also tested in a study by Ted Kaptchuk of Harvard University. In a pilot study published in 2010, two groups of subject were studied: one group was given no treatment, and another group was told they would be receiving placebo pills and that the pills could potentially have healing effects (Feinberg, harvardmagazine.com). Although further research needs to be done, the study showed that the group given placebo pills had significant improvements over the group given no treatment whatsoever. This improvement was so significant, it rivaled the improvements of groups that had been given the actual drug in other studies (Feinberg, harvardmagazine.com).
Another claim raised against placebos is that they are not deemed to be true medicine. Several proponents of conventional medicine believe medicine is based on years of research and has a measured benefit when given to a patient. Placebos are different in the sense that they are given the label of alternative medicine, which consists of things such as pills, needles, and saline injections. Placebos also have difficulty proving they are effective from a scientific viewpoint. However, if the treatment is effective for an individual patient, why shouldn’t they be used? People go to the doctor in the hopes of being healed and alieved of their symptoms. If placebos can accomplish this, what’s wrong with that? Wouldn’t it be considered unethical not to use the placebo, if there was a possibility of treating the patient when other methods were ineffective?
Citation:
Feinberg, Cara. “The Placebo Phenomenon.” Harvard Magazine. N.p., 03 Mar. 2014. Web. 03 Feb. 2017.
Lichtenberg, P. “The Ethics of the Placebo in Clinical Practice.” Journal of Medical Ethics 30.6 (2004): 551-54. Web. 3 Feb. 2017.
Placebo Effect. Digital image. WordPress. N.p., n.d. Web. 4 Feb. 2017.
Kenquavius, I really enjoyed reading your blog because I have the same sentiments towards placebos. If placebos have been proven to be effective, then what is wrong with using them?My question is, what part of the scenario is unethical? the fact that patients are being deceived or that the medicine does not supply medical benefits?
Consider this scenario: what if a patient was given a placebo treatment and it seems to help them with whatever illness. The doctors finally tells the patient that the treatment is a placebo. Does the patient have the right to be upset with the doctor even though the medication has been effective?
Kenquavius,
This was a really interesting take on the placebo effect in medicine; I didn’t even know this was an actively occurring “treatment” before I read this article or your post. I do agree with you in saying that despite the fact that placebos are not traditional medicine, if they work for some people then they should be legitimized as a medical treatment. To me, as a physician I believe it is your job to help a patient to the best of your ability whether that be using traditional or alternative medicine.
I think a really great example that is pretty common for young adults our age is the wearing of placebo glasses while you are studying. While there is no known literature on this subject, I personally know many people who swear by the fact that wearing glasses (with non-magnified essentially “fake” lenses) helps them to study better and be more productive than they would be without glasses. Though this is at a much smaller and essentially less serious scale since we aren’t talking about a medical treatment, I think the main idea still stands that if there is a placebo out there that helps you in a positive way, then it should be put to use.
I found another interesting study that looks at a very similar idea that I previously discussed, but adds in an actual medical condition (convergence insufficiency). Basically, this study took children who had convergence insufficiency and treated them with base-in reading glasses and placebo reading glasses. The results they found were that both groups improved their reading abilities and there were no significant differences in how well the improvement was. This is another great example that placebos can be just as effective as a traditional medical treatment.
Modern medicine has made incredible advances in the realm of treatments and medicines, but sometimes I think just going back to basics is just as good in many cases. Placebos can save the healthcare industry time, money, and resources if there was a legitimate investment into the field. I strongly believe that it doesn’t matter if a physician uses traditional or alternative medicine, as long as the patient is being treated to the doctor’s best ability.
Works Cited:
Lichtenberg, P. “The Ethics of the Placebo in Clinical Practice.” Journal of Medical Ethics 30.6 (2004): 551-54.
Scheiman, Mitchell, and Lynn Mitchell. “A RANDOMIZED TRIAL OF BASE-IN READING GLASSES VS. PLACEBO READING GLASSES FOR THE TREATMENT OF SYMPTOMATIC CONVERGENCE INSUFFICIENCY IN CHILDREN.” American Academy of Optometry (2004).
I completely agree with your take on this issue. There has been much research on the placebo effect in both psychology and medicine and many placebo medications have had successful outcomes. I believe that as long as the patient is aware that he or she is taking some sort of medication, whether it be a placebo or traditional medication, then there is nothing wrong with using this method. Why should a physician use resources to administer traditional medication if placebo treatment is available and possibly just as effective without the side effects? It is the physicians duty to do what is best for the patient and I do not believe that there is anything unethical about the use of placebo medication if it has no harmful effect on the patient.
Kenquavius,
I loved your blog post. I agree with your opinion that placebos should be used, especially if they are useful in healing patients. Those that oppose placebos do so because they are hesitant to lie or be lied to about the medication they are taking and the possible effects. To complement the Harvard University study, theguardian wrote an article including a study in which they investigated whether or not the placebo effect was still effective in patients that were told they were taking a placebo. The most interesting aspect of the study they described in the article was the fact that they were able to conclude that “harnessing placebo effects without deception is possible in the context of a plausible rationale” (Connor). With this information I think there is no excuse to not allow placebos to be used in medicine. Doctors and nurses can be completely truthful with their patients by disclosing that their patients are taking placebos without harming the placebo effect in any way. Due to this discovery, there is no conflict between doing what is in the best interest of the patient and being truthful. As a result, I argue that there is no downside to using placebos.
On a different note, I love the question that you chose to end your post with: “Wouldn’t it be considered unethical not to use the placebo, if there was a possibility of treating the patient when other methods were ineffective.” I think that it is the doctor’s responsibility to do everything in their power to help a patient. In my opinion, it would be unethical if a doctor chose not to offer a placebo to a patient because they don’t want to be untruthful. In my opinion, the doctor’s duty to help the patient outweighs the patient’s right to information. For example, if it had not been proven that the placebo effect would still be effective despite the patient being aware that it was a placebo, I would still choose to temporarily lie to my patient in order to help them heal. In my mind, nursing someone back to health is more important and valued than knowing that the drug you are taking is simply a sugar pill.
Morgan Brandewie
Works Cited:
Connor, Steve. “The Placebo Effect: Is There Something in It after All?” The Observer. Guardian News and Media, 06 Nov. 2016. Web. 06 Feb. 2017.
I completely agree with your point about if placebos are effective and have no major side effects then why is there still great hesitation when using them? If it works, it works, right? I’m also glad you brought up the issue about placebos not being “real” medicine because it’s a similar case with herbal and naturalistic medicine. Both have shown their effectiveness in practice but still aren’t implemented into mainstream medical techniques. Traditional Chinese medicine (TCM) has been practiced for 5,000 years and is built on the basis of herbal therapy and various mind and body treatments. Herbal medicines have a very high level of toxicity compared to prescription drugs and majority have minor side effects (if any). The most common issue people have with them is that some herbal medicine can interact with drugs and induce serious side-effects. Despite the impressive track record, Western medicine only recognizes it as a complementary health approach or secondary measure. A lot of the reason for under-use, in my opinion, lies in politics and big pharmaceuticals. If there were more education and open communication about the use of TCM we could see less associated side-effects and long-term health complications than with heavily used pharmaceuticals.
Sources:
https://nccih.nih.gov/health/whatiscam/chinesemed.htm
Tsuei, Julia Eastern and Western Approaches to Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1238216/
Hello Kenquavius!
Thanks for taking a specific stance on placebos—I truly enjoyed reading this post and it led me to reevaluate my own thoughts. I agree with you in the ethical sense that placebos, if proven effective, should be used to aid in patient care. An aspect of placebos that I’ve been thinking about recently, however, is their consequence. What are the consequences of relying on a placebo to diffuse a medical issue, and what types of signs and symptoms could be missed if a placebo masks them? I’m not even sure the extent to which this could occur, if at all, but like all medical treatments the use of placebos should be approached as only one aspect of a multi-faceted approach to a medical case. Below is a link to an Emory Neuroethics Program blog post I ran across written by a fellow Emory student, Sarika Sachdeva. It outlines some of your own points and brings up some new ones, too. Thank you again!
-Elisabeth Crusey
http://www.theneuroethicsblog.com/2016/10/prescribing-placebo-effect.html
To address the question at the end of your post, I happen to agree with the stance that it would be, to an extent, unethical for the caregiver to stop giving a placebo if it’s having a positive impact. However, I have to qualify this statement. I think that, if there is another, proven treatment that is more effective, then it is justifiable to switch to that treatment. In addition, if an (autonomous) patient is strongly objected to receiving the treatment, as with other treatments, I think the physician is obligated to stop the treatment. I agree with Lichtengberg’s statement: “If the patient is helped by the placebo, discontinuing the placebo, in absence of a more effective treatment, would be unethical” (553).
I would be interested to hear the perspective of the people who are opposed to a placebo treatment, and the arguments that they would raise about why the treatment isn’t justified, and if they are purely economical reasons or moral reasons.
Citation:
Lichtenberg, P. “The Ethics of the Placebo in Clinical Practice.” Journal of Medical Ethics 30.6 (2004): 551-54. Web. 3 Feb. 2017.