Sunday, 17 February 2013

How to solve the problem of placebos

Right now, the problem is placebos are considered unethical, but the overall aim of medicine is to improve the quality of life in regards to physical health. These are at times in direct conflict with each other. Below I will argue why and under what circumstances placebos should and shouldn't be used.

There is a large debate at the moment amongst the medical industry about the use of placebos . At the moment, use of placebos (whether in the form of sham surgery, inert medication, or false information) is considered unethical and bad practice.

This assertion is based on the current principals of practice which include a patient oriented autonomy method of decision making, where the patient is presented with facts about options' risks and benefits, and the patient makes a decision. This required informed consent, thus, it is unethical to deceive the patient, as required for effective placebo treatment.

Now I do not advocate rampant placebo use by medical practitioners, below is a simple list of other reasons why placebo use is unethical. However I postulate that a set of guidelines can be developed to direct the use of placebo use by medical professionals under certain circumstances. At the end of this article, I will create a rudimentary set of guidelines as a starting point for debate.

Why placebos are unethical:
1) The use of placebos requires the patient to be deceived, which is incompatible with the practice of informed consent.
2) The chance of being given a placebo may cause patients to not trust medical practitioners, and to seek alternative therapies for serious impairments (which is ironic, because "alternative therapies" rely almost exclusively on the placebo effect).
3) Real treatments have predicted success rates depending on the patients diagnosis, placebos do not, thus false hope could lead a patient to make life decisions based on the predicted outcome of his treatment, which is an untruth.
4) They take resources and funding away from developing actual treatments for pathologies.
5) They cost the government or taxpayer money for a treatment which is known to be inert.

Taking these into account, some guidelines could be developed which allow for the use of prescribed known placebos to patients. The only additional requirement would be that it become common practice in society to the point where it is accepted as "just the way it is" and not thought about.

Guidelines for ethical placebo use:

1) Only qualified medical practitioners prescribe them. They are government controlled, and they are kept separate from the world of "alternative medicine".
2) All other legitimate options for treatment or cure have been exhausted.
3) The use of a placebo treatment does not interfere with or prevent the use of legitimate treatment.
4) The placebo treatment is less expensive than a legitimate treatment for the same pathology.
5) The claims of the efficacy of the placebo are not such that the patient would be further disappointed/ disadvantaged should the placebo treatment not work.
6) Special additional training be given to practicing practitioners and/or training be included in the basic medical degree, before the use of placebo treatments is allowed.
7) Placebo treatments be researched as legitimate options to improve quality of life, before government authorization.

There are still many further issues for this topic, but I hope this can be an acceptable starting point for further discussion.

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