This study generated a lot of headlines in the popular press that
were painful to read but easy to explain away.
The problem with
getting info from poplular press, especially papers like the New York
Times and
the AP is that they often have an unstated editorial agenda. It is mainly
to
sell papers and sometimes this happens by sensationalizing a rather weak
conclusion as is the case in this paper.
If you look at the paper, the investigators actually went through a
rather
diabolical system of trying to get doctors to say what the investigators
wanted
them to say and then reached even further in their conclusions to say that
doctors prescribe plecebo treatments.
As an ethicist my job is to discern the truth, and clearly the
authors of this
study and the reporters of the press articles had no interest in the
truth.
The press articles imply that doctors all across america are
prescribing sugar
pills for diseases like skin cancer, when in fact according to the article
only about 2
percent of the doctors studied ever really prescribe what most people
think of
as plecebo treatments, namely sugar pills or saline water.
The article goes through a complex and deceptive survey to get
physicians to
admit what we already know. Sometimes doctors prescribe treatments that
may not
work because the patients ask for them or because physicians think
patients want
them. Many of us are guilty of prescribing a new NSAID for a chronic pain
condition, being pretty sure it will not work, but at the same time
realizing
that it may, and also that there is little downside. We may also be
guilty of
prescribing antibiotics for a cold, being pretty sure that it won't make a
difference, but because we think the patient wants it, and just maybe it
is an
early pneumonia that isn't showing up on xray yet.
I've often ordered and ankle film on a sprained ankle, even though I
know it is a sprain because the patient wants
it, and also because I am fallible and have missed fractures that I was
sure
were sprains.
While this is not exactly great medical care it is a far cry from the
more
ethically circumspect practice of prescribing placebo treatments, yet this
is
what the study investigators conclude. They imply that anyone who writes
antibiotics for what is probably a viral illness, but may be a bacterial
infection is engaging in unethical subturfuge.
These
conclusions are a lie and need to be disputed. They do nothing but
undermine
the doctor patient relationship and society's confidence in the medical
profession.
Sincerly,
Jeffrey Thewes MA, MD
Competing interests:
None declared
Competing interests:
No competing interests
02 November 2008
Jeffrey Thewes MA, MD
Emergency Physician, Ethicist
Providence Hospital, 16001 W. 9 mile Rd.Southfield, Michigan 48075
Rapid Response:
This placebo study is painful
This study generated a lot of headlines in the popular press that
were painful to read but easy to explain away.
The problem with
getting info from poplular press, especially papers like the New York
Times and
the AP is that they often have an unstated editorial agenda. It is mainly
to
sell papers and sometimes this happens by sensationalizing a rather weak
conclusion as is the case in this paper.
If you look at the paper, the investigators actually went through a
rather
diabolical system of trying to get doctors to say what the investigators
wanted
them to say and then reached even further in their conclusions to say that
doctors prescribe plecebo treatments.
As an ethicist my job is to discern the truth, and clearly the
authors of this
study and the reporters of the press articles had no interest in the
truth.
The press articles imply that doctors all across america are
prescribing sugar
pills for diseases like skin cancer, when in fact according to the article
only about 2
percent of the doctors studied ever really prescribe what most people
think of
as plecebo treatments, namely sugar pills or saline water.
The article goes through a complex and deceptive survey to get
physicians to
admit what we already know. Sometimes doctors prescribe treatments that
may not
work because the patients ask for them or because physicians think
patients want
them. Many of us are guilty of prescribing a new NSAID for a chronic pain
condition, being pretty sure it will not work, but at the same time
realizing
that it may, and also that there is little downside. We may also be
guilty of
prescribing antibiotics for a cold, being pretty sure that it won't make a
difference, but because we think the patient wants it, and just maybe it
is an
early pneumonia that isn't showing up on xray yet.
I've often ordered and ankle film on a sprained ankle, even though I
know it is a sprain because the patient wants
it, and also because I am fallible and have missed fractures that I was
sure
were sprains.
While this is not exactly great medical care it is a far cry from the
more
ethically circumspect practice of prescribing placebo treatments, yet this
is
what the study investigators conclude. They imply that anyone who writes
antibiotics for what is probably a viral illness, but may be a bacterial
infection is engaging in unethical subturfuge.
These
conclusions are a lie and need to be disputed. They do nothing but
undermine
the doctor patient relationship and society's confidence in the medical
profession.
Sincerly,
Jeffrey Thewes MA, MD
Competing interests:
None declared
Competing interests: No competing interests