h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

So yes the prescription of 'placebos' blurs the distinction between scientifically based medicine, founded upon prescription of drugs that have been subject to double blind trials, and non scientifically based medicine. I like to have it clearly separated in my mind.

Maybe there should be more research into exactly what the 'placebo effect' is?

Hi Gif,

>should doctors be encouraged (i.e. paid from taxes) to spend more time with each patient?

Well, I would assume that a reasonable doctor would, in principle, spend as much time as needed listening to and speaking with his or her patient. A reason for this being to get as clear an idea as possible of the patient's condition, but also establishing some trusting relation. This includes answering any relevant question by the patient, about how a treatment works, what after effects there might be, how should I tell my friends about my illness, whatever. That would be all part of the 'care' aspect of medicine.

Now, the trouble (in France, at least) appears to be that there are few doctors and many patients, so that they don't really *have* much time to spend with each patient. Financial incentive won't make days any longer. The best one can do would be to incite (?) more people to become doctors. Coincidentally, I read an article about just that this morning, and how the French system doesn't encourage medical students to become General Practicioners (but specialists instead - it seems that some of the educators glorify specialisation and sneer at GPness), amongst other problems. Link in French in the next posting.

Link (in French) for Post 2962:
http://martinwinckler.com/article.php3?id_article=942

Placebos can have side effects, presumably.

It would be an interesting experiment (if not one that would pass an Ethics Committee) to try and convince a group of patients that a sugar pill will give them a headache.

In fact...it is entirely possible that some of the side effects of *real* medicines are attributable to negative placebo. I imagine if someone is convinced that a medicine is a nasty, poisonous, ineffective creation of Big Pharma, they will be less able to tolerate it. This effect may carry over to sugar pills which are presented as pharmaceuticals.

So...even with placebos, we surely have to assess benefits against harm?

(NOTE: I am *not*, of course, saying that most side effects are imaginary.)

Well, someone (Gif?) did mention the nocebo effect before. Reputedly the way that some people used to die when cast a spell upon. All the sorcerer had to do was to subtly let the victim know.

Amusingly, it is the way with wich Fantomas kills one of his victims in one of the books (A1136341, shameless plug). He blindfolds her and lets lukewarm water drip on her arm. She is thus led to believe that he cut her vein and is bleeding to death

By the way, does anybody know wether on boxes of placebo pills there is a list of ingredients? So if it just written 'sugar', wouldn't that look sort of suspicious?

>By the way, does anybody know wether on boxes of placebo pills there is a list of ingredients? So if it just written 'sugar', wouldn't that look sort of suspicious?<

Yes this is an excellent point toy box. This is why I like to always scrutinise my packets...and of course these days you also get the extra leaflet with the list of side effects, and all manner of information about the usage of the drug for different conditions. Or maybe they only prescribe placebos to really thick people who will be easily duped?

I wonder if there has ever been a court case where one of these placebo prescribing quacks got their diagnosis wrong, about hypochondria, and the patient just got sicker or something worse.

-Or maybe they only prescribe placebos to really thick people who will be easily duped?-

I feel the same way about placebos, it seems unethical to trick someone. However, a doctors first responsibility is to the health of her patient and, like it or not, a true hypochondriac cannot be convinced that there is nothing wrong with him. Think of warner, can anything dissuade him of his delusion? Hypochondria is a similarly fixed state of mind.

If the doctor refuses to treat her patient then the patient will quit the doctor and go to some unscrupulous quack for help. Where he will get a placebo, this time perhaps not a harmless one. And will likely spend a lot more for it.

This is close:

http://www.telegraph.co.uk/news/worldnews/1583169/Diabetic-girl-dies-as-parents-pray-instead-of-calling-for-medical-aid.html

And this is not far off either:

http://news.bbc.co.uk/1/hi/england/2666411.stm

Thanks for asking Gif, I am ok, I was even better earlier due to a bit of experimentation with legal medication, anything illegal would throw me right off the cliff at moment,lol!
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The hair is still short though,lol.
If I get Crazy again, well even more Crazy, it will be a No1 next. I have been entirely off anti-depressants for a month now so up and down like a yo yo and can't even think about going back on one until after MRI scan being done in a week or so, and blood test results checked, so scan is important to say the least in the sense of it being done!

>If the doctor refuses to treat her patient then the patient will quit the doctor and go to some unscrupulous quack for help. Where he will get a placebo, this time perhaps not a harmless one. And will likely spend a lot more for it.< tumsup

tumsup I don't think its a doctor's role to have to second guess what a patient may or may not do with the truthful information they are given about what the doctor diagnoses is the problem. That would be to treat people like children. I think a doctor should be relied upon to give an honest professional opinion. I think that makes people feel safe because they then know where they are and who exactly they are dealing with. Whatever someone chooses to do with that information is their choice.

Effers, I hate to say it but, you're right

There's just no way to save a fool from himself. I hate the predatory businesses tarted up as medical clinics or worse, ministries.

I especially hate the cowardly legislators who give legal exemptions to fools who pray over a dying child who could have been easily saved.

Your second link 3Dots rather backs up my argument that any medicine that plays on the woo woo of non 'doubleblind trial based medicine' whether it be 'homeopathy' or 'placebo', should play no part in what a scientifically trained GP prescribes.

There should be absolute clear boundaries so that the vast majority of people know where they are and can make choices accordingly.

I think the real argument that is emerging here is how crucial is the value of the double blind trial as to determining what gets prescribed by the NHS.

Everyone's entitled to a second opinion.

Gif

Sorry, double simpost.

That was on the subject of ignoring one doctor and going to another who will prescribe the 'desired' treatment.

Gif

"Trust me. I'm a doctor."

I liked the Daniel Day Lewis character in 'The Incredible Lightness of Being'

He would say to women 'I'm a doctor, take off your clothes' and they would.

I suspect that simply saying "I'm Daniel Day Lewis, take off your clothes" might have the desired effect - as long as you are Daniel Day Lewis of course.



F

-- as long as you are Daniel Day Lewis of course.-

Oh,, so that's why it doesn't work for me! And here I was thinking that there might have been some creeping insincerity in my voice.

1 Then I saw an angel coming down from Heaven with the key of the pit and a huge chain in his hand.
2 He seized the dragon, the serpent of ancient days, who is both the devil and Satan, and bound him fast for a thousand years.
3 Then he hurled him into the pit, and locked and sealed it over his head, so that he could deceive the nations no more until the thousand years were past. But then he must be set free for a little while.
Holy Bible: Revelations Chap 20

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