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Participate in this Ethical discussion.

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Admin:
Placebo is a dummy medicine containing no active ingredients; an inert treatment; Anything of no real benefit which nevertheless makes people feel better & it works because of the patient's belief in it, not because of the actual physical change it produces.

Please justify your answer?

Sjama:
i do believe that i cant lie to someone who is despaired for help and from that point i would not give placebo just to please that patient.

Dr.Adnan:
There has been many medical studies reporting the efficacy of placebo in treating many chronic conditions. your judgment to give placebo  depends on the situation, e.g in Rural Somalia you may see elderly patient who claims that injection is their only treatment, you try to convince them but "You know How somalis think" , Madax-adayg kicks in and they refuse, the solution is one single shot of saline and you may not see that patient for a year or a two, plus you don't that patient to  suffer in his hallucinations for a long time.

The thing we should be concerned about is Addiction to Placebo, which is one of its new side-effects . Psychiatric consult is recommended, if not available try to address the patient and his family directly about the problem.

One other problem is breaching the patients autonomy and trust in the account of beneficence, so this conflict between Autonomy and beneficence is to be handled carefully for it might effect future doctor-patient relationship and bring mistrust between them.

After all, Doctors should be smart to know when placebo is of advantage to the patient and when it is harmful ......... ;D

Diagnostic:

--- Quote ---Using placebos therapeutically requires extraordinary caution:

First, how placebos affect the mind remains to be elucidated.
Second, therapeutic placebo use entails deceit, which can seriously impair the doctor-patient relationship (which alone can have a strong placebo effect).
Third, the physician may misconstrue a salutary pla-cebo effect as evidence that the patient's illness is wholly or largely a neurosis.
Fourth, there is no legitimate program for health professionals that focuses on how and when to use placebos and on how to judge their effects.
Fifth, there are no standards for managing possible aftereffects of placebo administration—i.e., for dealing with any consequences of learning that a health problem and/or relief from it was "all in one's head." But the dearth of information on the placebo effect and the need for caution do not negate the legitimate findings of clinical researchers and should not rule out—or automatically render unethical—all therapeutic placebo uses by clinicians.
--- End quote ---
by Kenneth E. Legins

We are discussing here whether it is ethical prescribing harmless placebo but did we think about prescribing harmful unnecessary medications for a patient just to increase our income as experienced in some our doctors back home.

I have seen with my own eyes several patients holding a bag full of different medications which to my surprise some of them interact with each other.

Another common problem is ordering unnecessary expensive and sometimes invasive investigations e.g X-rays for the same reason mentioned above & when you ask why this doctor ordered "Liver or Renal Function Test" for a patient complaining of common cold or simple pneumonia, the answer will be: to lessen the patient's anxiety or unacceptable justification for "ruling out" other causing diseases!!!

To them, I say: please use your clinical reasoning and critical thinking to minimize your large differential diagnosis list before ordering such expensive tests.

Such behavior of prescribing dozens of medications and doing ultrasound for every patient complaining of abdominal pain created false belief among the community that a good doctor is always who gives bunch of drugs and scans the patients with his machine!!!!!!!......

By lessening the patient's anxiety or avoiding him the side effects of unnecessary drugs justifies the placebo prescription.

Admin:
Researchers at Harvard Medical School have found that placebos work even when administered without the seemingly requisite deception.

The study published yesterday in PLoS ONE
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015591

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