Doctors prescribe drugs that don't work

BY RUTH HILL
Last updated 05:00 04/07/2009

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Three out of four New Zealand doctors have prescribed placebo medications to patients, new research suggests.

Medical researcher Shaun Holt said the practice could be costing the taxpayer several million dollars.

Of 157 doctors surveyed, 72 per cent admitted dishing out placebos, including vitamins, herbal supplements, "harmless" medications, salt water injections and sugar pills.

"But what surprised us was the most commonly prescribed placebos were antibiotics, which is obviously a concern because of the rise of antibiotic resistance and potential side-effects for patients," Dr Holt said.

A placebo is an inert medicine intended to lead the recipient to believe that it may improve their condition.

Patients' unjustified demands for medication was cited as the most common reason for prescribing placebos (34 per cent), followed by non-specific complaints (25 per cent), and exhausting other treatment options (24 per cent).

Dr Holt, who co-authored the paper in The New Zealand Medical Journal with Massey University psychologist Andrew Gilbey, said he believed placebos were ethical "as long as the doctor considers them to be in the best interests of the patient". "The placebo effect is quite powerful," he said.

A recent New Zealand survey suggested patients accept placebo use, at least when there is no available alternative. However, given the deception involved, it has been suggested that placebo use could harm the doctor-patient relationship. The American Medical Association warns that placebos are unethical and could expose doctors to malpractice suits.

Other medical authorities claim placebos are bad because they condition patients to believe that pills fix every ailment.

Dr Holt, who is calling on the Medical Council to issue guidelines on placebos, said the total cost to taxpayers from placebos could be "several million dollars" in subsidised GP visits, medicines and pharmacy charges. "There could be an argument for bringing back sugar pills, which are safer, just as effective and certainly cheaper."

Wellington Independent Practice Association chairman Richard Tyler, a Johnsonville GP, said it was "not what you give, it's how you give it".

"A doctor that hands something over with a couple of grunts is not going to get the same result as someone who listens to the patient, explains the illness and the treatment. You can't separate that from the placebo effect."

Pharmac medical director Peter Moodie said data showed doctors were prescribing antibiotics responsibly. He agreed it was not acceptable to waste money prescribing medicines with no effect.

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Both the Health Ministry and the College of General Practitioners declined to comment.

PLACEBO EFFECT

A placebo is a sham medical intervention, such as a pill or even an operation, intended to make patients believe it will help. If someone thinks something will make them better, it sometimes does a phenomenon known as "the placebo effect".

HOW DOES IT WORK?

Placebos are associated with the release of natural painkillers in the brain, including dopamine. Taking a placebo creates a "self-reinforcing feedback loop" in the brain: during pain an individual recalls having taken the placebo and reduced pain reinforces its status as a painkiller. About one-in-three people appear susceptible to placebo effects.

NEGATIVE EFFECTS

The so-called "nocebo effect" occurs when patients taking placebos develop side-effects associated with real treatment. Some patients suffer withdrawal symptoms when they stop taking placebos.

- © Fairfax NZ News

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