Saturday, July 04, 2009

Doctor beat-up

This is an entirely spurious headline designed to antagonise patients and taxpayers;

Doctors prescribe drugs that don't work

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.

The placebo effect exists, therefore if a drug improves someone's condition, it has 'worked'. The writer tells us as much in the article;

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.

Doctors are quite probably adept at identifying the one in three.

And what about prescribing drugs as a diagnostic tool? If the doctor guesses wrong, the drug 'doesn't work'. But it does eliminate one possible diagnosis so hasn't been a waste of money.

There is a subtle but significant difference between a drug not doing what it is therapeutically supposed to do and it being a waste of money.


Shaun Holt said...

Hi Lindsay - you're right, that was not the message that I was trying to get across, I've posted the media release here....

Media Release

Cheers. Shaun

Lindsay said...

My problem wasn't with you, Shaun. It was the way in which the media frames what are often quite complex issues. Thanks for the link.

Manolo said...

The Dom Post looks (and reads) more and more lightweight these days.

Time to reconsider renewing the subscription.

MacDoctor said...

Well said, Lindsay. Clearly placebos "work" because the patient gets better. It makes absolutely no difference if the medication was active or inert as the desired result was achieved.

As I have said on my blog, the only proviso for using placebos ethically is that there is no evidence based therapy that could be used instead. Otherwise it is perfectly ethical and by no means a waste of money if people get well!

Shaun Holt said...

It was reported well on TV1 last night...



brian_smaller said...

I feel a little sorry for you Docs who have people demanding drugs for conditions that don't require them. It doesn't surprise me that you prescribe placebos in certain cases.