German doctors are advised to use more placebos



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Drugs not working? German doctors are advised to use more placebos
By Maria Cheng, The Associated Press – 1 day ago

LONDON — For German patients plagued with problems like chronic pain
and mild depression, doctors may soon be trying something a little
different: a placebo.

After completing a major study on the use of placebos, the German
Medical Association recently concluded the fake pills sometimes work
better than real medicines and recommended that doctors give them out
more often — even without explicitly telling their patients.

That is in stark contrast to guidance from American and British
authorities, who say using placebos without the patient's consent is
unethical. Placebo pills are often made from things like sugar, flour
or dust, though doctors also use other things like vitamins, herbal
supplements or drugs with very little active ingredient.

According to the German group, placebos don't come with any nasty side
effects and could be the last hope for patients with hard-to-treat
ailments where no good medicines exist.

"You shouldn't give placebos for anything, but there are certain
situations where they can be quite helpful," said Dr. Peter Scriba,
chairman of the German Medical Association's advisory board.

He said placebos could help patients with mild anxiety, depression,
chronic inflammatory problems, pain and asthma.

Experts have long recognized that placebos can sometimes cause
physiological changes in patients who expect to get better and brain
scans have shown that the brain reacts to placebos in the same way it
does to actual drugs. They say placebos work best for diseases where
there is a subjective component like perceptions of pain — and that
they wouldn't work for other problems like broken bones or cancer.

Scriba said placebos shouldn't be used for conditions where an
effective therapy exists and that doctors must tell patients they're
getting something unusual. But Scriba said doctors aren't obliged to
actually use the word 'placebo.'

"You could tell the patient you have something that has helped other
patients with their condition and you consider it possible this
treatment might help," he suggested.

Some experts were horrified by the less-than-forthright approach.

"That's what I call lying," said Ted Kaptchuk, an associate professor
of medicine at Harvard University. "I'm not saying it's wrong, but it
would be unacceptable in the U.S."

The American Medical Association warns that doctors who use placebos
without telling their patients may undermine their trust and cause
harm.

Kaptchuk thought there might be a role for placebos, but said doctors
haven't yet figured out how to harness their potential. "In the U.S.,
we have a commitment to transparency," he said. "The Germans seem to
be saying that it's OK to lie a little bit."

Still, he said using more placebos might wean people off drugs that
haven't proven to be very helpful and could also save health care
systems millions of dollars.

"The amount of drugs people are taking to really only get a (minor)
benefit is astronomical," Kaptchuk said. "A lot of doctors will say
it's easier to write a prescription but we're not giving patients the
best treatment possible when we rely on drugs."

Last year, Kaptchuk and colleagues published a study that found people
with irritable bowel syndrome who knowingly took a placebo still got
better, providing some proof that doctors don't always have to deceive
patients when giving them dummy pills.

Previous surveys have found up to half of the doctors in Denmark,
Britain and the U.S. regularly give their patients placebos without
telling them.

In Britain, medical authorities completely reject the idea that
placebos might be valuable.

"We don't agree with the use of placebos at all because by definition,
they're a medication that has no value," said Tony Calland, chairman
of the British Medical Association Medical Ethics Committee. "Using
placebos isn't scientific. It sends medicine back into the 19th-
century."

Other experts said some patients might get better simply by spending
more time with their doctors.

"The doctor-patient relationship is critical to the placebo effect,"
said Irving Kirsch, a professor emeritus at the University of Hull in
Britain who has studied placebos. He said for some people, placebos
are a case of mind over matter.

"Patients who trust their doctors and have a psychological expectation
of getting better could trigger a reaction in their body," Kirsch
said.

Some Germans didn't seem averse to the idea of being prescribed less
medication since the new placebo recommendations were issued, but said
trusting their doctor was paramount.

Monika Sommer, 59, said she would take a placebo if her doctor
recommended it.

"I would be willing to try it," she said in Berlin. "If you don't
know, you have faith in the idea that you are getting something that
will help and often, psychologically, that is enough."

"You just need something to take," she added.

Associated Press Writer Melissa Eddy in Berlin contributed to this
report.
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