[Interview] Practice MMI: Placebo Effects

Placebo (Ethical Decision Making)

Dr Cheung recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr Cheung doesn't believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches and muscle aches, because he believes that it will do no harm, but will give them reassurance.

Consider the ethical problems that Dr Cheung's behaviour might pose. Discuss these issues with the interviewer.

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Outline: 

- ethics in informing the patient

- placebo effect as reassurance is trickery and undermines physician-patient trust

- using useless drugs may make the patients feel treated, and they do not have to follow other measures to improve their non-specific symptoms

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Response:

Although the goal of doctors is to improve the well-being of the patients, physically, mentally, and emotionally, I believe that using placebo effects to trick patients into a false sense of safety and reassurance is unethical. It may be true that placebo effects sometimes are real; the mechanism of psychology affecting physiology is poorly understood, but not unheard of. And sometimes the patients may even demand the drugs that they believe are useful.

Despite that, I will explain two reasons why using placebo effect may be unethical, and propose a better approach to dealing with these patients.

First, using the psychological effect of placebo to sooth the patients is at best a well-intended lie. It puts the patient's trust for this doctor and even the entire medical system at jeopardy, since the patient may find out that the drug he or she was prescribed has no effect to improve his or her conditions. 

Second, even if the patient does not find out the ineffectiveness of the prescribed drug, providing him or her with this false sense of security may undermine other efforts to improve his or her health. For example, if the patient is reassured by the placebo for fatigue, he or she might ignore the suggestion to quit smoking, which may actually be the root cause of his or her fatigue.

In the situation when the cause of the patients' symptoms are ambiguous, the physician should be honest and open about the ineffectiveness of placebo, and suggest treatments that are actually beneficial for the health of the patients. These may not even need to be pharmaceutical; for non-specific symptoms that do not have medical treatments for, suggestions for a healthy life style such as regular exercise, a balanced diet, and adequate rest would be more beneficial for the patients.