The Unethical Use of Placebo
Professional ethics should always be maintained in any kind of professional relationships. In the field of medicine, the use of certain drugs and how doctors deal with their patients are also subject to ethics. Doctors, at all times, must be honest with their patients in prescribing and administering drugs. For instance, doctors who prescribe placebo to their patients in place of normal medications without the knowledge of their patients is considered as a form of deceit; and as such, a violation of doctor’s professional ethics.
Placebo is a drug or a form of treatment which does not have a direct and valid pharmacological effect; but rather administered with the doctor’s assurance to the patient of its positive results. The effects of the drug are only dependent on the patient’s expectations and his or her trust towards his or her physician (Cuncic). Indeed, there are cases that placebo drugs render positive effects for patients with common illnesses. In addition, there are instances that the effects of placebo positively surpass those incurred by normal and validly used drugs (Harris A2).
Despite the positive results obtained from the prescription of placebo drugs, ethical issues must still be tackled concerning the use of this drug. In line with this, the paper will discuss why the prescription of placebo must be controlled and restrained to a minimal level. As such, several arguments are presented to prove that the use of the placebo is unethical.
First, continuous prescription of placebo drugs instead of valid medicines may further endanger the life of the patient. Although there researches that showed that many patients have been cured by placebo and showed significant effects to the patients’ recovery (Harris A2), such studies lack some factors that may lead to the assumption that placebo is indeed useful and significant to the patient’s recovery. In addition, a doctor, by prescribing placebo to his or her patients, is risking the recovery and life of the patient. Despite some researches presenting the positive results produced by the drug, there have been no concrete and absolute studies that may point that the drug will work at all times. Furthermore, the effect of the drug is often dependent on the amount of trust and confidence that the patient has for his or her physician. As such, if the patient has less confident to his or her doctor, then it is likely that a drug that has no concrete medical effects may not work to cure his or her illness. Thus, prescribing placebo may only worsen the patient’s condition rather than relieving it.
The placebo effect has two main components. The first is the administration of a dummy drug that looks like the usual prescribed drug. The second is the assurance from the doctor that it can help the patient recover from the illness. However, the truth still lies that placebo does not have a standard composition (Sherman). There is neither a definite way on how the drug should be administered nor how the drug is formulated. As such, doctors can change the composition of the drug as they prefer. Administering a placebo also means that doctors are prescribing untested drugs which may beneficial or harmful for the patient’s health depending on how his or her body reacts to the drug. Thus, doctors who prescribe untested drugs which do not have assurance on how it will affect the patient are unethical.
Another factor of placebo’s effectiveness lies on a good doctor-patient relationship. Placebo may only have good effects among patients who regularly visit their physicians (Cincic). As such, if a patient does not fully trust or know his or her doctor, it is more likely that the drug will not serve as a positive reinforcement for the patient.
According to the report by Gardiner Harris (2008) in the New York Times, some doctors use placebo as an antibiotic. Using the placebo in place of an antibiotic is very unethical because it deprives a patient with he or she actually needs. In line with this, there is no proof that the drug will not have a negative effect on the patient.
The placebo is tested to have significant positive effects on common disorders like depression and headache. It is reported to yield desirable results when put in good use (Harris A2). However, even if the placebo did have positive results for the patients, in the event that the doctor reveals the kind of treatment used to the patient, it can greatly affect the relationship between the doctor and the patient. Even if the patient can understand the doctor’s intention behind the action, the patient will remain doubtful of the kind of drug being administered to him or her. As such, it is not impossible that the patient will lose his or her confidence on the drugs that will be prescribed by the doctor in the future.
Another argument used against the prescription of placebo is that contrary to the belief that placebo is effective and cheap (Harris A2), the price of the drug usually varies according to the drug that it mimics. In truth, placebo drugs are more expensive because there are no regular companies that manufacture a placebo mainly because it does not have a regular formulation and only imitates the composition of a certain drug. As such, a doctor who prescribes a placebo drug must order the drug as he prefers it, thus making it more expensive which the patient has to compensate. In this situation, the patient has to pay more for a medicine that does not guarantee relief.
Another argument presented against the use of placebo drugs says that this practice may encourage drug dependency. A study was conducted wherein the doctors gave their patients placebo whenever they asked for a drug for common illnesses and achieved optimal results (Harris 2). This practice of prescribing a placebo drug encourages a wrong notion that one must always take a drug whenever feeling ill in order to get better. This idea is then widely discouraged by doctors worldwide; they do not resort to prescribing chemically engineered drugs if there are other options available for the patient because taking pills may induce negative side effects and drug dependency.
Another point of contest for using the placebo drug is attributed to the side effects that it may cause. Although generally, it is assumed that placebo has minimal effects, it may still induce unknown side effects. With its composition that usually varies and commonly unknown, its effects are also likewise unknown to the patient. Though there have been no reported accounts of major side effects, there are still no concrete proofs that it cannot induce harmful effects on the patient.
In general, doctors who prescribe placebo drugs to their patients will be commended if the treatment succeeds and if the patient gains understanding of why it has to be done. However, the problem may arise in the event that the drug does not help to treat the patient’s illness. In addition, this practice can also affect the doctor’s reputation; and consequentially, affect the professional relationship between the patient and the doctor.
Placebo can only be effective when the patient’s trust and confidence with the drug and his or her physician is high. As such, the drug can only work if the patient is entirely confident of the doctor’s judgment, and in some case, oblivious of the real medicine that is being prescribed to him or her. In this case, deceit on the part of the doctor is needed before the administration of the drug can be effective. In general laws of ethics, anything that is done with deception is unethical and wrong regardless if the intention is clear and geared to induce positive results.
Generally, the unethical use of placebo worldwide has aroused a big doubt on the healthcare industry. As such, the government should impose a policy to restrain and regulate the prescription of placebo drugs. More importantly, a set of punishment must also be provided for medical practitioners who will continue to do this practice without valid reasons and without undergoing an intensive research on the case at hand.
Cuncic, Arlin. 28 November, 2007. “Placebo”. About.com. 24 March, 2009 <http://socialanxietydisorder.about.com/od/glossary/g/placebo.htm>.
Harris, Gardiner. “Half the Doctors Routinely Prescribe Placebos”. New York Times. 24 October, 2008: A2.
Sherman, Lisa. 01 October 2008. “Components of the placebo effect” The Free Library. 23 March 2009 <http://www.thefreelibrary.com/Components of the placebo effect.-a0188159213>.
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