Placebo special needs

Placebo special needs considers a survey which shows wide use of active placebo treatment in the medical community. How does this impact on Chiropractic?

The survey

Five ethicists surveyed 1200 randomly selected physicians, of which nearly 700 responded.

  • Approximately 50% said they prescribed placebo meds on a regular basis.
  • Only 399 thought placebo treatment ethically permissible.

Placebo better than no treatment

Placebo treatment has been shown to be superior to no treatment at all. So, in the treatment of FIBROMYALGIA, the respondents were asked if they would prescribe dextrose for non-diabetic patients, if it was proved to be superior to no treatment at all?

Only 10% said definitely not, and 58% said it was moderately or highly likely they would.

"Active" placebos

Physicians were clearly happy about prescribing a substance that was "non-active" for its placebo effect, however when it came to "active" placebos (this wasn't researched), one rheumatologist thought it inappropriate for example to prescribe a NSAID like naproxen which is known to have significant side effects on the kidneys.

"That's not a placebo," said Dr Norman Gaylis. "The first thing for us is to not harm our patients."

Chiropractic placebos

How might this impact on us as Chiropractors? Would we

  1. use ultrasound when it has no proven effects?
  2. adjust a painful neck when no fixation was found?
  3. adjust a neck for Carpal Tunnel Syndrome when it has not been proved to have any effect?
  4. adjust the neck of the dizzy patient, knowing full well that the possibility of an adverse effect was reasonably high?
  5. adjust the lumbar spine of a patient with a sequestered disc for its placebo effect?
  6. refer a patient with a brachial neuralgia for surgery when it has not been scientifically proved to be effective? In effect, placebo surgery?
  7. give exercises, use traction, prescribe a corset or bed rest for the patient with acute low back pain when the research is not unequivocal?
  8. do only gentle massage on the elderly osteoporotic patient?

Placebo journal

In the consideration of the placebo special needs of our patients certainly asking the patient to keep a placebo journal (obviously one wouldn't call it that) should be considered. Likewise, accurate SOAP notes measuring the patient's response to our placebo treatment is highly desirable.

I wonder how 1200 Chiropractors would respond if ethicists were to ask us such searching questions?!! I suspect 44% or more would also decline to respond!

Placebo special needs

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