In Practice

Earthquake of a story going on right now on this topic. We have so many pharma companies pushing so many drugs on TV that now we find the only escape for doctors being pilloried by patients for the latest drugs is to prescribe sugar pills. What a world. For more interesting/entertaining thoughts on this topic, see Writing Frontier's "Ask Your Doctor" at

http://writingfrontier.com/2008/07/12/hello-world/

Placebos might work for subtle things,and keep ones anxiety down so as to minimize a condition but it seems to me it's very limited in scope and applicability.I believe religion is a good placebo for the mentally ill.It can keep them from acting out,or shall we say, keep them in their place.-Sure glad you feel better!! Sincerely, David

This strikes me as far worse than paternalistic; it appears to be the self-aware providing of bad medical care. It is outrageous that so many doctors not only subscribe to this ridiculous (and potentially harmful) expediency, but freely admit to doing so. How is one to trust the judgment of doctors who regularly adopt this sort of sketchy ethical decision making?
kk

O Writing Frontier intern: you should realize that the In Practice blogs are not quite the highest volume traffic that you might expect or desire when attempting to leech off readers. In addition, your writers should really try to get some new material set up when repeatedly linking to the WF webpage. (For a better laugh try Best-of-Craigslist, the writers are not professionals but the posts are soooo much funnier than WF)

As for trolls, the rule is---don't feed them ["keep them in their place."] one comment though, didn't Freud say that each and everyone of us are mentally ill, the only thing varying upon degree, so "them" is really all of us.

My question is the following: wouldn't your surgeon have expected you to find out more, even at a perfunctory level, about this remarkable "no side effects" drug, after all, you are a doctor, a psychiatrist? And as you say, even if you aren't a doctor, nowadays everyone has easy access to all manner of information, listed on, for example, the Physician's Desk Reference, WebMD, etc.,etc.

Did you wholeheartedly embrace your surgeon's pronouncements? Did the surgeon have the balls and bravura to assume that you would take him at his Word, wouldn't be in the least curious, and wouldn't carry out any further investigation on the effects of the drug?
My point is, the power of the mind is a truly extraordinary thing and cannot be undervalued, the Placebo Effect does not play out if you are not a "true believer"(or truly misled as the case may be).
Unethical? Maybe, Positive expectancy is not a bad thing if it adheres to the "no harm done" rule. But I agree with Karen K., it is a violation of trust by the doctor---we are not children and the prescribing doctor, the "I know what's best for you" parent.

Professor Adam J. Kolber has a well-argued paper on the subject: "A Limited Defense of Placebo Deception" available at SSRN: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=967563