A Honest Doctor, Sort Of

In an interview in the December 16 New Scientist (ungated for now here), psychiatrist Patrick Lemoine explains how what he sells is partly illusion:

How much do doctors use placebo therapy?
The most reliable estimates suggest that around 35 to 40 per cent of all official prescriptions are impure placebos, by which I mean pharmacologically inactive substances contaminated with a tiny amount of active ingredient – not enough to have a clinical effect, but enough for doctors to claim it does. …

Doctors hate not to be able to predict or control the outcome of a treatment, because it makes them feel like charlatans. As a result they tend not to prescribe pure placebos – that is, totally inactive substances – but impure placebos. This way they can fool themselves, at the same time as they fool their patients, that the treatment has predictable, scientifically tested effects.

Can you give an example of an impure placebo?
Magnesium is one. Rare conditions resulting from a deficiency of magnesium produce some symptoms very similar to those of anxiety. Magnesium is therefore often prescribed for anxiety in Europe, even though the cause, in most cases, is unlikely to be magnesium deficiency. …

Are you guilty of prescribing placebos?
Impure placebos, yes. I confess that I prescribe magnesium for anxiety. My patients are generally satisfied and sometimes I even have the impression that not only do they show a remarkable improvement, but their relapse is almost immediate if the treatment is interrupted.

If I’m honest with myself, I don’t really want to know if that improvement is a true pharmacological effect or a placebo effect. On the other hand, I would personally never prescribe homeopathy, because I consider that to be a pure placebo and my conscience wouldn’t allow it. …

Prescribing pure placebos can’t be a good thing, because it involves a lie on the part of the doctor. But if you know what you’re doing, giving an impure placebo can be justified. Even better, though, would be to persuade the patient that chemistry is not always the answer; that there are other ways to heal – through sport, for example, or love.

Doc Lemoin is honest to admit he is selling an illusion, but dishonest to think that this is not a lie if there is any chance whatsoever that a chemical effect is involved.  Don’t expect him to put much effort into pointing out the sport or love alternatives though, or to support allowing non-doctors to sell such illusions. 

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  • New to the discussion, and maybe missing the point. That said, the massive and documented placebo effect, and the games the medical industry and pharmacological industry play, using essentially the placebo effect may in fact be a great handle on the amount of “bias” in ourselves, or our culture. Belief systems become a background bias. But aren’t I entirely naked against the randomness of an unpredictable universe without a belief system and the inherent bias it bring?

    There’s a great little book on the logical fallacies of medical practice if anyone is interested, it’s available online… I can look it up.

  • Hi, dloye, and welcome, I would love to see that book.

    I run into this kind of thing a lot when I go to the doctor for mild ailments. They frequently prescribe an antibiotic even for things that I know are not helped by antibiotics! But I always get better anyway…

    A couple of weeks ago I went in because I had a persistent cough. It had been hanging on for two weeks, really bad and keeping me awake at night. I kept waiting for it to go away but it didn’t, so I finally went to the walk-in clinic. The doctor prescribed an antibiotic and said I should feel better in three days. Now, from what I understand there’s really not any likelihood that bacteria are causing this kind of cough. But I took the antibiotic anyway and sure enough, I felt better in three days. Luckily, for me placebos work even though I don’t believe in them… I think it’s because I’m easy to convince!

    But generally this kind of over-prescription of antibiotics is a big problem in the medical field and is seen as contributing to the development of antibiotic resistant bacteria which can cause really serious illnesses. I think it is a good example of the kind of thing Robin is talking about, these impure placebos.

  • Calca

    CocaCola didn’t reveal its formula for a very long time, yet people don’t mind this non-transparency. More generally, are “secrets of the trade” to be considered biases?

  • Wow, a higher percentage than I would have guessed! And doctors, on average, make about $200,000 a year. Like certain lawyers and dozens of other professions, their careers are built on exploiting bias.

  • Hal, the book Follies and fallacies in medicine can be downloaded from this link. I’ve read maybe a third… it includes a great discussion of placebo effect. http://curezone.com/ig/m.asp?i=19272