How scientific!
I believe it takes too much time talking to the patient and explaining his REAL problem.
It only takes one minute to prescribe whatever it is.

"only rarely do they explicitly describe them as placebos"
Current medicine came from the treatment of solders in war, where they took orders from the officer/doctor.

Medicine today is a voluntary transaction, the patient has a problem, the doctor has a method of treatment. The doctor is presumed more learned and takes a parental-authoritative role. If a placebo works, then it is healing the patient, so it is doctoring.

In psychiatry there are voluntary and INvoluntary transactions.
The mentally ill patient is to take the role of compliant private(lowest military rank). Not to question orders/treatment, to believe whatever the officer/psychiatrist says is true. To be an obedient child. Deviation from compliance is antipsychiatry, not following orders, an act of rebellion against father/mother.
The placebo effect works if you believe in it and damnit YOU ARE NOT BELIEVING, believe it it will you?

How can that be considered ethically acceptable if there is not true informed consent. People trust that when their doctors says they're giving you a prescription for a certain medication, when they fill that prescription they are essentially giving consent about taking that medication. Am I wrong with this line of thinking?

While some of this might be for what the doctor considers "psychosomatic" complaints (a dangerous assumption), I bet a lot of it is for patients who *demand* antibiotics for viral infections and are not willing to accept the impossibility of such. :-P

I'm probably going to be the odd one out here, but I believe in the use of placebos. NOT antibiotics or sedatives, though.

The old time docs used to LISTEN to their patients and everyone went out the door with a bottle of the good doctor's homemade sugar pills or "elixer".

I used to have clients whose homes were full of little bottles of Doc Brooks' distinctive red "medicine". We all knew it was coloured sugar water, but the fact is there are tons of ailments for which medicine has little to offer. When you took your spoonful of Doc Brooks' elixer you remembered your visit with him. You remembered he cared about you. You remembered you were not alone. And you felt better.

I think we've lost something in this era of excruciating honesty--that so frequently forgets to mention side effects or the fact the prescription isn't likely to actually work.

The notion of using antibiotics and sedatives as placebos seems to violate that "do no harm" rule in the Hippocratic Oath.

Sherry

Would that in 1989 my p-doc had prescribed a placebo.

I've had a couple of pdocs where, once we had established a level of mutual trust, were very straightforward in stating antidepressants are effectively no better than active placebo, and in fact are just active placebos.

I am sure that I have been the recipient of antibiotic prescribing as a way to keep me quiet. I don't really call the prescribing of active meds even when it's just for "psychological" reasons placebo prescribing though. Certainly I don't call "sedatives" placebos. So I'm not sure I get the point here exactly. Sedatives probably quiet people down in all sorts of contexts but that's not the same as having the power of their own beliefs make them better. Active meds are not sugar pills/placebos because they have all sorts of confounding effects whether they are being prescribed as a way to "fool" the patient or not.

Regarding my comment "The placebo effect works if you believe in it " and psychiatric drugs. Yes there are sedative and other effects from psychiatric medicine. That the medicines will fix your non physical intellectual mind is what I am referring to in placebo effect. Logical reasoning, wisdom , rational correct/good choices, intelligence and introspection do not come in a pill form... well introspection might but I don't think it should be taken every day.

It's one thing to prescribe an actual sugar pill, or a multivitamin, and call it something else (especialy when it comes to treating disorders where the active/real medications are only about as effective as placebos anyways), it's entirely different to prescribe another drug, no matter how safe it is thought to be, and tell the patient you are giving them something else. All sorts of interactions in medications are possible, if the patient has no chance to check if those interactions could happen because they think they are taking a different medication, then the doctor should get sued if something happens to them. And if the pharmacy is compliant in this sort of trickery they should be sued as well.

Anyways, Do pharmacies carry "sugar pills"? And if docs are just rxing sugar pills or vitamins and calling them painkillers or antidepressants etc., HOW do you get that past the patient?

Are doctors and pharmacies allowed to conspire to trick a patient in such a way that they can miss-label a bottle of sugar pills or multivitamins as something like Vicodin or Prozac? Or are people just that stupid that they don't even read the labels of thier medications beyond the dosing recomendations of "take 1 pill every four hours for pain", onto where the drug/active ingredient name and dosage is printed???
Do pharmacies fill a bottle with inactive placebo and then lable it as the active drug? If they do so, then what happens to that extra stock of active drug that is left over? Is there some sort of internal monitoring system for the filling of placebo rx's???

I understand that the placebo effect can work for some people and actually works very well for some conditions compared to how well you woudl think actuall meds would work. Personaly I would have rather got a sugar pill for my depression all those times than the actuall drugs and what those drugs put me thru. But to rx something like a sedative to trick a person into thinking it is a pain med, that causes all sorts of problems. Not only do they have no chance of actually knowing what interactions they are at risk for, or if they have an allergic reaction which medication it is that they are actually allergic to, but they also may end up going to another doctor when the placebo pills don't work saying "the Percocete I was given wasn't strong enough, I've been on it for a year, my current dose is XXXmg per day, it's not enough, and my doctor still wont give me anything stronger so I've come to you." And then they get rx'd a stronger opiate pain med by a pain management clinic and OD because they actually had no tolerance to opiates because they were never put on an opiate in the first place. THAT is dangerous. And don't fool yourself, antibiotics are not harmless, if one is given an antibiotic to take daily and is told it is a pain reliever or something else, and thus ends up taking it for much longer than it normaly is prescribed, antibiotics can cause organ damage, some are very tough on the body, and they do have interaction s like any med, they can cause you to have an overgrowth of harmful bacteria while killing all the proactive bacteria in your body and cause you to become septic due to your guts becoming a breading ground for the wrong sort of bacteria (toxic megacolon).

There ought to be guidlines as to when and how and what type of placebos may be used in medical practice. If the current medications available to treat a certain disorder all show themselves to be non-significantly more effective (ie only as effective as) than placebos, then non-active placebos should be allowed to be used. But when it comes to conditions where placebo's are shown to be much less effective than the actual drugs used to treat that condition they should not be used. I understand placebos can work for pain for some people, but the placebo effect does wear off over time. I think it would be a nasty trick (and maybe it is also a conspiracy for pharmacies to make more money, the pharmacists to be able to take home the pain pills that should have been given to the patient, and maybe even split them with the doctor??? I am sure it has happened at least a dozen times this week if there is no monitoring system in place)... for a doctor to keep rxing a patient placebos for pain even if the placebo wasn't working, but I am sure it happens, and probably not always because it's in the best interest of the patient.

I really hope there are some regulations about how pharmacies and doctors can handle rxing placebos because if there isn't and it is as simple as the doctor calling your pharmacy and letting them know that you will be coming in with an rx to Vicodin or Oxycontin, but that the rx is to actually be filled with tylenol and just written as if it is oxycontin etc (again giving even something as "safe" as tylenol as a placebo could lead to an overdose of tylenol if a patient is getting this as a placebo and not made aware of it)... then there are definately some corrupt doctors and pharmacists out there either doubling thier money or getting thier fix by tricking patients.

I don't like the idea much. Not unless it never get as far as the pharmacy where the real drugs are and the doctor are doing this by buying sugar pills or vitamins and putting them in a bottle in thier office and labeling them there and not involving the pharmacies and the dissplacement of real drugs that are not going where they are suppossed to be going. That seems safe enough and leaves little room for corruption.

Knowing that this goes on pretty often really leaves me with a alot of questions as to how doctors and pharmacies go about it.

A good rule, look up anything you are given, read a few sources, that do not quote or copy each other, we have all seen the same article on different sites.
Then, take the pill and if the symptoms go away, stop for a day or two if is it safe to do. Then start again, if the symptoms go away again it is probably real.
I do this with nutritionals to see if they really do anything.
Do not do this with antibiotics if you have an infection, or if you are suicidal and not able to deal with the feelings.

When prescribed any medication-there is always the risk of being given the wrong medication in the end. It happens often. I am beginning to think that our Professional Sports Players are bound to a higher ethical code than those working in the medical field.....

"from the study: ethically permissable". There is something wrong with that. Period.There IS something wrong with doctors that believe that lying to a patient(witholding the truth regarding their med being real vs. placebo)is OK and ethically OK. Once again, patients being played for fools trusting doctors.

This really disgusts me.

katie lou, You asked:
"Do pharmacies fill a bottle with inactive placebo and then lable it as the active drug? If they do so, then what happens to that extra stock of active drug that is left over?"

I don't know about the placebo business but I can tell you there is a shocking absence of control over the inventories of pharmacies. My neighbours own a pharmacy. The entire family are a bunch of drug addicts and drunks. They steal from the stock, the pharmacist was trading sex for drugs with an addicted customer, it goes on and on. Literally, nobody's minding the stores that sell drugs. I was pretty amazed by it all. Now I'm a church secretary and that pharmacist is a member of the congregation. I haven't seen him yet and will try not to throw up on his shoes if I do, but it'll be hard.

Two words: informed consent.

Does anyone know if a Z-Pac, which is an antibotic and has it's own packaging could also be made up with sugar pills using the same packaging by the Pharmaceutical company to be dispensed by the Pharmacy if so ordered by a doctor? Does a doctor have to tell his patient he/she is being given a sugar pill?