The Importance of Placebos

One of the dangers of patient satisfaction surveys and websites:

If we keep overprescribing [antibiotics], they will be completely ineffective. The consequences of this are huge,” Mangione-Smith says.

Why, then, do physicians prescribe them when they’re not called for?

One reason might be to keep their ratings high.

In the study, reviews for the telemedicine service were quite high overall — 87 percent of encounters earned 5 out of 5 stars for patients. But the reviews were significantly higher if the patients received a prescription, especially if it was for an antibiotic. Seventy-two percent of patients gave 5-star ratings after visits with no resulting prescriptions, 86 percent gave 5 stars when they got a prescription for something other than an antibiotic, and 90 percent gave 5 stars when they received an antibiotic prescription.

In fact, no other factor was as strongly associated with patient satisfaction as whether they received a prescription for an antibiotic.

Hadn’t heard this about anti-biotics before. It’s hard to describe the rather intense pressure my wife is under to prescribe pain-killers. Of the handful of times her safety has been threatened, all but one involved drugs she wouldn’t prescribe.

Even though there’s no addiction issue, it’s not hard to imagine that there are lesser variations of this for anti-biotics.

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5 thoughts on “The Importance of Placebos

  1. I admit: I prefer placebos that are sugar pills.

    I wonder if there shouldn’t be a new “antibiotic” released that is nothing more than sugar pill. I googled “drug name generator” and found this site.

    I got the name “Cortiranon” and, me being me, I liked it because it contained “anon” there at the end.

    Back to the point, there should be a new “antibiotic” called “Cortiranon” that is nothing more than sugar pill.

    Doctors can prescribe it to patients who think they need an antibiotic but they don’t. “TAKE ALL OF THE PILLS ACCORDING TO THE SCHEDULE!”, the doctors can yell. But, in this case, it won’t matter.

    If, on the off chance, a patient shows up who actually has a problem? A real problem that requires real antibiotics? Well, give them one of the real ones. Amoxicillin, maybe.

    If the patient demands to also get this Cortiranon that they’ve heard works so well on their friends? Argue with them for 10 minutes. Then give in. But make them take the Amoxicillin too. ACCORDING TO THE SCHEDULE!

    And get the five stars.

    Everybody’s happy.

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  2. My doctor – knowing I am a biologist – told me that the newest thinking on sinus infections is that many of them are viral or fungal, so antibiotics won’t touch them.

    I had gone in with sinus and upper-tooth pain, expecting a prescription. I didn’t get one. I was okay with that even though it did take a LONG time for whatever it was to move out of my system. (I’ve also read that antibiotics are hard to GET to the sinuses; they are poorly-perfused or something).

    I dunno. Unless I have reason to believe a doctor doesn’t know what they’re talking about, I’m not going to downrate them for not giving me an rx when it’s not called for. But I guess other people are different?

    I’ve been prescribed prescription painkillers for stuff (eg., wisdom-tooth extraction) and was like “let me try with ibuprofen for a day or so first” and usually wound up not filling the prescription, because I’d rather have a little pain than be totally out of it…and most OTC things work okay for me.

    The flip side of it is that I know people with chronic pain who ARE helped by prescription painkillers and who wind up having to go through hoops to get them because of concerns about addiction or “street value” or some such.

    I also wonder if advertising meds on tv has some influence on people demanding stuff, though I admit I hear the list of possible side effects and shudder and cross myself a little bit and hope I never have to have that medication.

    I don’t know what the answer is. Maybe it’s “Stop surveying the hell out of everything.” I loathe how I get e-mailed “satisfaction surveys” about nearly every purchase or transaction I make, and I generally don’t fill them out. Why should I give my time just to pad someone’s resume? I’ll let a business know if (a) they did a really outstanding job or their employee was really super, so that employee can get a good note in their file or (b) it was really bad, and something needs to be changed (or: “I’m not using your service again,a nd here is why”)

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  3. You know, I read articles like this all the time and my experience (pretty extensive by this time, with first myself in the 70’s – I was a very sickly child, then my much younger brother and sisters in the 80’s, then my own children from 1991-present, and then my clients and their kids for the last 10 years, not to mention myself) has been that in many, many instances it is the doctors pushing the medication on people. I certainly don’t doubt that people can and do request/demand medication from a doctor but up until very, very recently the doctors were really pushy with the antibiotics, and other medication all of which has risks to it.

    I can’t even count the number of times I took antibiotics as a kid and I’m sure I needed them only a few times if that, even. My brother was on antibiotics for 6 weeks straight for “a cough that wouldn’t clear up.” Someone in our house was almost always on antibiotics growing up. There was a perpetual bottle of pink stuff in the fridge from November to May.

    Then with my older sons in the 90’s, I was one of the earliest incarnations of those annoying entities known as “crunchy moms” and did not want to have my kids given medicine unnecessarily (probably because my body was a walking pharmaceutical company by that point). But the doctors acted like I was killing my child if I didn’t want the pink stuff for every sniffle and didn’t want to treat a fever. “But I read that fever is the body’s natural defense mechanism”….”STOP READING THINGS, give them this medication or they will surely perish, you monster.” This happened repeatedly. So it’s hard for me to buy this as being fully true.

    Ironically, several times I have gone to the doctor for actual emergencies and then been totally blown off. Once my son had pneumonia and I had to knock-down, drag out fight them to test his oxygen saturation levels to prove it (this is a “test” that entails sticking a thingy-doo which they already have sitting there in the office on a person’s finger for 10 seconds). I had optic neuritis which could have blinded me and it took me several doctor visits to be diagnosed (their first line of defense – “you have a sinus infection, nah, we don’t need to run any tests, here’s some antibiotics”.) I had a heart problem from childhood that I couldn’t get diagnosed until after 15 years of doc visits and then 8 years later was finally given medication for it, and a fairly serious autoimmune disease that took a year to diagnose and for which I’m still trying to get adequately treated. My treatment entails me looking up stuff on online forums that other people are taking and asking about it and the doctor saying “Oh yes that’s a great idea, here’s a scrip.”

    So again, this idea that doctors are innocent victims and they can’t just say no to people who think they need treatment doesn’t ring true because they seem to have no issue saying no to ME even for some pretty red flag symptoms. True story: “Doctor, my heart is racing 200 beats a minute and when this happens I feel on the verge of blacking out” “Are you SURE? You’re a young healthy woman and young healthy women don’t have heart problems.” 15 years later: “You were wrong that your heart was beating 200 beats a minute. It was actually beating 220 beats a minute!! har har har. Yeah it’s a super common thing, lots of people have it, especially young women!” Ok dude, this has ruined my whole adult life, glad it’s a joke to you.

    As a result of all this, I’m curious if this has more to do with the notion that the doctors who have listened to the patients and treated them with respect rather than blowing them off and saying “It’s a virus, it’s anxiety, you’re fine, get out of my office now” end up with higher patient satisfaction.

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