This Is MS Multiple Sclerosis Community: Knowledge & Support

I've often wondered why doctors don't use placebo more often for MS, especially if they do it as described in the article below where, "34 percent said they told the patients the substance was something that "may help and will not hurt."

My vote would be for doctors to prescribe vitamin D or omega-3 as they are widely available, won't hurt, might help and aren't expensive.



Doctors say placebo use common

Jan 3, 2008 - Reuters - Placebos are a surprisingly common prescription, according to a U.S. study in which nearly half of the doctors surveyed said they had doled out a dummy pill at some point.

Researchers at the University of Chicago said on Thursday the study raises ethical questions and suggests a need for greater recognition and understanding of placebo use.

"It illustrates that doctors believe expectation and belief have therapeutic potential," said Rachel Sherman, a medical student at the University of Chicago, whose study was published in the Journal of General Internal Medicine.

The idea behind placebos is that when patients think they are getting an effective treatment, they sometimes feel better, even though the pill has no proven benefit.

They are often used in clinical trials to compare the benefits of drugs, and many times patients taking placebos show some improvement. But few studies have shown how doctors use placebos in routine practice.

Sherman and Dr. John Hickner, a family medicine professor at the University of Chicago, sent surveys to 466 internists at three Chicago-area academic medical centers. About half, or 231, responded.

Of those, 45 percent said they had used a placebo during their clinical practice, a number that surprised the researchers. But 12 percent of those surveyed said placebos should never be used.

"I think this shows that it strikes a chord among physicians. We may underestimate the body's natural healing potential," Sherman said in a telephone interview. "This shows that doctors may think that, too."

But Sherman said the practice brings up ethical issues, including whether a doctor has an obligation to provide patients with informed consent.

Of respondents who reported using a placebo in clinical practice, 34 percent said they told the patients the substance was something that "may help and will not hurt."

About a third gave other information to patients including, "this may help you but I am not sure how it works."

Nineteen percent said it was a "medication," and 9 percent called it "a medicine with no specific effect." Only 4 percent of the doctors said, "it is a placebo."

Part of the reason doctors are not forthcoming about giving a placebo is that in order for it to work, patients need to believe it can help, Sherman said.

One way around this dilemma is to ask all new patients for their consent in advance. "The patient could say no. Then you avoid any of these ethical questions," Sherman said.

Reuters link

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It is sometimes brought up that the CRABS have an efficacy rate similar to a placebo. Maybe the docs are already prescribing a placebo (albeit an expensive one).

gwa

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Bob, I mean prescribe something like a placebo on top of what is already being done, not instead of presciption meds. No ethical issues I can see if they do it as I suggested in the first post.

GWA, you're right, I wonder if the placebo effect is an all or nothing thing, or can you make a placebo effect stronger by having more than one placebo?

dignan,

One thing that I see as I read comments from people that are taking the CRABS and who are getting worse while on them, is that they are afraid to stop because they might get even worse.

My thought is that the drug companies are scaring newbies into taking the meds even though the research doesn't back up the claims on the pretty glossy pamphlets given to patients.

Doctors frequently give patients a wad of reading material about the meds and let them choose if they want on them or not. I went to a neuro yesterday because my internist asked me to go see him so that she had a person to call if I needed help. He told me that he was not convinced that the CRABS were doing much good and that there was no way to tell if they were helping patients.

The CRABS are of no interest to me because I am SPMS and have had MS for going on 36 years. I do know that I would not personally take them if I were just diagnosed. My own criteria for taking a med is that it must do some good and MAKE ME BETTER now.

Now the drug companies are taking their old product and testing it with another med, such as estriol, instead of looking for something that really works. They can stall for another 20 years instead of hunting for something that will make a difference.

Gotta go, I am starting to sound like Harry.

gwa

Does the placebo effect only affect how a patient feels, or has it been known to show up in MRI's and other criteria considered beyond the realm of patient control?

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COB,

The reason I went to the neuro was because my internist wanted me to have an MRI because she was checking for reasons that would explain pressure in my head.

My MRI was clear and the radiologist told her that my brain was not the brain of an MS patient because I had no lesions! So I went to the neuro who looked over everything and did his thing with his little rubber hammer.

He told me that approximately 5% of MS patients do not have lesions that show up on MRI's and that there was no doubt in his mind that I have MS. Considering that I am about a 6.5 on the EDSS scale, I was not surprised at his conclusion.

My point is that we have known all along that lesions(detectable ones) have no correlation to symptoms and yet lesion load is the gold standard for all CRABS and clinical trials. It is also known that lesions come and go and a med may have nothing to do with it.

Since I show no lesions, what should I attribute to that? Maybe it is the Vitamin D I take. Maybe it is just the placebo affect.

gwa

GWA, you wrote:

You express my similar opinions, but better than I can. I would be pleased to sound like Harry and you!

I still think the logical first step is to FIND the CAUSE OF MS!!

All these researchers and drug companies can't have STUMBLED onto an effective treatment when they have no definite cause, only hypotheses. They might as well be dialing numbers at random on the telephone, trying to reach me!