An ongoing dialogue on HIV/AIDS, infectious diseases,
October 27th, 2008
Antibiotics as Placebos?
This article in the BMJ is geting lots of news: Out of 679 practicing physicians in the United States, about half admitted to prescribing placebos on a regular basis. A “small but notable proportion (13%) of physicians reported using antibiotics.”
My first instinct was surprise that the rate was this low, but then I remembered that public perception of this practice might not be so favorable. As a result, the appropriate MD response to this news is to be “shocked, schocked …” that placebos are being prescribed, and to express grave concern at the ethics of the practice. So undoubtedly some of the doctors surveyed in that study probably didn’t tell the truth.
From an ID perspective, reading that antibiotics are sometimes used as a placebo is hardly news at all. Since about half of the US population believes that antibiotics are helpful for the common cold, all a clinician has to do is prescribe a Z-pack for a runny nose to a patient expecting antibiotics, have that patient get better (colds do, after all get better eventually), and the practice is reinforced. This exact exchange must transpire hundreds of thousands of times a day in doctors’ offices and emergency rooms.
I’ve written here about one potential cure for this problem (C. diff), but it’s not exactly something you’d want instituted as a preventive measure.
Is there a way to exploit the placebo’s powerful effect in clinical practice that doesn’t seem so sneaky? And doesn’t expose patients to medication side effects? Here’s one: Our office has a terrific coffee/tea maker, and I’ve found that handing a patient with a bad cold a cup of freshly made green tea in a nice mug works wonders. I don’t believe we ever covered that in medical school.