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kbrown's picture

Catch 22

Hi everybody,

So I thought last week's discussion brought up some really interesting topics with respect to the ethics surrounding the administration of placebo treatments. With the onset of current literature demonstrating the effectiveness, even superiority of placebo controls in drug treatment studies, scientists and researchers at least, seem to be advocating for a turn to using placebos as medically accepted drug treatments for a variety of disorders and symptoms.

However, as was mentioned in class on tuesday, the use of placebo drugs such as sugar pills as treatments has a whole slue of ethical and moral issues surrounding it which seem, at least at this point, to create a substantial barrier for the use of these types of treatments. One such barriers surrounds the stigma attached to placebo drugs; namely that if one's symptoms are helped by a placebo, the symptom itself must have been psychosomatic, a term which seems to lead people to the conclusion that they had "made up" their symptom, a cause for embarassment for most. However, I think if we are to really advocate the use of placebos, we need to better define the term "psychosomatic". Personally the barrier between psychology and physiology for me is very thin. Often a physical issue will create a psychological problem, as we have found for various types of mental disorders, and likewise, as with "psychosomatic" symptoms, the system simply seems to work in reverse, and a pyschological issue will create a physical problem. Most patients seem to be much happier knowing that a psychological problem was created by some "defect" in their physical system, perhaps because of the commonly heald belief that physical problems can be "fixed" by surgey or drug treatments. If we are to use placebos effectively in the future, without making patients feel "crazy", then the field must redefine psychosomatic for the general public as something more acceptable.

Also, I wonder whether it is possible that placebos, by altering thoughts, emotions, and the psyche of a person more generally, might be able to essentially mimick the action of drugs by using endogenous chemicals in the brain. If this were the case, it might likewise be more acceptable to explain the use of placebos to "encourage" the body to use its own resources to treat physical symptoms.

Another good point that was brought up, and one that I think goes to the crux of why it will be hard in the future to incorporate placebo drugs into regular treatment rituals, is the issues surrounding paying for these placebos. It does not seem ethical to make people pay exorbinant amounts of money for a sugar pill, especially when the amount could be excluding a socioeconomically lower portion of the population from a possibly effective treatment. However, it seems to me that the way that our society deals with medical treatments would not allow for an effective while also cheap drug treatment. Especially because the effectiveness of placebos are so dependent on the patient's belief in the drug's effectiveness, I would venture to say that if the patient felt it was "too easy" to obtain the drug (namely that it didn't put them out financially), that their belief in its effectiveness would be altered. The phrase "you don't get something for nothing" pretty aptly explains the way that most people think about science and medicine today. For one to obtain a cure, some sacrifice must be made. I also think that society's hesitency to use placebo treatments ties into the way in which doctors and scientists are revered in society today as "miracle workers" somehow above normal society. There seems to be a certain sense that treating patients with something that is readily available in any common household would undermine the pedestal on which the medical field and the people in it have been placed. I think that for placebos to work effectivly as an actual medical treatment, the entire midset of the medical science industry, as well as the way that society interacts with it, must be changed, and that is not an easy feat.

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