Sometimes I count it as a victory when I manage
Just to drag my aching body out of bed
The doctors, mystified, could not produce an answer
So they told me it was all in my head
-- Everybody Knows About Me
The person who inspired the song
"Everybody Knows About Me" pointed me to a
New York Times article last night. According to this piece,
half of doctors regularly prescribe placebos.
The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.
The bioethicists are having a field day with this one. On the one hand, it's wrong for medical practitioners to lie. Patients trust doctors to know more than they do (though many with obscure diseases like ME/CFS often find themselves having to educate their own physicians), and to provide valid information and treatment. Prescribing medication that has no clinical effect on the illness is a clear betrayal of that trust. On the other hand, if the placebo effect actually works, then the doctor has in a sense provided real treatment ... right?
Well, not so fast. Scroll a few paragraphs down, and we find this telling quote:
Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.
But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. [Emphasis mine.]
Readers with fibromyalgia or ME/CFS or similar are at this point already throwing things at the screen, and don't need me to explain what's wrong with the good doctor's argument. But for those of you who are unfamiliar with fibro, here's a breakdown:
- Fibromyalgia is a real disease. It is formally classified as such in the International Classification of Diseases under Soft Tissue Disorders.
- Instead of bothering to do any actual research, Dr. Schreiber simply assumes his fibro patients are being "difficult."
- He prescribes medication that not only doesn't help, but might cause harmful side effects. Fibromites have enough pain in their lives without also having to deal with gastrointestinal problems.
- The doctor gets paid for dispensing treatment he knows to be clinically ineffective.
"Everybody Knows About Me" contains a passage describing how some medical professionals write off real pain and suffering as "all in your head" instead of admitting they have no idea what's wrong. That really happened to the guy I wrote the song about. Maybe he was lucky, though. At least the doctors who say you're crazy let you know where they stand. They don't trick you into going back to them instead of continuing the search for someone who will believe you ... and who will at least try to help.
