Arnold Kling  

What Would Robin Hanson Say?

Ten Minutes, Eleven Questions... From the Cutting Room Floor: T...

Sally Satel writes,

About one in two American doctors say they prescribe placebos to their patients, and more than two-thirds believe it permissible to do so, according to a new study from the National Institutes of Health.

Nortin Hadler believes that some of the ailments for which placebos are often prescribed are in fact not real ailments.

Robin Hanson would also not be shocked to see faith-based medicine being practiced.

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COMMENTS (9 to date)
floccina writes:

I always wonder what kind of weight should I put on you linking to someone like Nortin Hadler in the positive way do that you do here. Is it a mild recommendation? Does it mean that you have some level of confidence that he is not a quack?

PrestoPundit writes:

What does this cost? Anybody have an estimate?

Arnold Kling writes:

I think Hadler is not a quack. He is very much evidence-based. Some of his views may turn out to be wrong, but he has a lot of data on his side.

John Thacker writes:

I can imagine situations where I'd want a doctor to give me a placebo but not tell me. They do often work, thanks to psychological trickery. But if I knew about it, they wouldn't.

Ella writes:

I've wondered if doctors would do it, and, honestly, I've hoped they would do it more. My grandmother is something of a hypochondriac, but the most dangerous health scares she had (with the exception of one) and the ones with the most lasting problems were caused by drug interactions for conditions she only thought she had. E.g., she was convinced she had a heart problem, so two different doctors put her on three or four different kinds of heart and cholesterol medication because they said it would keep her quiet, and it caused a series of ministrokes. Finally, my uncle started giving her multivitamins and telling her they were her heart medication (with the doctor's approval, of course). Her heart and cholesterol were and are still fine.

For what a single anecdote is worth.

Mike Feehan writes:

I always ask my doc if there isn't a generic equivalent that is less expensive than the placebo he is prescribing.

Will writes:

Actually, I think this has more to do with the patient than the doctor.

The patient comes in sick and knows, rather simply, that medicine makes people unsick. He does not know what medicine, how much, or even if any particular medicine will do much of anything for the particular sick he is.

The doctor, on the other hand, has a rough idea of what kind of sick the patient is and, assuming he is correct, knows whether or not medicine makes much sense. Some things, I believe, just need to take their course. But patients do not want to hear that. They came to a doctor. They want to be unsick. And, at least to them, that means medicine.

If the doctor does not prescribe SOMETHING, the patient may get a second opinion. And if that doctor prescribes something, he is likely to capture a new patient. To prevent this from occurring, doctors prescribe placebos.

...if only there were a way to credibly signal to your doctor that you will not be going elsewhere regardless of the treatment strategy he chooses.

Dan Weber writes:
I always ask my doc if there isn't a generic equivalent that is less expensive than the placebo he is prescribing.
You shouldn't. Patients do better with expensive placebos than cheap ones.

Dr. T writes:

Physicians learn about placebo use. Placebo use is effective and ethical in the right circumstances.

Examples: A patient has a problem that will get better on its own. However, this patient does not believe the doctor, and he feels that medication is needed. The doctor is unlikely to convince the patient, so it is ethical and effective to prescribe a placebo.

A patient is a known hypochondriac who refuses psychiatric help. The patient has an invented illness with psychosomatic pain. Prescribing a placebo may resolve this problem and alleviate pain (until the next time).

These examples are not rare, so I'm not surprised that most physicians have prescribed placebos.

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