But then again, how do you deal with someone who is just constantly thinking they’re sick when they’re really not sick or they’re just experiencing some minor things. I guess refer them to a shrink?

I do know people who would put a doctor in a bad spot. Every once in a while I wake up with a stiff lower back. It happens from sleeping on it wrong. I just need to stretch out a bit and take an asprin if its bad.

I had an ex who was such a drama queen if that ever happened to hear I swear she would be complaining she couldn’t walk and demanding that her back must be broken and begging a doctor to help her because she was on the brink of going paralyzed. That’s just how she was.

They’re describing it as a placebo in the study, but they haven’t told the patient that they’re prescribing it as a placebo. I know doctors who have done this. They explicitly do not tell the patient that they don’t expect the drug to do anything pharmacological to benefit them. One (now retired) used to give a drug known to cause nausea but not do a whole lot else. He’d warn his patients that it would cause nausea, but not to worry — that only meant it was working. (Kind of like Listerine’s old advertising campaign. “If you can feel it burning, that means it’s working!”) That’s a thornier ethical situation than a vitamin, since one could argue he was deliberately giving his patients an unpleasant experience for no real benefit — except to fool them into thinking they’d taken a drug which was effective for their complaint.

I don’t think it’s right to knowingly deceive patients, except in the context of a clinical trial. If nothing else, the patient may discover that you deceived them and then not only will the placebo stop working, but you will have completely destroyed their trust in you. The best-case scenario is that they’ll conclude you’re incompetent. More likely, they’ll conclude that you think they’re a pathetic, overly-emotional person who is easily deceived and who isn’t really sick. They may also generalize that impression to doctors as a whole.

No, it is never right to lie to a patient. Despite the temptation to give them a pill to shut them up and make them go away, doctors should never prescribe fake medicine on the pretense of it being effective. There are words for that: quackery, fraud, and theft by swindle.

- So, she said, if I do as much as go open a window because a patient asks me to, that can be questioned! I have to be able to say *why* I opened the damned window. And quite frankly, I won’t be able to tell that.

- Hmm, I replied, didn’t you tell me that comfort is something that has been clinically proven to have positive effect on a patient’s general health, and that discomfort also is detrimental to the recovery process?

She pondered for a second… then broke out in a smile.

- Why, yes… yes, you’re right!

Hence she concluded that she can, by finding the right studies, prove that opening the window for a patient is in fact clinically proven to be good for a patient’s health and if the patient asks her for it, she’s next to obliged to comply! Unless of course other factors associated with that action are counter-indicative… say for instance that some idiot is standing outside the cancer ward window smoking.

Have a look at http://www.badscience.net/?p=620 and so on.

It is important for patients who have been prescribed high doses of OTC medications to stay in touch with their doctor, since in many cases, high doses are okay for a short period of time but very very bad in the long run. Acetaminophen in particular should not be used in large doses for very long, as it has a hepatotoxic metabolite, called NAPQI, which is usually metabolized further in conjugation with glutathione — but over time, the liver’s glutathione resources can be depleted and then the NAPQI is free to bind to liver cells and cause hepatic centrilobular necrosis.

Anyway, I’m curious whether the study also counted doctors prescribing non-OTC levels of OTC medications as prescribing placebos. If so, then the numbers are likely skewed a bit.