From David Armstrong
As a practising physician in the UK’s National Health Service, I would love to be able to prescribe “pure” placebos occasionally, when I feel it is in my patient’s best interest (16 December 2006, p 42). A multitude of factors, however, prevent me doing so.
The trusts that manage hospitals are terrified of anything that smacks of paternalism, or over which they might be sued by a disgruntled patient – so they would not allow it. I am sure that the General Medical Council, which regulates my profession, would take a similar view.
Current dogma is that patient, not doctor, knows best, and that the use of pure placebo would be legally regarded as deception. I do not know of a pharmacy that would dispense a pure placebo, as they, too, are tightly bound by regulations governing cost and “evidence-based prescribing”.
As a result, I am sometimes forced to prescribe “impure” placebos – vitamins and the like. I often see pleasing results in cases where there is a significant psychological component to the symptoms. This has always struck me, however, as being in some ways a greater deception than using a “pure” placebo.
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Carrickfergus, County Antrim, UK
