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When we agree to another medical examination or have a prescription filled, we do so in the belief that what we are doing will help us get better. We believe there must be strong evidence that each medicine works, otherwise why would our doctor use them?
Well, as London-based GP Rob Hicks explains, that might not be the case. Many of our most popular treatments have little or no evidence supporting their use, but are prescribed because doctors "make a decision that it is sometimes worth a go." Dr Hicks adds, "'Quite often you don't have strong scientific evidence, but so long as it will do no one any harm then why not try it?"
As you'll discover, "why not try it" underpins many of our most common treatments, many of which are little more than placebos.
What is a placebo?
A placebo (Latin, for "I shall please") is a medication that has no efficacy at all, or is not shown to work for the condition the patient came in with. One such placebo is antibiotics. Although this is a genuine medication, when prescribed for a non-bacterial illness (such as a viral cold) it becomes a mere placebo, and any immediate recovery is illusionary or coincidental.
Some doctors have even prescribed harmless sugar pills, which are placebos of the simplest kind, having no efficacy for any medical condition whatsoever.
Isn't that wrong?
Placebos offer relief. Even if a condition cannot be cured, they can help a patient feel better. In an essay, Harvard Medical School professor Ted Kaptchuk proposed that placebos were a vital part of healing, relieving patients' symptoms. They provide relief because the patient thinks they are receiving treatment, in the same way the doctor's white coat and diploma on the wall act as reassuring signs of competence.
Symptoms are relieved, even if the patient knows they are taking a placebo: one study found patients with irritable bowel syndrome reported improvement in their conditions, even after they knew the pill they were taking was a sugar pill.
Back to our placebo-prescribing GPs: three-quarters admitted to prescribing a medicine without proven results on a daily or weekly basis. The GPs said they prescribed the placebos because their patients had requested them, or to reassure the patient.
Dr Jeremy Howick, co-author of the study from the Universities of Oxford and Southampton, said:
"This is not about doctors deceiving patients. The study shows that placebo use is widespread in the UK, and doctors clearly believe that placebos can help patients."
The chair of the Royal College of GPs, Dr. Clare Gerada, said it is acceptable to use placebos, so long as no harm is caused and the medication is inexpensive.
Now, let's look at the most common medications that you might not realise are placebos:
Brits spend £400 million on over-the-counter cough syrup every year. But is it really doing us any good?
In 2014, Cochrane reviewed 29 trials, taking in almost 5000 patients with acute cough (lasting less than eight weeks and mostly caused by a virus).
Respiratory medicine expert at the University of Hull, Professor Alyn Morice said,
"Despite the large expenditure on cough remedies, evidence for them is poor. No new drug of proven effectiveness has been licensed for acute cough in over 30 years."
If your cough is caused by allergy, cough syrup containing Diphenhydramine, an antihistamine, may reduce the severity, but not the duration. Professor Morice says that if you're buying cough syrups for non-allergic coughs, you're probably wasting your money.
Omega-3 Fish Oil for the Heart
Many patients take Omega-3 fish-oil supplements daily to protect against angina and heart disease. However a 2012 study, published in the Journal of American Medical Association, analysed 68,000 patients, taking 1.5g of fish-oils (or a placebo) daily over two years. They found that those taking fish-oils did not have statistically fewer heart attacks than those who took the placebo.
Pills for Mild/Moderation Depression
More than 57 million prescriptions were written for antidepressants in 2014 by British doctors. But psychiatrist, Dr. Joanna Moncrieff says evidence for their use is thin. She says:
"I don't think antidepressants do anything useful for mild to moderate depression and the difference between an antidepressant and a placebo is minuscule. They do seem to have an emotional numbing effect which some people may like, but I'm not sure that is useful in depression."
Oliver James, chartered psychologist and author, believes that the focus should be on psychodynamic therapy, which can help people get to the root of their problems.