Ethics of Placebo and Cover-up

[Rye]

I am in a homeopathy thread on SB and I came up with an idea that's pretty interesting ethically.

Essentially, my idea comes from the following:

1) Homeopathy is a pseudoscientific fraud. It works by the placebo effect, and the people who practise it are predators, using desperation, gullibility and coincidence to sell water to people as a "treatment" for their ailments. That's not right.

2) The placebo effect is real, and it's wrong to dismiss it all together. While real remedies are vastly more important, correctly administered placebos can in fact work as part of a patient's treatment, for instance, if they're hypochondriacs, or for pain relief and some other things.

3) The NHS is paying the private sector for homeopathic remedies too. This isn't right either, since as noted, they are frauds and parasites and are selling water at a grossly inflated price.

4) The patient may want to pursue homeopathic remedies, and it would be wrong to deny them that choice, and chance at the placebo effect.

Now, given the above, I think it could perhaps be justified for NHS hospitals to have a homeopathy "point of sale" in pharmacies that sells tapwater to patients, at the cost of the water and bottle and the printed label giving the directions for use (for instance, a capful after meals and before bed). This would provide all the placebo benefits of homeopathy, without any of the money going to the frauds and vultures.

At the same time, it is knowingly lying, and it would dispense with the superfluous "labour" of homeopathy (all the dilutions, all the chemicals involved at the start), meaning that it's likely it would have to be kept secret and covered up. Is this the more morally justifiable thing to do?

[Spoonist]

You already have similar behaviour in ordinary medicine. Usually involving first time parents with their baby. You give them something harmless (but still medicine-approved ie checked for side effects) and tell them to follow the instructions and get back if it get worse.

The same applies in some cases of hypocondria as well where there are a few labels of sugar pills with fancy medical names that can be prescribed.

[Anguirus]

Saw this argument on Facebook recently as well. I see the merit, but the problem is that people will cheerfully throw "modern medicine" under the bus in favor of homeopathy...we see it all the time. And that's a poor decision. The placebo effect, while powerful, is not as good as actually treating the problem.

It also sits ill with me to have any accepted cures that rely on the scientific retardation of our population, which needs to decline.

[Junghalli]

Now, given the above, I think it could perhaps be justified for NHS hospitals to have a homeopathy "point of sale" in pharmacies that sells tapwater to patients, at the cost of the water and bottle and the printed label giving the directions for use (for instance, a capful after meals and before bed). This would provide all the placebo benefits of homeopathy, without any of the money going to the frauds and vultures.

Something that should be considered here is that there's evidence that the placebo effect works better if the placebo is more expensive. Making it too cheap might reduce its effectiveness.

[Alyrium Denryle]

The Placebo effect is already in place in medicine. All medication are tested against it, because every medication given also applies it. There is no reason to accept homeopathy at all.

[mr friendly guy]

While I mock how the British health system has funded homeopathy, * I did wonder about a similar idea in regards to patients which strike me as somatising to some extent (not that I imply that they don't have an organic pathology, but that their behaviour makes the problem and their perception of the problem worse). That is as a thought experiment I wondered whether it would be ethical to add a placebo into the medications we are giving and say its the combination of the medications with a synergistic effect blah blah subspace medical babble blah blah might make things better.

I decided they most probably won't be pleased if they found out it was a placebo.

Back to the actual example, I am not sure if the benefits outweigh the costs. The benefits of course are an increase placebo effect, however most of the medications we use to treat such a condition has pretty much been tested against placebo and found to be superior. Thus one wonders how much benefit this extra placebo effect would bring. This is compared to the cost, not in terms of financial (which I assume would be modest to hire someone to sell the "cure" and setting up a store to sell it in the hospitals) but the fact that people start accepting fradulent treatments as legitimate. I just can't see the two balancing out at this point in time.

* some of my UK colleagues didn't realise the NHS funded a bullshit homeopathy clinic. Thank God for Richard Dawkins. And yes I realise the irony in the 2nd comment.

[Dorsk 81]

Now, given the above, I think it could perhaps be justified for NHS hospitals to have a homeopathy "point of sale" in pharmacies that sells tapwater to patients, at the cost of the water and bottle and the printed label giving the directions for use (for instance, a capful after meals and before bed). This would provide all the placebo benefits of homeopathy, without any of the money going to the frauds and vultures.

Something that should be considered here is that there's evidence that the placebo effect works better if the placebo is more expensive. Making it too cheap might reduce its effectiveness.

It's not really the cost there that's the issue, it's more the subject's perception of the cost. A similar study by Branthwaite and Cooper in 1981 took 835 women and split them into 4 groups, they were either given aspirin or a placebo, but half of the placebo were packaged in blank, neutral boxes and the other half packaged in brand-name boxes, same with the aspirin. They found that obviously the two groups taking the aspirin had better results, but more than that, they found the group taking the brand-name packaged aspirin had better results than the blank packaged ones, and the same with those taking the placebo. If you're already lying to a patient about the efficacy of a treatment to exploit the placebo effect then lying about it's cost to further exploit it seem pretty rational.

[ShadowDragon8685]

Now, given the above, I think it could perhaps be justified for NHS hospitals to have a homeopathy "point of sale" in pharmacies that sells tapwater to patients, at the cost of the water and bottle and the printed label giving the directions for use (for instance, a capful after meals and before bed). This would provide all the placebo benefits of homeopathy, without any of the money going to the frauds and vultures.

Something that should be considered here is that there's evidence that the placebo effect works better if the placebo is more expensive. Making it too cheap might reduce its effectiveness.

It's not really the cost there that's the issue, it's more the subject's perception of the cost. A similar study by Branthwaite and Cooper in 1981 took 835 women and split them into 4 groups, they were either given aspirin or a placebo, but half of the placebo were packaged in blank, neutral boxes and the other half packaged in brand-name boxes, same with the aspirin. They found that obviously the two groups taking the aspirin had better results, but more than that, they found the group taking the brand-name packaged aspirin had better results than the blank packaged ones, and the same with those taking the placebo. If you're already lying to a patient about the efficacy of a treatment to exploit the placebo effect then lying about it's cost to further exploit it seem pretty rational.

I think the problem there is how do you lie about the cost without grossly defrauding the patient?

Tell them some bullshit like "In <x> country, this treatment costs $1000 a pop, but thanks to our powers of import it's coming to you for beans?"

[Dorsk 81]

If the NHS is picking up the bill it isn't an issue, is it?

[PeZook]

Yeah, just go "That'll be 80 pounds...but oh wait, this treatment is fully subsidized, so no cost to you! Thank you and have a nice day!" if you really want to implement the measure.

[Anguirus]

Turned up this cartoon recently: seems relevant.

http://darryl-cunningham.blogspot.com/2 ... pathy.html