Decision time for doctors about placebos

Last week we were treated to the sight of hundreds of British doctors voting on whether homeopathy has a place in the NHS – a surreal spectacle on a par with watching a geologists’ union arguing what their position on the likelihood of a flat Earth should be. Naturally BMA members voted overwhelmingly in favour of the motion that homeopathy should not be provided on the NHS, but many among their ranks were sceptical of the move, and not all of them were believers in 18th century magic.

In fact their arguments weren’t really about homeopathy at all, but made a compelling case for a wider debate about British medicine’s elephant in the room – the placebo…

Before we continue, let’s be clear, an argument for placebos is in no way an argument for homeopathy. For one thing, homeopathy is a rip-off – why should the NHS pay a fiver a time for magic sugar pills when a tube of Smarties costs 50p, comes in lots of different colours and has pretty much the same evidence base?

And as happy as many people are to believe that medical training can be replaced by Google and a DVD box set of House MD, the fact is that homeopaths are not trained in the same way that doctors are to make diagnoses or give out prescriptions. Nobody claims that all real doctors are perfect either, but with the best will in the world, giving homeopaths responsibility for front-line medicine is like letting toddlers fix your car because they can drive a go-kart and make “vroom vroom” noises…

But the committee’s discussion of placebos focused on ethics rather than pragmatism, and in the real world the ethics may not be as clearcut…

“We do not require doctors to use only evidence-based treatments, in any form of medical care, but we do expect doctors to do their best to ensure that any treatment they offer is in the patient’s best interests. This will generally mean that any known risks of the treatment are outweighed by the potential benefits to the patient.”

There are no easy answers here, and with existing guidance as vague as this doctors are left to make their own judgement calls about the use of placebos.

I believe homeopathy should be consigned to the history books, so I’m happy to see doctors standing up to ignorance and calling for a ban. But a bigger debate should be had about the role of placebos in healthcare, because at the moment they’re being used anyway, and simply banning them one by one on an ad hoc basis probably doesn’t constitute an effective health policy.

Good discussion about placebos. Doctors both sides of the pond pretty much agree – although I have to admit I get extra chuckles living in one of the better known Southwest Spa towns offering every treatment specialist from Wiccan to Space Alien intervention.

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