Placebo special needs considers a survey which shows wide use of active placebo meds in the medical community. How does this impact on Chiropractic?
Five ethicists surveyed 1200 randomly selected physicians, of which nearly 700 responded.
Placebo treatment has been shown to be superior to no treatment at all. So, in the treatment of FIBROMYALGIA, the respondents were asked if they would prescribe dextrose for non-diabetic patients, if it was proved to be superior to no treatment at all?
Only 10% said definitely not, and 58% said it was moderately or highly likely they would.
Physicians were clearly happy about prescribing a substance that was "non-active" for its placebo effect, however when it came to "active" placebos (this wasn't researched), one rheumatologist thought it inappropriate for example to prescribe a NSAID like naproxen which is known to have significant side effects on the kidneys.
"That's not a placebo," said Dr Norman Gaylis. "The first thing for us is to not harm our patients."
How might this impact on us as Chiropractors? Would we
In the consideration of the placebo special needs of our patients certainly asking the patient to keep a placebo journal (obviously one wouldn't call it that) should be considered. Likewise, accurate SOAP notes measuring the patient's response to our placebo treatment is highly desirable.
I wonder how 1200 Chiropractors would respond if ethicists were to ask us such searching questions?!! I suspect 44% or more would also decline to respond!
Many insurance companies now only pay for physical therapists to provide a chiropractic adjustment; that's in the face of powerful research proving that inclusion of DCs to perform their own technique would save them a good deal of money. One has to conclude that political medicine has gone off on another tack to contain our profession.
It's being successful with some doctors of chiropractic quitting. Others become involved in some dodgy practices, like demanding that patients sign up for a whole year of treatment in advance, in order to stay in business.
In recessionary times, the going is tough when the insurance won't pay.
Is the day approaching for a new Wilk versus the AMA and the insurance companies?
The chiropractic profession has tried hard to stay on the moral high ground; those who stoop to unscrupulous practices need to be exposed and disciplined if we are not to stoop to the low blows that medicine has often resorted to contain and eliminate us.