Survey: Half of US doctors use placebo treatments

[SadisticNature]

I still think my comment; "Also you continue to assume that the doctor has no understanding of the patient they are seeing nor any understanding of how they can be helped.
Comparing people to cars is insulting, cars can not think or feel!", stands.

I did use the term understand not compassion. The car comment was directed at something Sadistic said. But your rebuttal does not seem to have the medicos referring to patients in the manner they "refer" to themselves. As for remembering, we all give differing portions of the data we are assailed with different priorities. I know I do! Things that are in a given place, readily available to me, does not require me to have those items in priority memory files.
Further I agree that being a member of the Grey school of medicine vs the Yang school can use you up very fast! But the thing we want doctors to do most of all is "fix" us. Why? Because there is something "wrong". After that I expect them to talk to me not at me.

I still find the idea that you think doctors should be able to give placebo's to patients is grossly inconsistent with your stated desire to lower malpractice claims.

I'm not saying doctors are going to be wrong often with placebo's but I think even if they are wrong 1 time in 1000 patients that is going to be a large number of lawsuits. I think the claim that doctors aren't perfect is rather reasonable and backed up by the data.

Even if 999 out of 1000 patients that are given placebo's do better than those who are not, the doctors have no business giving out placebo's because when they are wrong its going to be a serious mistake.

What kind of damages do you think an insurance company will have to pay when the following situation occurs:

(i) Doctor diagnoses patient as a hypochondriac
(ii) Doctor proscribes placebo
(iii) Patient thinks placebo is working and doesn't see a doctor again until their next regular checkup.
(iv) Patients symptoms were actually related to cancer which is discovered at this checkup roughly a year later.
(v) Patient eventually dies as a result of the cancer.

In situations like this the damages can be colossal because for many cancers survival rates are very good for early diagnosis, while for later diagnosis survival rates are far worse. Cases like these are easy to win and easier to get a big settlement on, because the doctor is involved in deceiving the patient which results in them not seeking other treatments or care.

[Thorne]

(i) Doctor diagnoses patient as a hypochondriac
(ii) Doctor proscribes placebo
(iii) Patient thinks placebo is working and doesn't see a doctor again until their next regular checkup.
(iv) Patients symptoms were actually related to cancer which is discovered at this checkup roughly a year later.
(v) Patient eventually dies as a result of the cancer.

One problem I have here, though. If the patient's symptoms are relieved by the placebo, then their is not problem. If it's cancer, or some other serious disease, the placebo would not work. He might feel some relief for a brief time, perhaps, but as the disease progresses the placebo effect falls off. Chances are the doctor would not let him go for a year anyway, but have him check back in a week or two. If at that time the symptoms are relieved THEN he might diagnose hypochondria, not before.

And I doubt that any reputable doctor would go right to placebos anyway. He'd have to have some kind of indication from the patient's history before taking that step.

[DuncanONeil]

One problem I have here, though. If the patient's symptoms are relieved by the placebo, then their is not problem. If it's cancer, or some other serious disease, the placebo would not work. He might feel some relief for a brief time, perhaps, but as the disease progresses the placebo effect falls off. Chances are the doctor would not let him go for a year anyway, but have him check back in a week or two. If at that time the symptoms are relieved THEN he might diagnose hypochondria, not before.

And I doubt that any reputable doctor would go right to placebos anyway. He'd have to have some kind of indication from the patient's history before taking that step.

Agreed! I thought to, but did not mention the return visit. I have yet to visit a doctor for a medical complaint that has not included a return within a short period of time!

[SadisticNature]

Agreed! I thought to, but did not mention the return visit. I have yet to visit a doctor for a medical complaint that has not included a return within a short period of time!

People are very good at convincing themselves their treatments are working. So much so even the survival rates can go up from placebo's. Patients are both less likely to experience symptoms and less likely to complain about them when they think they are already doing something about it. This is the reason medicine tests use double blind trials.

[Thorne]

People are very good at convincing themselves their treatments are working. So much so even the survival rates can go up from placebo's. Patients are both less likely to experience symptoms and less likely to complain about them when they think they are already doing something about it. This is the reason medicine tests use double blind trials.

That's all true, which is why a reputable physician wouldn't prescribe a placebo until he'd exhausted all other possibilities. But in the end, if you have a patient with inconsistent symptoms who has no testable problems, you might prescribe a placebo. Let's face it: the patient's reaction to the placebo can be as informative as any other tests the doctor may have done.

The key point, though, is that the placebo is not prescribed lightly but only after a thorough familiarization with the patient. And this may (possibly, should) include a psychiatric analysis.

[DuncanONeil]

People are very good at convincing themselves their treatments are working. So much so even the survival rates can go up from placebo's. Patients are both less likely to experience symptoms and less likely to complain about them when they think they are already doing something about it. This is the reason medicine tests use double blind trials.

Did you know that they are required to perform said trails three separate times?

[SadisticNature]

Did you know that they are required to perform said trails three separate times?

A lot of medicines pass trials and then get pulled for safety reasons. So lowering standards to lower costs would be suicidal. Or do we want to forget about all those drugs that the drug companies have been sued over and stopped making for problems. After all these drugs got through testing as is without problems. If anything lowering the standards is going to raise costs because the companies will have more problematic drugs in the market and higher legal damages from said drugs, raising the price of every drug that company makes.

[DuncanONeil]

How about the FDA process being voluntary rather than mandatory?
Then it is an issue of personal choice as to whether you choose to be safe of choose to take a chance on a medicine that may help. As it is an informed choice there is little to no liability for the provider.

Drugs that are in use in nearly every country but here are prohibited for use by even terminal patients because of not being "approved" by the FDA. In spite of the level of positive outcomes by patients that have used the medicine or procedure! Is it fair for the FDA to condemn these people to death just because ALL of their hoops have not been cleared?

A lot of medicines pass trials and then get pulled for safety reasons. So lowering standards to lower costs would be suicidal. Or do we want to forget about all those drugs that the drug companies have been sued over and stopped making for problems. After all these drugs got through testing as is without problems. If anything lowering the standards is going to raise costs because the companies will have more problematic drugs in the market and higher legal damages from said drugs, raising the price of every drug that company makes.

[DuncanONeil]

In this age of defensive medicine, where doctors run every possible test for every possibility, the likelihood of a misdiagnosis is small. When all science says there is nothing wrong and the patient essentially demands medication what is a doctor to do? Follow the science, do nothing, allowing the patient to seek a doctor that may have less ethics and prescribes an actual medication from which the patient dies of a side effect?
In the realm of malpractice "claims", many of them have nothing to do with the practice of medicine. The data reflects that most are without merit and have the appearance of an attempt to engineer a lottery win. Most of which goed to the legal community!

I still find the idea that you think doctors should be able to give placebo's to patients is grossly inconsistent with your stated desire to lower malpractice claims.

I'm not saying doctors are going to be wrong often with placebo's but I think even if they are wrong 1 time in 1000 patients that is going to be a large number of lawsuits. I think the claim that doctors aren't perfect is rather reasonable and backed up by the data.

Even if 999 out of 1000 patients that are given placebo's do better than those who are not, the doctors have no business giving out placebo's because when they are wrong its going to be a serious mistake.

What kind of damages do you think an insurance company will have to pay when the following situation occurs:

(i) Doctor diagnoses patient as a hypochondriac
(ii) Doctor proscribes placebo
(iii) Patient thinks placebo is working and doesn't see a doctor again until their next regular checkup.
(iv) Patients symptoms were actually related to cancer which is discovered at this checkup roughly a year later.
(v) Patient eventually dies as a result of the cancer.

In situations like this the damages can be colossal because for many cancers survival rates are very good for early diagnosis, while for later diagnosis survival rates are far worse. Cases like these are easy to win and easier to get a big settlement on, because the doctor is involved in deceiving the patient which results in them not seeking other treatments or care.

[SadisticNature]

I think this falls into the realm of opinion. I certainly feel its a hassle to get doctors to run tests they ought to rather than the other way around.

The doctor isn't responsible for what other doctors choose to do. The consequences of actions are not justified by "oh someone else would have done it anyways, but worse".

As for your opinion that the data reflects most claims are without merit and have the appearance of an attempt to engineer a lottery win, I certainly feel this is not the case from the actual examples you gave. Waking up cut open on a table is certainly a valid complaint and is a situation that can do serious psychological harm.

The numbers can be interpreted in many ways. It could be that 90% of the cases that go to court are being lost because the standard of proof is incredibly high to patient disclaimers, and that proving negligence can be difficult. It could also be that 90% of the cases that go to court are lost because there are too many opportunists who file flimsy cases. This doesn't say most of the cases are flimsy though, maybe the medical insurance companies are smart enough to settle the good cases and only push on the bad ones.

It is incorrect to say there is no opportunism in this area, but its also incorrect to say that because there is some opportunism there are no legitimate cases.

In this age of defensive medicine, where doctors run every possible test for every possibility, the likelihood of a misdiagnosis is small. When all science says there is nothing wrong and the patient essentially demands medication what is a doctor to do? Follow the science, do nothing, allowing the patient to seek a doctor that may have less ethics and prescribes an actual medication from which the patient dies of a side effect?
In the realm of malpractice "claims", many of them have nothing to do with the practice of medicine. The data reflects that most are without merit and have the appearance of an attempt to engineer a lottery win. Most of which goed to the legal community!

[DuncanONeil]

You want to say; "It could also be that 90% of the cases that go to court are lost because there are too many opportunists who file flimsy cases." After having said; "People are very good at convincing themselves".

The example (note the singular) that was presented does not rise to any level of error on the doctors' part. The patient feels no pain, does not see the incision area. To file a lawsuit against the doctors has no merit. Waking up in a room you have already seen when you expect to wake up in a recovery room does not give the patient the right to take large sums of money from the doctor. By your logic I should have sued the obstetrician that cared for the birth of my daughter because of the ring she wore while examining my wife dilation!

Evidence requirements in cases of this nature only requires a preponderance of evidence. This relatively easy to meet.
Also do not forget that the 90% of cases that fail in court only 4% of cases filed are successful. Does not mean they actually had merit, although I am sure some do. Level of merit aside, level of plaintive success aside the total number of claims all has a cost attached. If the incentive of a extremely large payday is controlled the flimsy, meritless cases will begin to die off. This has a direct effect on costs from reduction in monies going to non-medical effort. And a future effect in the reduction of multiple testing, repetitive testing, testing just in case. All of which has an effect on costs.
And no cost is not all I am thinking about. Yet as a nation we all are concerned about the cost of medical treatment.

Seems as though a large part of your arguments are based in a series of what ifs. That is serial assumptions. You are willing to entertain that opportunists are working the system yet assert that it is minimal.
But the most egregious statement is; "its also incorrect to say that because there is some opportunism there are no legitimate cases". Such a claim is not supported by any statements made nor by logic. No one has ever claimed that legitimate cases of malpractice occur, and admitting that opportunistic cases exist does not deny legitimate ones.

I think this falls into the realm of opinion. I certainly feel its a hassle to get doctors to run tests they ought to rather than the other way around.

The doctor isn't responsible for what other doctors choose to do. The consequences of actions are not justified by "oh someone else would have done it anyways, but worse".

As for your opinion that the data reflects most claims are without merit and have the appearance of an attempt to engineer a lottery win, I certainly feel this is not the case from the actual examples you gave. Waking up cut open on a table is certainly a valid complaint and is a situation that can do serious psychological harm.

The numbers can be interpreted in many ways. It could be that 90% of the cases that go to court are being lost because the standard of proof is incredibly high to patient disclaimers, and that proving negligence can be difficult. It could also be that 90% of the cases that go to court are lost because there are too many opportunists who file flimsy cases. This doesn't say most of the cases are flimsy though, maybe the medical insurance companies are smart enough to settle the good cases and only push on the bad ones.

It is incorrect to say there is no opportunism in this area, but its also incorrect to say that because there is some opportunism there are no legitimate cases.

[SadisticNature]

You want to say; "It could also be that 90% of the cases that go to court are lost because there are too many opportunists who file flimsy cases." After having said; "People are very good at convincing themselves".

The example (note the singular) that was presented does not rise to any level of error on the doctors' part. The patient feels no pain, does not see the incision area. To file a lawsuit against the doctors has no merit. Waking up in a room you have already seen when you expect to wake up in a recovery room does not give the patient the right to take large sums of money from the doctor. By your logic I should have sued the obstetrician that cared for the birth of my daughter because of the ring she wore while examining my wife dilation!

Evidence requirements in cases of this nature only requires a preponderance of evidence. This relatively easy to meet.
Also do not forget that the 90% of cases that fail in court only 4% of cases filed are successful. Does not mean they actually had merit, although I am sure some do. Level of merit aside, level of plaintive success aside the total number of claims all has a cost attached. If the incentive of a extremely large payday is controlled the flimsy, meritless cases will begin to die off. This has a direct effect on costs from reduction in monies going to non-medical effort. And a future effect in the reduction of multiple testing, repetitive testing, testing just in case. All of which has an effect on costs.
And no cost is not all I am thinking about. Yet as a nation we all are concerned about the cost of medical treatment.

Seems as though a large part of your arguments are based in a series of what ifs. That is serial assumptions. You are willing to entertain that opportunists are working the system yet assert that it is minimal.
But the most egregious statement is; "its also incorrect to say that because there is some opportunism there are no legitimate cases". Such a claim is not supported by any statements made nor by logic. No one has ever claimed that legitimate cases of malpractice occur, and admitting that opportunistic cases exist does not deny legitimate ones.

Either merit is determined by the legal system or it isn't. If it isn't, then claiming the 90% of cases that were dismissed have no merit is wrong (some might involve missed filing deadlines or off on a technicality decision). If it is then you have no basis for claiming the 4% of successful cases lack merit.

You have basically taken a list of possible reasons, provided no evidence for one or the other being true, picked the one you liked and assumed it was true.

[DuncanONeil]

"If it is then you have no basis for claiming the 4% of successful cases lack merit."

I made no such claim!

Either merit is determined by the legal system or it isn't. If it isn't, then claiming the 90% of cases that were dismissed have no merit is wrong (some might involve missed filing deadlines or off on a technicality decision). If it is then you have no basis for claiming the 4% of successful cases lack merit.

You have basically taken a list of possible reasons, provided no evidence for one or the other being true, picked the one you liked and assumed it was true.