Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits? Something unsettling about this for me. So much of illness wrapped up in distress. We need reassurances, however irrational the ritual that brings them. Why is there no space for this in conventional medicine?
Because it isn't quite that simple. Overprescription of antibiotics isn't usually done only for the placebo effects, but other social reasons as well. A significant subset of patients react poorly to "it's probably viral and so we probably can't do anything". As bad as antibiotic overuse is, lying to patients and fraudulently prescribing a treatment is still much worse than giving someone antibiotics in the 5% chance that something is bacterial.
I don't think that lying to patients to falsely reinforce their untrue beliefs is a solution to the problem -- it'll probably create an additional problem by reinforcing beliefs of the legitimacy of pseudoscience.
Although not as effective as deceptive placebos. I personally suspect that the subset of people for which honest placebos work well overlaps significantly with the same subset of people who already believe "pill = good" above the expert advise of their doctors.
On a 4 page list of my notes on issues and treatments I mentioned that my symptoms always got better on doxycycline for a couple of months. My ancient neuro-ophtomogist oh, you have Sjogrens. I’m like what’s that? Apparently he had seen that many times before.
Antidepressant/SSRIs are a much bigger one. The actual experimental evidence for these drugs, contrasted against placebo, is shockingly weak. Moreso, SSRIs come with tremendous side effects. At the very least we should be making an effort to gradually phase these out of society. In reality, we've gone the other direction and floored it - with SSRI prescriptions growing exponentially.
I have seen the argument that the weak evidence for their effectiveness is entirely due to them being better placebos. What makes them a better placebo? Ironically, it is (according to this theory) that their side-effects are obvious to the patient, so those who are actually on them are more sure than the controls are that they are taking the drug under test, as opposed to the placebo being used in the trial.
SSRIs do have a studied and recorded physical effect of inhibiting serotonin reuptake, but what that actually does to someone is still not entirely understood, past "it can help with depression and/or maybe ADHD".
It's unfortunate that SSRIs have harmful long-term effects—I know some people who have been dependent on SSRIs for around a decade, and probably will be forever because of the neurotoxicity.
The main point is it's not even clear it can help with depression, at least not anymore than a sugar pill. I'm going to avoid referencing any single study since you can find a study to support practically any reasonable view. Instead I'd just encourage you to look up: 'ssri vs placebo' anywhere. The overwhelming body of evidence concludes that if there's any effect, it's absolutely negligible. And, as a previous poster mentioned, it may well simply be due to the fact that doing a double blind with SSRIs is not really possible. They have such a tremendous physical effect than any subject will absolutely know if they're getting the "real" thing.
And to be clear a placebo doesn't mean the effect of such isn't real. Mental state provably affects the body in all sorts of ways. Interestingly enough the placebo effect is often substantially stronger in Americans than in other groups as well [1]. The two main hypothesis there are that more poorly performing drugs are making it past regulators, the other is that the overwhelming amount of direct-to-consumer medical advertising creates a greater faith in the power of pills than in other countries - US/New Zealand are the only developed countries that allow direct to consumer medical ads. Or perhaps a mixture of both, like in many things.
> Doctors in surveys around the world have admitted to prescribing antibiotics as placebo, yet homeopathy is off limits?
You are comparing something that has cured many of humanity's illnesses (in fact, there's a good chance that you are alive thanks to antibiotics) with something that has the curative properties of rubbing quartz crystals or drinking blessed water.
Of course there is something unsettling about that comparison.
I’m not sure what the bias is here - maybe halo effect? - but the issue at hand is that the antibiotics are being used in a scenario where they cannot be effective. They are, in that way, a placebo to the same degree that homeopathy is, despite any other properties outside of the acute situation.
Say I have some really great tasting distilled water. Perfectly pure, exactly what I need if I wanted to quench my thirst. Now, I also have an empty gas tank.
Should I put water or flat Coca Cola in the gas tank? They are both bad, despite the separately superior qualities of the water. Or, maybe a better comparison is putting diesel in vs coke. They are equivalently bad for the engine despite one of them being used for a similar but separate situation.
Your metaphor is does not work well because water and coke are both pernicious to a car. A better one would be quelching thirst with water versus coke. Both will calm thirst, and are reasonably “neutral”. The second has pernicious effects, especially in some people (diabetes for example)
Distilled water has other uses besides drinking. It can be used in chemistry for example. You would not get good results in chemistry if you replaced distilled water with coke. “I can drink water, surely I can use coke instead of water on this chemistry experiment, because I can also drink coke” is clearly faulty logic.
And yet, that’s exactly what people do with homeopathy.
While it should always be presented as a “complement” to medicine(because it can have some mental/placebo effect in some people, in some cases), very often people take it as a substitute (the marketing word is “alternative”) to medicine. This is something that the homeopathic industry can’t help but “allow happening”. In fact they are motivated to promote that way of thinking. First it increases direct sales. Secondly, the more mixed up their product is with medicine, the stronger the placebo effect will be, and that will increase sales further.
Unfortunately the placebo effect is very limited. You can’t mend a broken arm with placebo alone. You can’t cure cancer with placebo alone. And yet people replace chemotherapy with homeopathic “remedies”. And then they die.
In short: doctors should never give homeopathic remedies, because that puts them on the same level as medicine. That will ultimately make some homeopathic makers richer, but it will also get some people killed.
Prescribing antibiotics where they will be nothing more than a placebo is undesirable, but prescribing homeopathy where it will be nothing more than a placebo (i.e. in every case except dehydration) would have a number of undesirable consequences, including a predictable increase in the number of people who will turn to homeopathy when antibiotics are needed for themselves and, more importantly, for their children.
This reminds me of a cartoon (in the New Yorker?) where a patient is demanding a better placebo as the current one is not working.
There is space for placebos in conventional medicine. Doctors CAN and are allowed to prescribe placebos.
However medicine strives to maintain a separation between an actual body of scientific knowledge and placebo treatments. So, yes, while a placebo can be effective nobody is going to transcribe that placebo onto actual scientific knowledge as if it wasn't a placebo.
Right, so antibiotics work as a placebo, but am I going to put that knowledge down into textbooks that antibiotics can cure the common cold just because such knowledge effectively works as a placebo? No.
Antibiotics are not pure placebo. They are also given to make sure there isn't a bacteria ready to take advantage of the weakened immune system. The regular treatment for COVID also included antibiotics, for the reason I mentioned.
