0

I recently discovered that 97% of doctors in the UK have prescribed placebos. The general context seems to be within the mental health space, but I can’t find any firm restriction to the type of conditions that can be treated. I’m curious about what fundamentally underpins this ability legally on the part of the doctor.

A hypothetical scenario:

  1. I am depressed and speak to my doctor
  2. The doctor prescribes me what I am told is Blorpizine made by FooCorp, but actually it’s a sugar pill
  3. I go to a pharmacy and have to pay for the prescription. By its very nature, they would have to have all the FooCorp branding on the packet for me to believe the placebo, but it doesn’t contain any of the active components that the box lists so it’s not only falsely using the brand but all of the warnings on the leaflet are completely false about the potential side effects of eating sugar
  4. I actually start feeling better from the placebo effect. I speak at length to my best friend about how amazing this treatment is, as they’re also suffering
  5. They go to their doctor and, given a number of treatment options, they elect to go with Blorpizine because it was a personal recommendation by me. This is despite it being the riskiest option they were given.
  6. My friend is seriously injured in a suicide attempt after starting the the real medication because of a side-effect.
  7. News about FooCorp is mounting because this wasn’t the first time this effect has happened, so they’re plastered all over the newspapers and their brand slated, but it’s being prescribed at a higher rate than expected because of this placebo trend
  8. I stop taking “Blorpizine”, and then end up dead because I lose the placebo effect and I’m now more emotionally-damaged now than before. My friend finds out about this from the postmortem and they're... not happy.

So much seems to have gone wrong here across multiple parties based on the initial lie of one individual. I can find The Legal Implications of the Administration of Placebo to Psychiatric Patients but that primarily addresses point (2) and says nothing about the (in my mind, plausible) chain of events that happened next. What is the fundamental defence of my doctor for not precipitating my death, the severe injury of my friend, the brand deformation of FooCorp and probably innumerable other things? There must be some foothold for 97% of them doing it and not being sued continuously.

From the first article I linked, this makes no sense as a framework or defence in my hypothetical case:

In the UK, the GMC does not explicitly discuss or prohibit the use of placebos in the treatment of patients, other than mentioning placebos in a footnote of their research guidance. But the council's guidance does advise that doctors should always be open with patients, explain what they are prescribing and to answer a patient's questions honestly and fully.

'The GMC is silent on placebos, which leads to ambiguity,' believes Dr Howick. 'They do state that doctors "should not withhold information" from patients, as to do so would prevent the patient from providing informed consent. Since some ways of using placebos could involve the suggestion with the patient that the placebo is a "real" treatment, the GMC view is often interpreted by GPs as a ban on placebos.'

11
  • 1
    You misread the study - it is at least once, which means that having ever given a placebo to a hypochondriac means you are counted.
    – Trish
    Aug 19, 2023 at 13:51
  • I'm not sure how that changes my question or the statistic? There might be one doctor that gave 500 placebos to a single patient - they're still a single doctor in the sample pool of at least once?
    – roganjosh
    Aug 19, 2023 at 13:55
  • The statistic in itself is not a good one, it is deliberately made to make a news headline.
    – Trish
    Aug 19, 2023 at 13:57
  • Equally, what is a "hypochondriac"? That's a diagnosis, still entirely down to the subjective determination of my doctor. That's basically a prelude to my question and I'm just illustrating how it might play out. I'm not interested in that - I want to know what the legal underpinnings are here even if 5% of doctors did it
    – roganjosh
    Aug 19, 2023 at 13:57
  • 3
    Your (3) is not realistic: the box will accurately describe its contents. More likely is a pure placebo (the box will not list any active ingredients) or a placebo irrelevant to the particular disease (e.g. the box may say for example the active ingredient is ascorbic acid but your illness will be unaffected by Vitamin C) or a sub-therapeutic dosage (including homeopathic medicines). An ethical issue is whether prescribers have to reveal what they are doing and why, particularly if there is evidence that doing so tends to worsen typical outcomes.
    – Henry
    Aug 19, 2023 at 14:26

1 Answer 1

6

Point 3. is wrong

When a placebo is prescribed, a placebo is prescribed; it doesn’t masquerade as another drug.

If Biopizine is a sugar pill, then the box will have all the normal dress of a drug but the leaflet and list of ingredients will be totally clear about what it actually is. The ingredient list will say “sucrose” or “saccharose” or even “beta D Fructofuranosyl alpha D glucopyranoside”, which, unless they paid attention in chemistry class, most people won’t recognise as table sugar. However, the doctor and the pharmacist know exactly what’s going on.

Quite often, a placebo is not totally inert but is an actual drug being used for the purpose. Usually it’s a mild drug with little or no side effects like paracetamol, aspirin, or codine. Things that would be useful for symptom relief in the particular case but sold under a different brand name for the purpose of leveraging the placebo effect.

So, when your friend goes to their doctor and says “My mate recommended Biopizine“, their doctor can say “Biopizine is not appropriate for your case, your friend had a different form of depression.”

There is no legal proximity

The negative consequences for both you and your friend are too far removed from the original doctor’s action for there to be legal liability.

Your decision to stop taking the medication (placebo or otherwise) without consulting your doctor was not reasonably foreseeable at the time of the prescription.

For one, your doctor knows that the placebo effect is pretty random. Some people benefit a lot, some a little, and some not at all.

Second, all treatments have risks. The risk of you finding out it was a placebo should have been considered by the doctor but obviously can’t be disclosed to you. For this reason, the use of placebos outside clinical trials is ethically questionable but it is widespread and not clearly illegal. Legal liability arises when a person does not act reasonably - if placebo prescription is an accepted part of medical practice and not prescribed by legislation, then the courts will likely find that your doctor was not negligent.

For your friend, your doctor is not their doctor. Your doctor has no duty of care towards them.

You must log in to answer this question.

Not the answer you're looking for? Browse other questions tagged .