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Is One of Your Medications a Placebo?

Almost half of doctors use placebos to treat patients, but only 4% are up front with patients about it, according to an American Medical Association article. Having doctors admit that they dance around the truth to get patients to agree to a medication they don’t know is a fake is troubling. It also poses ethical questions about patient-provider relationships. But…

Placebos have an important role in medical treatment. I’d be thrilled if one did the trick for me. Telling the patient that they’re getting a placebo undermines the placebo effect, thus negating the potential benefit. I wouldn’t want to know if my doctor prescribed a placebo for me — at least not at first. However, I also expect my doctors to be honest with me.

The phrases physicians used were:

  • “[It is] a substance that may help and will not hurt. “34%
  • “This may help you, but I’m not sure how it works.” 33%
  • “It is medication.” 19%
  • “It is medicine with no specific effect.” 9%
  • “It is a placebo.” 4%

The article Doctors Use Placebos But Don’t Tell Patients describes the study and the American Medical Association’s response to it.

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Is Seeing a Specialist Always Best?

When people ask me about finding a doctor, I almost invariably tell them to see a headache specialist. Seeing someone with headache-specific knowledge is important because headache disorder education isn’t widespread. But is seeing a specialist always the best idea?

Dr. Aniruddha Malpani of The Patient’s Doctor writes:

Most patients want to go to the doctor who has special expertise in handling their particular problem. They will spend a lot of time and energy tracking down the “biggest name in the field” – and then leave everything up to the doctor. This can often be a short-sighted approach, because specialists are biased, and it’s important to be aware of this bias.

While it’s true that an expert has a lot of experience in dealing with a particular problem, this extensive experience also introduces all sorts of bias in the way he handles this particular problem. There are many reasons for this.

Because he is used to seeing complex cases which have been referred to him, he often cannot deal with simple bread and butter problems ! He also sees life through a distorted lens, and may not be able to see the big picture. Because he cannot afford to make mistakes, he often overtests and overtreats. He often asks for esoteric and expensive (and painful) tests, to differentiate himself from the other ordinary doctors. He also usually bad-mouths alternative options of dealing with the problem – after all, this is his competition! He is reluctant to refer cases which he cannot handle, because this would damage his aura of omnipotence and omniscience.

Often, in the pursuit of narrow goals, he loses objectivity; and is more interested in doing research rather than treating patients. Many experts are so used to seeing only sick patients, that they often cannot recognize a normal variant!

What do you think? Let us know in the comments below or on the online support group and forum.

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What Do You Think of Your Doctor?

I need your input. I’m forever being asked what I know about particular headache specialists or clinics. I know the ones I’ve seen and that’s about it. You’re the expert on what you’ve experienced. Please share your opinion by commenting on the doctor who treats your headaches.

Fine print: You may identify the doctor or clinic by name, but be nice even if you didn’t think much of the doctor. You can point out what you disliked without trashing the person. Please keep in mind that people have differing opinions about particular doctors. I will delete inappropriate comments.

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Empathy and Shared Experience Between Doctor & Patient

Can a doctor who has a headache disorder understand — and treat — your illness better than one who doesn’t? Is shared experience necessary for empathy?

“How could I possibly understand or help her, she seemed to be asking, if I had not personally experienced her pain?

“Her question caught me by surprise and made me pause. O.K., I’ll admit it. I’m a cheerful guy who’s never really tasted clinical depression. But along the way I think I’ve successfully treated many severely depressed patients.

“Is shared experience really necessary for a physician to understand or treat a patient? I wonder. After all, who would argue that a cardiologist would be more competent if he had had his own heart attack, or an oncologist more effective if he had had a brush with cancer?

“Of course, a patient might feel more comfortable with a physician who has had personal experience with his medical illness, but that alone wouldn’t guarantee understanding, much less good treatment.”

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This Time Last Year, March 3-10

Posts from The Daily Headache, March 3-10, 2006

Nerve Stimulator-Imposed Restrictions
According to Medtronic’s Living Well newsletter, these activities might be harmful for people with nerve stimulators: using an electric blanket, skiing, sledding, golfing, amusement park rides. Would I have still gotten the implant if I knew about all these limitiations?

Woman Heartbroken After Ending Love Affair
After years of agony, I finally say goodbye to one of the great loves of my life.

Getting the Attention We Deserve
ABC News aired a piece on new treatments for migraine, the first of a three-part series on migraine. It appears to be a good step toward reducing the stigma of migraine.

Acupuncture & Birth Control Deja Vu
Results of new studies on these migraine topics were released.

Pain Resource: Doctors for Pain
Get a glimpse of this excellent website on treating and coping with chronic pain.

The Ultimate Question
I finally try to answer the question about my occipital nerve stimulator that I’m asked the most: How much does it help? Since I had my stimulator removed in September, this post now seems quaint.

News From Annual Pain Meeting
Studies discussed at the American Academy of Pain Medicine‘s meeting included nerve stimulation and opioid levels in the blood of chronic pain patients.