Belly Laugh

Belly Laugh

I'm back from a 12 day trip to the Land of the Angles. Did you miss me? Or even notice that I was gone? Either way, I have returned.

I was at QED in Manchester and had a great time at a wonderful conference. An 'ends justifies the means' comment was made to me by one of the audience:

If I had to have chemo that is going to make me feel crappy, even though acupuncture is a placebo, if it makes me subjectively better, what is the problem with using it?

Good question. And it gets down to ethics.

I realize that one persons ethics is another persons belly laugh. You may think it is morally wrong to eat meat or have an abortion or gamble. Another may not. What is ethical behaviour can vary from person to person.

In medicine there is an ethical framework within which we try and practice and it has four principles

Respect for autonomy - the patient has the right to refuse or choose their treatment.

Beneficence - a practitioner should act in the best interest of the patient.

Non-maleficence - "first, do no harm".

Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment.

Pseudo-medicines violate two of these principals.

A patient can only make autonomous decisions about their care if they are given accurate, truthful, information. Since the only way a placebo therapy can work is if you lie to the patient, in clinical practice you could not use a therapy whose effects are no better than placebo.

The other is do no harm. In medicine, everything can potentially cause harm. Most of the time, except under dire circumstances, everything you do for a patient should have the potential to do more good than harm.

The classic interpretation is that if a therapy is equal to placebo it has no efficacy. Since pseudo-medicines are no better than placebo, they have no efficacy. Strictly speaking, since they do nothing pseudo-medicine can only offer harm.

Outside of clinical trials the use of placebos is not ethical. And since many pseudo-medicines are at best placebo, their use is not ethical as well. It is why even if acupuncture might make you feel better, there is no ethical way to provide it.  At their core, pseudo-medicines are not ethical.

Points of Interest: 4/17/2014
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