I have always claimed fibromyalgia is a fake disease of victimization invented by doctors to pad their bottom line by prescribing drugs to give hypochondriac patients psychological cover for a broken mind — that tries to adversely effect the body — but fails.

This week, the further proof of my argument was provided in a study indicating fifty percent of American doctors routinely prescribe placebos for their patients and similar results were reported for doctors in Denmark, Israel, Britain, Sweden and New Zealand.

“This is the doctor-patient relationship, and our expectations about being truthful about what’s going on and about getting informed consent should give us pause about deception,” said Dr. Miller, director of the research ethics program in the department of bioethics at the National Institutes of Health.

Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.

But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. “Is that a placebo treatment? Depending on how you define it, I guess it is.”

The troubling part of the placebo effect is that, in order for it to work, doctors have to lie to their patients.

Doctors can’t say, “here’s a fake pill to heal your fake pain,” or the placebo won’t be effective, so lies need to be told to get the patient to believe in a new, false, healing that might help them feel better.

Is it appropriate for a doctor to purposefully mislead a patient?  Because any prescribed placebo is an intentional lie.

Controlled clinical trials have hinted that placebos may have powerful effects. Some 30 percent to 40 percent of depressed patients who are given placebos get better, a treatment effect that antidepressants barely top. Placebos have also proved effective against hypertension and pain.

But despite much attention given to the power of placebos, basic questions about them remain unanswered: Are they any better than no treatment at all? Must people be deceived into believing that a treatment is active for a placebo to work?

Why do placebos work?  Is it the power of the mind?  Or is it the influence of the doctor?

Are there any “placebos” that are prescribed outside the medical field to provide the same effect of healing a false symptom in order to temper the fevered mind?

Is there any other profession that intentionally tells untruths to those paying for comfort and protection?

31 Comments

  1. If what they show on legal shows is anything like reality, sometimes lawyers have to somewhat sugarcoat what they tell their clients so that they don’t do anything that would incriminate themselves while they are on the stand.
    Something I have learned about the whole Fibromyalgia as Hypochondria thing is that you should never suggest it to someone who comes to you to cry on your shoulder about it because they almost never react well.

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  2. Ths is scary.
    I am not sure which one does more harm – taking a fake pill for a fake illness and getting dependent on it or suffering from an imaginary illness and going down every day…
    David, this is the best look I have ever seen of this page – magnificent.
    By the way, today is Diwali here, one of the famous religious festival of Northern India. It is 3/4 days in North, 2 days in Calcutta, I am enjoying the fireworks from my room now!
    http://www.bbc.co.uk/religion/religions/hinduism/holydays/diwali.shtml
    http://images.google.co.in/images?hl=en&q=diwali+fireworks+images&um=1&ie=UTF-8&sa=X&oi=image_result_group&resnum=1&ct=title
    http://images.google.co.in/images?hl=en&q=diwali+diya+images&um=1&ie=UTF-8&sa=X&oi=image_result_group&resnum=1&ct=title
    On that note, I wish everyone a happy and prosperous life and a Happy Halloween in advance!

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  3. Hi Katha!
    It is scary! It seems like ordinary business, though, in the medical profession. I can understand the use of placebos in blind medical tests to determine if a medication is effective or not — but to purposefully prescribe a placebo the doctor knows if fake but that the patient does not know is fake — concerns me. I understand a lot of patients today want a pill — ANY PILL! — to “heal” what they think ails them, but sometimes the best path for the doctor is the harder one of, “Grow up! There’s nothing wrong with you!” No doctor should play into hypochondria for personal profiteering.
    Today’s Cityscape — as of this moment — is Portland, Oregon! I agree the colors are a nice mesh. We’ll have to each keep a list of our favorite cities so we can use them more often after we use up everything in the bag. SMILE!
    Congrats on your Diwali celebration! I appreciated your invitation to light a candle, but I had no idea where to put my light because on the web map I did not know enough about the India divisions to properly place my wish. It’s sad the site only allowed a celebration in India. Why not allow the rest of the world?
    Thanks for the links. Love it.
    I hope you’re taking images of the fireworks outside your window for us!

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  4. Gordon —
    Love the lawyer connection! There is definitely a fine “placebo line” between confession to your lawyer and keeping your mouth shut. If you confess to your lawyer then your lawyer is required to assume your guilt instead of providing the best “innocent” defense… even if obviously feigned.
    You’re right that Fibromyalgia is now big business — even though it means nothing — and to even begin to suggest the problem is in the hypochondriac’s mind, and not body, is to certainly tempt the wrath of the prescribed. Be wary — but don’t give in — because if you buy into their “diagnosis” they will run you dry and around in circles.

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  5. Fibromyalgia is an unseeable, unknowable monkey on the back that can take any form; doctors can only fathom ways to frighten it away but they know it will never go away.

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  6. Yes David! I knew it was Oregon, had to be – just spectacular!
    I am ok with the “grow up” reprimand more than the “fake pill”…the second one seems to be useless. But well, if that brings good business – that is what is going to be practiced.
    I understood you would have a hard time figuring this “light a diya” thing, I should have mentioned it earlier.
    LG will contribute Rs.1/- to CRY for each candle, so if anyone wants to go for it – they can just do it here!
    http://www.in.lge.com/diwali/index.aspx
    I would want Calcutta to have the most numbers of candles, so you can choose West Bengal in the place of “select a state” and Calcutta in place of “select a city”. Or else, you can choose any place/ state/ city you want! Good luck!

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  7. Hi Katha!
    Yes, the landscape of Oregon is truly beautiful. I, too, prefer a bodily reprimand over swallowing a pill — even when the pill is not a placebo! SMILE!
    I followed your instruction — the site uses “Kolkata” instead of “Calcutta” — and my diya is now alighted! I think I was number 81.

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  8. Hi David!
    Thanks for lighting the “diya”! Sorry, it was my fault – it is “Kolkata” not “Calcutta” any more.
    You are right, “light a diya” should be arranged from anywhere in the world, I think the Non-Indians in general won’t know what “Diwali” is and LG won’t take the headache to tell them either…
    I am ok with the “bodily reprimand” till I can handle it – but if I have some serious job scheduled in front of me then I want medicine – no placebo please – that goof-up won’t work me!
    Oregon is beautiful indeed, I had been in Ashland once in fall and the beauty is just breathtaking. Thanks!

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  9. It was a fun experience to light the diya, Katha, thanks!
    The article I linked on the fake medication discussed a child’s “medication” that doctors prescribe for hypochondriac children and their parents called “Obecalp” — “placebo” spelled backward!
    I hear Portland is the most beautiful city in the USA and the fact that more people want to live and work there than there are jobs available, testifies for that rumor.

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  10. You are always welcome!
    Ha! “Obecalp”! What a pity! Any “opecalp” is reading this?
    I also heard that Portland was the most beautiful city, never been there…well, sometime in my life!

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  11. It is a pity, Katha, and you know writing prescriptions for placebos must be the ultimate insider joke among doctors — especially when they work! Ha!
    I know a lot of people from Oregon. They are all quite kind and incredibly friendly and polite.

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  12. What a sheer waste of energy David, both of the doctors and the patients!
    There are so many serious cases out there who really need medical attention.
    People from Oregon have to be friendly, it is just the impact of the gorgeous landscape! One of my friends took me there to her home in Ashland for a 3 day vacation, absolutely lovely!

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  13. I guess the issue is what do you do with a hypochondria patient, Katha, that demands treatment and won’t leave you alone until you “heal” them with a pill? I guess sugar pill or placebo is the easiest way to “medicate” that sort of worried mind without doing any immediate damage.
    It’s hard to meet native Oregonians, though. They never leave the state! SMILE!

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  14. I am not sure how doctors in this country deal with this kind of situation – as our medical prescriptions and medications are free – or covered by a standard prescription charge of £7.10 under the National Health Service.
    If you have a recognized condition – there are guidelines for treatment – I am not sure what these are for this condition.
    There are some exceptions to this are some medicines for Alzheimer’s Disease and new cancer drugs are some notable ones.
    I can imagine that there may well be a placebo prescribed particularly if it is cheaper that any actual real medicine.
    In an ideal or holistic situation the mind and body should be treated together.
    As an aside – while I was researching Lyme’s Disease, Fibromyalgia is listed as one of the most common symptoms.

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  15. Thank you for the insight from the UK, Nicola! You have a health system that makes much more sense to me than our mishmash of insurance and co-pays and primary care providers.
    Our government representatives have a spectacular healthcare program they can use for the rest of their lives and some argue THAT should be the sort of federalized healthcare that everyone in the USA should have as a birthright. The republicans reply, “Oh, we could never afford THAT for everybody!” Their treachery and duplicitousness is lost on them.
    Fibromyalgia — in its basest sense — is a generalized, unexplainable, achiness that can’t be pinpointed or tied to any verifiable condition. Bedrest and aspirin used to be the home remedy before the insurance company and drug manufacturers got involved to monetize the aftershocks of the American Dream.

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  16. Fibromyalgia sounds as though it can be grouped with ME/CFS/PVFS. Are ME/CFS/PVFS recognized in the USA ?
    My experience of Lyme’s Disease was that it was far more recognized in the USA than it is in the UK.
    I am given to understand that I was “lucky” as I actually have a positive blood test result and could therefore get the appropriate treatment.
    I understand that there are many that miss the first stage who go onto develop the symptoms of ME/CFS/PVFS and Fibromyalgia . Also there seem to be a large number of patients who are suffering from the latter group who then get a diagnosis of Lyme’s – often from USA Labs after getting negative tests from the NHS in the UK.
    There is a war of words and opinion about the validity of the USA test because of the involvement of the Insurance companies and drug manufacturers.

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  17. David,
    between the pharmaceutical industry and the healthcare business why will anyone be willing to invest in raising awareness about hypochondria and placebos?
    The fact that it drives a significant portion of their business while actually being effective in “curing” their unwitting customers, means that the motivation for doing something like that has to come purely from social conscience.

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  18. Hi Nicola!
    I think you’re going to have to define ME/CFS/PVFS for the rest of the world. SMILE!
    You were incredibly lucky with your diagnosis of, and recovery from, Lyme’s Disease. It can be hard to pin down and, as one doctor friend of mine told me, “You never really recover from it because it damages you inside and it influences how your body reacts to viruses and disease for the rest of your life. Your immune system is compromised.”
    Lyme’s Disease is nasty and early treatment is a big part of learning to control it and live with it. I know you’re doing really well and I am so thrilled to know that Lyme’s Disease isn’t always a lifelong punishment.

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  19. ME/CFS/PVFS
    From http://www.meassociation.org.uk/content/view/89/83/
    “It should be explained that there are a number of different names for what is an illness of uncertain cause affecting many thousands of people. Currently it is estimated that some 250,000 people in Britain are affected by this illness.
    * Myalgic Encephalopathy or “ME” (a term which The ME Association feels is more appropriate than the original, Myalgic Encephalomyelitis)
    * Chronic Fatigue Syndrome or “CFS”
    * Post-Viral Fatigue Syndrome or “PVFS”
    * Chronic Fatigue Immune Dysfunction Syndrome or “CFIDS”
    All types of people at all ages are affected. Severe and debilitating fatigue, painful muscles and joints, disordered sleep, gastric disturbances, poor memory and concentration are commonplace. In many cases, onset is linked to a viral infection. Other triggers may include an operation or an accident, although some people experience a slow, insidious onset. ”
    There are a lot of symptoms that fall within the spectrum – and as yet the testing system is not yet fully developed. ME was known as *scivers* disease in the UK for a long time – ie it was a short cut for “lazy people” to a social security payout.
    Your doctor friend echoes my understanding of Lyme’s – can I get your Doctor friend to talk to my Doctor who is of the view that as it was treated quickly I am now cured and that I have nothing to worry about.
    I have to say I now keep a symptoms log (no entries so far)and boost my immune system with supplements.

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  20. Thanks for that incredible definition, Nicola! That’s extremely helpful and immensely fascinating!
    I think as society becomes more compressed, more people begin to feel that squeeze in their bodies and they don’t have the tools to relieve the pressure on their own, and so they seek a medical release of the fluid tension.
    I will have to see if I can hunt down my doctor friend. I think he finished his residency and returned to his home country. I do know that Lyme’s Disease is not considered curable in the late stages because it then sort of comes and goes with the health of your body after initial treatment sort of like shingles does — but if you catch it early enough before it becomes pernicious you should be in good shape.
    Here’s a great link from the National Institutes of Health:
    http://www3.niaid.nih.gov/topics/lymeDisease/understanding/chronic.htm

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  21. Hi David,
    I understand your point, I remember satisfying my grandma with a “sugar pill” because of her constant complaining regarding health where as no physiological problems could be detected – the entire scenario happened under the supervision of a medical practitioner. But she was 86! And these are kids!!! God help them.

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  22. That indeed is David!
    My grandma started complaining about a headache – the reason for which couldn’t be identified after doing several EEG, ECG, MRI, CT Scan…this…that…and our house physician clearly didn’t want to increase any dose of medicine for her – so the “magic pill”! – It worked!

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  23. Thank you for that great link David.
    Thankfully (fingers crossed) I have an on the ball doctor who spotted and tested quickly and gave me appropriate treatment. He explained to me that if stage one is caught it is dealt with – but I will always carry the marker – similar to Chicken Pox. He believes that if stage one is treated you do not go on to get stage two or three.
    I have a friend who has chronic Lyme’s which took a long time to diagnose and was only diagnosed after a lot of other investigations. Sadly I don’t think there will be a cure for her due to the time it took to diagnose. She is concerned because she does not think I have had enough treatment.
    My consultant friend who I have mentioned before spoke to the consultant in charge of Infectious Diseases for the south UK and has been assured I have had the correct dosage.
    Hence the reason I like your Doctor friends view as it coincides most with mine and my limited research. I shall take it I am treated but support my immune system accordingly.
    Now back on topic.
    “I think as society becomes more compressed, more people begin to feel that squeeze in their bodies and they don’t have the tools to relieve the pressure on their own, and so they seek a medical release of the fluid tension.”
    I agree with you here – not only do our minds suffer from stress but our bodies too.
    I apply a larger remit than most to the word stress. I define it as a state where the mind and body cannot cope with the conditions around it.
    I suspect that our minds and bodies have not caught up with the changes to our mental and physical environment over the last twenty years.
    The other day we were talking about our lack of ability to concentrate – this has changed over the last twenty years – we are also having to live with considerable changes in the pace of life, what we eat and the atmosphere we live in.
    I think a lot of these syndromes are a result of society changing and technology advancing quicker than our bodies and minds ability to cope with them and the resultant stress is exhibited physically.

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  24. I’m glad you’re aware of your Lyme disease diagnosis, Nicola, and that you are actively aware of it and treating it by taking care of yourself! Lyme disease is hard to diagnose because people usually live with it for a long time even when the strange rashes appear and won’t go away. I feel for your friend. I know she is in pain.
    The danger I think we’re facing in the stress on our bodies and minds — and I do love your definition — is that as time passes and we age, the mind/body connection begins to decay. Our minds are stronger and better able to dismiss ailments of the body as nothing when they are early indicators of dangers to come. Our mind may not be able to balance and control the body as it wishes and so instead of forcing the body to mind, the mind just gives up and dismisses the task as hopeless.
    I know a lot of hardworking people who have sharp minds, but disastrous bodies — and others that have fuzzy minds and hard bodies — and this disconnect is all caused by modern stress and structures.
    I rarely have time to eat sitting down and an elderly friend of mine gets so upset when she sees me standing and eating because she feels I am not properly digesting my food. I’ve never had a problem eating standing up — she tells me that’s because I trained my body not to know any better and that I have no idea how much damage has already been done…

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  25. You’re right, Dananjay, this is a matter of social morality: Do we want our doctors to ever lie to us or purposefully mislead us?
    I think most people — when faced with those questions — would want the truth over a lie and transparency over deception.

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  26. How people can ignore those rashes I do not know – it was excruciating. Strange that you mentioned shingles because that is one of the things I thought my rash might be.
    “I know a lot of hardworking people who have sharp minds, but disastrous bodies — and others that have fuzzy minds and hard bodies”
    Do you think that this is because we no longer have time to do both? or like the concentration span issue – do you think that it might be another side effect of the TV generation and far too many sit and watch TV as kids instead of playing – ie we are becoming too sedentary as a society. In the UK this could be compounded by the lowering of importance of sport in our schools and the selling off of playing fields for housing.
    Your elderly friend sounds like my mother. I do have to say when I was recovering from my bowel operation they did advise me to sit for a while after eating to allow the food to digest properly.

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  27. I’m not sure how people can ignore the rashes — but it is usually the persistent rash that leads them in to see their doctor. Even doctors confuse Shingles with Lyme’s!
    I think the mind-body disconnect is caused by an intellectual economy instead of one based on hand and back labor. We no longer need to train our mind not to be bored while doing repetitive labor-intensive tasks, and our hand-eye coordination is no longer as sharp as it was in the fields while we worked with one eye on the crops and another eye on the outskirts for animal predators.
    Now we sit all day on the phone or before a computer and the only connection the mind has to the body is through the fingertips. It’s more of a numbing-down than a total severing, but the effects are the same: The mind no longer cares about the state of the body and the body is left to rot in place because the mind is pre-engaged. We live in two realities at all times: Our internet life where — we are beautiful and perfect — and then our real life where our minds are disintegrating and our bodies are falling apart.
    I’m all for sitting down while eating, and I do try to do that as much as I can, but I can’t remember the last time we had a proper kitchen table with chairs. So we stand or sit on the floor.

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