Because of the response to the previous post, Clinicians Can Choose How, Not If, They Influence Patient Compliance, I am posting references to two recent publications that address issues raised in that entry.
Cyberchondria
Microsoft has published the results of a study of cyberchondria, the behavior of individuals who use the Internet to gather information on health or healthcare. The Microsoft study tallies data from health-related Web searches on popular search engines (a 40 million page anonymized sample) as well as a survey of 500 Microsoft employees about their own health-search experiences.
The New York Times summarized the report’s findings:
The study suggests that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them. … Mr. Horvitz, an artificial intelligence researcher at Microsoft Research, said many people treated search engines as if they could answer questions like a human expert. “People tend to look at just the first couple results,” Mr. Horvitz said. “If they find ‘brain tumor’ or ‘A.L.S.,’ that’s their launching point.” … They found that Web searches for things like headache and chest pain were just as likely or more likely to lead people to pages describing serious conditions as benign ones, even though the serious illnesses are much more rare. For example, there were just as many results that linked headaches with brain tumors as with caffeine withdrawal, although the chance of having a brain tumor is infinitesimally small.
The study can be downloaded at Microsoft Cyberchondria Report
Survey Of Placebo Prescribing
Last month, BMJ published the results of a survey of the habits of American physicians re the prescription of placebos.The abstract follows:
Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists
Objective To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.
Design Cross sectional mailed survey.
Setting Physicians’ clinical practices.
Participants 1200 practising internists and rheumatologists in the United States.
Main outcome measures Investigators measured physicians’ self reported behaviours and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a “placebo treatment,” their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.
Results 679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).
Conclusions Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.
The citation and links to the abstract and full text (available without charge) follow:
Tilburt, J. C, Emanuel, E. J, Kaptchuk, T. J, Curlin, F. A, Miller, F. G (2008). Prescribing “placebo treatments”: results of national survey of US internists and rheumatologists. BMJ 337: a1938-a1938 [Abstract] [Full Text]
