Friday, June 6, 2008

Sure, Tricking Babies is Fun, But is it Right?

From Women's Bioethics Blog, here is a little motherhood moral dilemma for your Friday morning:
A New York Times article ( “Experts Question Placebo Pill for Children” --May 27, 2008) raises the question of whether giving children placebo pills for minor childhood illnesses is an ethical practice. Based on the premise that pharmacologically inert compounds can actually produce improvements in some medical conditions, Jennifer Buettner, a mother of 3 small children, developed a cherry-flavored chewable dextrose tablet, the first branded, pharmaceutical grade placebo. The therapeutic effect is based on the power of suggestion. If parents use the placebo to “trick” their children into thinking that they are taking real medicine, the children will consequently feel better.
Notice that the brand name, Obecalp, is simply placebo spelled backwards. Mommies and daddies are tricky, no?

Of course, there might be a catch to this 'magic feather' catch-all cure for minor childhood complaints, as the New York Times points out. First of all, clinical studies that use placebos are usually double blinded - neither the patient nor the person giving the placebo knows its a fake, making it easier to fool the patient. So Obecalp might not work if the moms and dads handing it out know its a sham. Yet, your parents probably knew there was no Santa, and they still managed to fool you for years (man, were you gullible), so I'm not buying the kids-will-see-through-this argument.

A graver concern is that fake medicines could condition kids into thinking that popping pills is the solution to every problem:

“Kids could grow up thinking that the only way to get better is by taking a pill,” Dr. Brody said. If they do that, he added, they will not learn that a minor complaint like a scraped knee or a cold can improve on its own.

Dr. David Spiegel, a psychiatrist who studies placebos at the Stanford School of Medicine, said conditioning children to reach for relief in a pill could also make them easy targets for quacks and pharmaceutical pitches later. “They used to sell candied cigarettes to kids to get them used to the idea of playing with cigarettes,” he said.

Despite the controversy, Obecalp went on the market on June 1st - you can now buy it over-the-counter. So, we are left with the questions - is it ethical to give your kids a fake drug and tell them that it is medicine? What if you tell them it's just sugar, but it might help them feel better anyway? Will Obecalp create a psychological dependency on pills? Is this anything new, or have parents been taking advantage of the placebo effect since parenting began?

(Oh, and for the 'why is this a feminist issue' folks... 1. parenting continues to be a central concern for many women, and it unfortunately is a task that falls largely on mothers, whether they have a partner or not. 2. I'm a feminist, I want to talk about it, and this is my blog, gosh darn it!)

(Magic feather via)


Kris-Stella said...

My mother had a great cure-all placebo: she would gently blow on the aching part of me. It worked miracles for tummy aches, scraped knees, anything. (This placebo for kids is common in Estonia, all the kids knew about it as far as I recall.)

So from personal experience I suggest that parental placebos a) aren't unethical, b) don't need to come in pharmaceutical boxes with the risk of conditioning kids to reach for pills, and c) don't need to have price tags, either.

Mächtige Maus said...

Ooo...I get to play Devil's advocate here for a second, a role I do not take often.

LaPH, you write: “Kids could grow up thinking that the only way to get better is by taking a pill,” Dr. Brody said. If they do that, he added, they will not learn that a minor complaint like a scraped knee or a cold can improve on its own."

Isn't that what we are already doing as a society? A coworker of mine several years ago started her six year old daughter (yes...I said six) on Ritalin for ADHD. I had a hard time buying into how you can tell at that age that she needed it. Or how about the massive epidemic of super bugs we have created in our society because parents will give children from an early age onwards massive doses of antibiotics for ear infections and the like that would essentially go away on their own? Now when they really need the antibiotic it doesn't work.

I'm not saying placebo pills for a three year old are the way to go, but for a society that already pushes pills on kids maybe a placebo for small colds isn't a bad idea?

Again...simply Devil's advocate.


Mächtige Maus said...

Ah...but isn't paying for a quick fix the American way? :)

Habladora said...

It looks like you guys are actually in consensus! Here is my problem with the Obecalp placebo - it encourages magical thinking. Really, magical thinking comes naturally to people - it is logical reasoning that is hard.

I think that I wanted to post on this, though, because I'm fascinated by the idea and truly undecided. If you read the whole NYT article, the ADHD example is actually addressed. The article mentions an experiment where they told kids that the ADHD medications they were taking were going to be slowly reduced, but that they would be given an 'extender treatment' that contained no medication. So the kids knew that the new pills were duds, but 80% of them still reported that the 'extender treatment' helped. I'm fascinated - and I just don't know what to do with that.

Casmall said...

It would be unethical for a physician to behave this way. Why is it ok for a parent?

Renee said...

I don't like the idea of this at all. We already live in an over medicated society and this teaches kids that there is a magic cure all pill for everything that ails. Pharmaceutical companies are trying to hook kids to this idea. It is all about future profit and not about helping a child.I also find it to be extremely dishonest. Our children trust us not to lie to them and this is a violation of that trust. As soon as they can understand we should be explaining to them what they are ingesting and why so that they can learn to make informed decisions, not just drug them so that we can have an easier time. I am absolutely incensed by this campaign.

the amazing kim said...

I think this is brilliant. If these were available in Australia, I'd buy hundreds of packets and use them for everything. If I missed the train, I'd take a placebo. If my housemate had a job interview, I'd give them a placebo. If a friend in another country had to wake up early, I'd send them a picture of a placebo. I wouldn't give them to my partner, because sugar pills actually have a practical use for diabetics.

Perhaps because I was always enamoured with the history of parents drugging their sprog. This is nothing new, and (impressively) is one of the few non-harmful options people have taken. It wasn't a hundred years ago that parents were still giving their kids gin, or putting opium or laudanum in the bottle.

Perhaps when the preschool pill-poppers grow up and learn that the magic pills had no real effect they might actually be dissuaded to turn to such pills as adults.
Much like the disillusionment of the Santa and Easter bunny myths inspire some to become atheists later in life, when they apply the same critical thinking to creation stories.

Placebos might actually be good: when older children actually discover they've been taking sugar pills all along they might be less inclined to take pills for no reason. Could be a good lesson in the immune system and the placebo effect of most medications.

the amazing kim said...

it encourages magical thinking
That's... kind of what childhood mostly consists of?

I mean, adults tell kids about Santa and Tooth fairies and Easter bunnies and spinach will make you super strong and that crusts will make your hair curly and vegemite will make your cheeks rosy and monsters live under beds and little pigs build houses and bears live between pavement slabs and... could it be any more magical?

Anonymous said...

A graver concern is that fake medicines could condition kids into thinking that popping pills is the solution to every problem:“Kids could grow up thinking that the only way to get better is by taking a pill,” Dr. Brody said. If they do that, he added, they will not learn that a minor complaint like a scraped knee or a cold can improve on its own.

This is the same thing I thought of the moment I started reading this post. I don't like taking medicine. I try REALLY REALLY hard NOT to take medicine to the point that I let a sinus infection go for too long and freaked out my doctor when I told him how long I'd had my symptoms. He said I was nuts. Anyways, the point is, you can't go running to the medicine cabinet any time you have a boo-boo, and that's what you're going to be teaching these kids.

daedalus2u said...

I have a blog about the physiology behind the placebo effect. There is nothing wrong with it, and a mother's "kiss it and make it better" is the archetypal placebo. It is important to help children to learn how to "stand down" from the "fight or flight" state that they are in after a boo-boo. That is what a mother's kiss does. It tells the child that everything will be ok, and they can relax and not have their physiology reved up so much. That is an extremely important thing to learn how to do.

I don't think that pills are necessary or desirable.