placebo, junior?

From NPR:

A new pill is going on sale this week, and it's marketed for times when kids need a little more than a kiss to make an "owie" go away. It's just a placebo as Tuesday's New York Times reports, a sugar pill. This non-medication is called Obecalp, or placebo spelled backwards. The pills are the brainchild of a mother who lives in Maryland, and they're being sold as a dietary supplement.

The Commentary from Dr. Douglas Kamerow:

There are so many issues here, I don't know where to begin. But first, let me tell you a story about placebos from my medical internship.

It was at a big urban county hospital, which took care of a mainly indigent population. Our pharmacy stocked two "special" painkilling drugs, available by a doctor's prescription only. One came in a brilliant red capsule and the other was deep purple. The interns were instructed that these pills were for people who abused pain medications and were to be dispensed with care — and with a good story. It turned out that the red one was aspirin and the purple one was Tylenol, although you couldn't find those exact words anywhere on the labels. And sure enough, I had a number of patients who said to me that they had to have that red pill, or that purple one, that it was the only thing that took their pain away.

If it's ever ethical to use a placebo — and I'm not sure that it is — this is a good example of when it might be appropriate: helping people with a chronic problem, using a real medicine, one that is not too dangerous and has some efficacy of its own. And not lying about what's in it.

Contrast this with today's story about the new children's sugar pill. First, who are we treating here? Children or their parents? If placebos are to work, the patients need to believe in them. Are we going to deceive the parents too, or is it just their job to deceive their children? And what will happen when the children grow up and find out that they were being sold a pill of goods, so to speak?

Second, what are we teaching the kids? That pills are the answer for all our aches and pains? And perhaps all our other problems, too? Not advisable. Third, what makes us think that kids want medicine? If all children are like my three kids, who are now all teenagers, they won't take medicine when they are little and they don't want it when they are big either.

And I don't buy the argument that a placebo pill is just like putting a "Band-Aid on a boo-boo." We know it doesn't make any difference, but we tell the kids that it does. Sure, there are kids who end up wanting a Band-Aid for every possible problem, but I have never seen an adult Band-Aid addict. I have seen lots of adults who want a pill for every ill.

When I told my wife about this new sugar pill for children, her concise response was: "That's sick." And while I might not go that far, I do think that this is a deeply bad idea, however well intentioned. Kids who are in pain or sick but don't require real medicine need someone to give them a hug, or a kiss, or if a treat is indicated, maybe a lollipop. But they don't need a sugar pill, and they certainly don't need to be deceived into thinking that it's the pill's magic, not Mom's or Dad's, that helped them feel better.

Family physician Douglas Kamerow, a former Assistant Surgeon General, is a health services researcher at RTI International. He lives in Maryland.