Kiss And Make It Better? A Placebo Pill For Kids
25 CommentsBy Ed Silverman // May 27th, 2008 // 8:19 am
Jennifer Buettner was taking care of her young niece when she had a brainstorm. The child had a nagging case of hypochondria and, after her mother-in-law suggested a Motrin tablet, Buettner later realized a placebo was just what the doctor ordered, The New York Times writes.
Buettner, 40, who lives in Severna Park, Maryland, with her husband and two children, envisioned a tablet that would empower parents to do something tangible for minor ills and reduce the unnecessary use of antibiotics and other meds. So she founded Efficacy Brands, which next week will sell chewable, cherry-flavored dextrose tablets, Obecalp, for placebo spelled backward. Bottles of 50 tablets will sell for $5.95, and a liquid version is also planned.
Because Obecalp doesn’t contain an active drug, the pills will not be sold as a drug under FDA rules. And they will be marketed as dietary supplements, meaning they can be sold at groceries, drugstores and discount stores without a prescription, the paper notes.
“This is designed to have the texture and taste of actual medicine so it will trick kids into thinking that they’re taking something,” Buettner tells the Times. “Then their brain takes over, and they say, ‘Oh, I feel better.’ ” But she doesn’t spell out the conditions that her pills could treat. As a parent, she says, “you’ll know when Obecalp is necessary.”
But some experts question the premise. “Placebos are unpredictable,” Howard Brody, a medical ethicist and family physician at the University of Texas Medical Branch at Galveston, tells the paper. “Each and every time you give a placebo you see a dramatic response among some people and no response in others. The idea that we can use a placebo as a general treatment method strikes me as inappropriate.”
There’s more to read below, but what do you think?
Should kids be given a placebo pill?
- No (63%, 92 Votes)
- Yes (37%, 55 Votes)
Total Voters: 147
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Franklin Miller, a bioethicist at the National Institutes of Health, is skeptical. “As a parent of three now grown children,” he tells the paper, “I can’t think of a single instance where I’d want to give a placebo.”
Much of the power of the placebo effect seems to lie in the belief that it will work, and some experts question whether this expectation can be sustained if the person giving it knows it is a sham. Most clinical trials that have shown benefits from placebos are double blinded. Neither the recipient nor the giver knows that the pills are fake.
“For this to work really well as placebo, you cannot let the parents know that it’s a sugar pill,” Brody tells the paper. “You have to lie to the parents, too, if you expect them to fool their kids.”
David Spiegel, a psychiatrist who studies placebos at the Stanford School of Medicine, says 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 tells the Times.
Buettner acknowledges that “we expect controversy with this,” but adds, “we are not promoting drug use.”
Docs themselves have been known to dole out placebos to overwhelmed parents, Brian Olshansky, a physician at the University of Iowa Hospitals, tells the Times. A screaming child with an earache may leave the emergency room with a prescription for antibiotics, even though the drug will not speed recovery and could potentially cause harm.
Buettner says her pill could satisfy that need while reducing potential harms from unnecessary meds. “The overprescription of drugs is a serious problem,” she tells the paper, “and I think there needs to be an alternative.”
At least one study has shown that placebos can be effective even when the patients know that they are inert, the paper points out. In a study last year, 70 children with ADHD were asked to reduce their medications gradually by replacing some of their drugs with placebo pills. The children and their parents were explicitly told that these “dose extender” pills contained no drug.
After three months, 80 percent reported the placebo helped. Although the study used a placebo in a different context from Obecalp, it did suggest deception might not be necessary for a placebo to work, according to the senior author, Gail Geller, a bioethicist at the Berman Institute of Bioethics at Johns Hopkins.
Geller agrees that parents should not deceive their children, but adds that a parent who truly believed in the power of the placebo was not really being deceptive. “In principle,” she tels the paper, “I don’t have a problem with the thoughtful use of placebo. The starting premise and your own belief about what you’re doing matters a lot.”
In years gone by, Brody says parents didn’t need a pill to induce the placebo effect. Mothers would promise to “kiss it and make it better” and it is that type of placebo children really yearn for, he tells the paper. “Does a sick child really want X-rays or MRI’s or the latest antibiotic?” he asks. “No. All the sick child wants is comforting.”
condor
Great. Let’s teach our kids that all problems are solvable — so long as they buy the right pill. Harrowing story, IMO, pharmalot — but a compelling find!
Nathan
I agree Condor.
The common ground that we all usually find on this site is that pharmaceuticals are over prescribed. The reason pharmaceuticals are over prescribed is because people want a “fix-it-quick” solution to their health issues. As parents, we need to teach our kids that there aren’t always easy solutions to the problems we face. The kids growing up on these “placebo pills” are going to grow up into adults that demand antibiotics for common colds and want a weight-loss pill to replace the need for exercise. We need to stop this kind of thinking when our kids are very young. All medicines have negative health-effects and should be used only when medically necessary. This “placebo pill” has no negative health effects and will teach children at the earliest and most moldable of ages that taking pills has no negative consequences.
Lichtstrasse 35
Look for CDER to demand a randomized, double-blind, double-dummy trial of this very dangerous medication…perhaps it should be Scheduled?
James
Condor and Nathan hit the nail on the head.
My question is this: the FDA sent warning letters to, and was able to shut down the manufacturer of the energy drink named “Cocaine” even though it had no cocaine, or anything else illegal in it. State and local police forces have successfully prosecuted drug dealers selling “fake” drugs (baking powder masquerading as cocaine, or oregano that is supposedly marijuana, for example).
It would seem that there is a compelling reason to stop the sale of this as it is marketed. If the prior examples are within gov’t dominion, would they have the same ability to stop sales of Obecalp (since it is mentioned as a “treatment for hypochondria”)?
Former pharma Marketing Exec
I’m with Condor and Nathan.
The comments of the ethicist at Johns Hopkins is a bit discouraging. She should recognize what most cases of hypochondrias are in young children - an invitation for some TLC from their parents. Maybe the kids are getting sick of their electronic babysitters. Outings to the park and old fashioned story telling should not be replaced by placebo drugs…
Justice in Michigan
Well, a nice instance of unanimity on this one so far. Many good points made.
Howard Brody, a valued colleague, notes in his own book on placebos that a key seems to be having a “plan” itself (as in any tx). Parents have always used “accoutrements,” I guess - chicken soup, a lullaby, perhaps an incantation of some kind.
The fact that today’s accoutrement is a pill - at least in this family - is a small example of an issue that may be much larger.
Justice in Michigan
Whoops. Well, the poll suggests less agreement than the comments. I’d be genuinely interested to hear from some of those folks.
Lisa Van S
Wow, I am also in agreement here. This truly, is a bad idea.
Piper
I’m going to be the black sheep here and say this isn’t a bad idea. It’s another form of mind over matter - if they believe it doesn’t hurt, perhaps it won’t. I’ve always believed that pain killers do not work and oddly enough, they never have for me. Perhaps the reverse could be true. Never underestimate the power of psychology.
Bobby C
It’s actually a pretty good idea — or, at least, a logical idea.
Much of modern medicine benefits greatly from the placebo effect. For some, just seeing the doctor, and submitting to his wisdom and authority, helps their health.
Plus, for some reason, millions of intelligent, successful adults believe there’s a pill for every ill — which is just facile.
Hypochondria + Placebo = good health.
CMC guy
As a parent I understand the urge and as scientist the logic is reasonable however still think it is not best approach. I can see the extrapolation Nathan suggests and unpredictability mentioned in the article and if a hug/kiss or chicken soup can accomplish the same probably is better in the long run for both child and parent.
In terms of name Obecalp could also mean “Oh be calm pill”?
Chris
I would rather see physicians using actual placebos rather than using drugs with potentially serious side effects such as antibiotics for placebo purposes.
Justice in Michigan
One detail lost in the discussion is that the child (no age given) “had a nagging case of hypochondria.”
Aside from the ethical and cultural issues that have been raised, my conjecture would be that the placebo will not last long if the girl actually is hypochcondriacal.
Either a new ailment will soon present itself and/or she will conclude that there is something “bad” for her in the pill mommy gave her. That will require another pill. Etc., etc..
One may also wonder how the child will feel if/when she is old enough to read the NYT article.
Lisa Van S
Hey Justice,.. A Wee Prejudicial!!!.. or just sexist! Why a she? Could be a HE.
Chris
LVS - Nieces are typically ’she’
>Jennifer Buettner was taking care of her young niece when she had a brainstorm. The child had a nagging case of hypochondria
M Helm, MD
I suppose this was bound to happen. As a pediatrician, I’m appalled. There are a number of problems here. First, depending on the age of the child, most don’t seek medication. Second, parents, not the child, are who will seek medication for a child. Classically, this has been antibiotics (useless in the absence of a bacteria infection) or cough-cold remedies (not proven safe or effective - though sometimes dangerous - in the age ranges of children mostly seen for these complaints). Sadly, it is also now common for parents to seek medication for undesirable behaviors (many times these have been previously reinforced). In more than a few cases I know, the undesirable behaviors are in fact developmentally appropriate/expected. Finally, I’ve had more than one parent complain when I didn’t prescribe the medication they wanted. This occurred even when I have prescribed a medication for a more fundamental problem I identified which led to the reason for the visit and the problem they perceived. However, I refuse to be a pill dispensing machine. I see my responsibility as being to the child I’m treating, not to fulfill the expectation of a parent for anything other than my best effort at quality medical care.
I can’t imagine a situation where actually prescribing a placebo would be ethical. It reinforces the too prevalent idea expressed by others that the solutions to all problems are found in a medicine. This is a bad practice. It also undermines the role of a care provider. Children (especially in middle childhood) are particularly likely to manifest emotional/psychological problems as physical health complaints.
Sure it may be that “hypochondria” is a way that a child could be seeking attention/attempting to meet an unfilled need - to which the answer of “take this pill” may reinforce some particularly bad practices later on. It could also be that there are unspoken problems with which the child really has no capacity to cope. Sexually abused children, children who live with violence, children who can not have stability and security because their parents are removed from them by death, divorce, drugs, or incarceration frequently present with bodily complaints.
It is true that there are some children who have some “hypochondiacal” tendencies. These are often learned from a parent or someone else in the home. Typically, it is pretty easy to tell when there is “secondary gain” reinforcing the behavior. In these cases, extinction of the behavior through removal of the reinforcement is the best approach (though one has to take care to be completely consistent), not changing to a different reward structure (in this case, the placebo pill). If on the other hand, there is no gain, there is possibly more to the complaints than meets the eye.
Justice in Michigan
Lisa! As Chris notes, Ed’s piece (and the NYT article) make it clear in the first sentence it was a “she.”
So, as far prejudging …. yikes!
(But I will forgive you- just send me a $499 gift so you don’t have to report it.)
I think Doc Helm’s comments are terrific. My experience working with “hypochondriacal” kids (of all genders) is that there is virtually always much more to understand about why they are convinced something is “very wrong” (which rarely has to do with their health).
condor
Much here, since I last looked in, is both witty — and wise. . . . great thread!
I reappear now, simply to note that mine was also offered in a hurried shorthand for one other thought, as well: This child — as all do — needs, and wants, the full-attention of her parents. Not every moment. But from time to time, at least.
In this case, IMO, a pill — any pill — is simply the wrong answer. A kiss, a hug, some chicken soup, a good book, read aloud (”Goodnight Moon” by Margaret Wise Brown, read slowly — deliberately, and with measured cadence) — and some reassuring attention send (in my biased parental opinion) a better message than “Take this pill — “p-l-a-c-e-b-o” spelled backwards. Is it clever? Yes.
Is it good parenting? “Not. So. Much.” — but that is just my own, perhaps jaundiced, opinion.
Matthew Holford
“…so it will trick kids into thinking that they’re taking something…”
I think it’s this that unnerves me, more than anything else - you think it’s OK to lie flagrantly to your children, and you imagine that they’ll still believe you, on another occasion? I don’t think I have an issue with the placebo, but I think it makes more sense to give to the child with a “her: take this. It has absolutely no therapeutic value, but your own mind’s restorative powers will have you feeling better, shortly,” would be preferable, and more likely to have the desired effect, too!
Matt
Kozzie
Of course parents lie to their kids. Why else would we all learn early who Santa, the tooth fairy and easter bunny are? Perhaps the key thing here is a child focused approach - rather than making generic statements about the entire population of small kids in need of a little attention?
Sepp
Well, I did vote “yes” on the poll.
the reason? It is better, I believe, to give a placebo than an actual drug, what with all the side effects…
I understand the ethical qualms. But where are those ethical qualms when doctors prescribe and parents give potentially dangerous meds to kids?
Isn’t it infinitely better to give a placebo, helping the kid’s own system to overcome whatever it is that’s ailing, rather than an antibiotic that runs the risk of ruining the composition of bacterial flora in that little body and cause all kinds of problems later on?
James
No, Sepp, it’s not. Sometimes antibiotics are necessary. And this goes to the other problem with Obecalp.
By putting this product out there, it sends a message to parents, however subtle, that it’s okay to treat a child with a sugar pill. You will have some situations, perhaps very few and far between, where a parent will ignore their child’s condition.
Case in point–when I was around 10, I had pneumonia. I *knew* I had pneumonia, even though I had never had it before (I also have asthma, so I guess I’m just in tune with my lungs). My mother thought I was whining, and that it was just a bad cold or the flu. After a couple of days, she finally took me to the doctor. Guess what? Pneumonia.
In my mother’s hands, Obecalp is dangerous.
And here’s another wrinkle–what if someone (Mom) buys Obecalp and puts it in their medicine cabinet. A few months later, Dad is taking care of the kids. Kid is whining–I’m sick, fever, etc. Dad gives child Obecalp. Child dies (fever, scurvy, bubonic plague, whatever). Dad says he thought it was medicine.
That’s a lot more dangerous than if the child were given a Prozac.
Sam
I agree with M Helm, MD, but realistically the habit by physicians to prescribe antibiotics to appease the parents when the infection is viral was so prevalent that we find it difficult to control mutated bacteria.
To a large extent the lay public believes if they don’t get a prescription drug
for their perceived illness, their physician has not treated them well and may
go to a physician who will give them a drug.
Lay people now a days have access to the internet and all kinds of medical
information - some good, some bad, but just because you can read does not
mean you can interpret the information correctly. Besides many medical
conditions have similar symptoms that the lay-person may not diagnosis correctly.
Sepp
I understand your concern, James.
But, as Sam rightly says, many times an antibiotic is given “to do something” not because it is really necessary.
What you are describing, James, are misinformed or very poorly informed parents. They may make a mess out of any number of situations, and a placebo is not the worst one of these. Of course if a kid is really sick they should consult a doctor. I would say it certainly isn’t the presence of a placebo that will prevent such consultation.
Better more information for parents, and a choice of using a harmless pill for small things (better if it had some vitamin C in it…) that do not need heavy intervention.
Andres L. Jimenez MD
I am honored to be in such a thoughtful discussion. I voted NO.
Why?
1) Because if you have a hypochodriac he or she and you use placebos you are reinforcing the hypochondriac behavior no matter how old he or she is. The sugar pill will do nothing but create more hypochondriac behavior.
2) In the event that something is really wrong it may delay, as has been already pointed out, proper medical care.
3) The use of a placebo is such a powerful specialized tool that it shouild be administered only by a qualified physician and not even all physicians realy know how to use it.
4) Etc.
Another issue, if the bottle really says that it is to treat hypochondriasis, that in itself is a false claim, since hypochodriasis is a condition and the pill in fact makes it worse, not better.
Unfortunately the phenomenon is a sign of our times.
By the way how does one acquire a cute name such as I have seen?