[ed. note: Michael Jorrin, who I like to call “Doc Gumshoe” (he’s a longtime medical writer, not a doctor) writes about health and medicine topics for us from time to time. His words and thoughts are his own.]
The word “placebo” is the first person singular, future tense, of the Latin verb “placere,” to please or be pleasing. It means “I shall be pleasing.” It was a familiar word in antiquity, with no medical meaning, as the first word of a dirge for the dead, Placebo Domino in regione vivorum – “I shall be pleasing to the Lord in the lands of the living.”
From that definitely respectable point of departure, the word took on a somewhat negative tone. To sing a placebo meant to be a flatterer, a sycophant, a servile and perhaps deceptive sort of fellow, the kind we would now call a con man or a hustler.
The first citation in my Oxford English Dictionary that relates in any way to the current medical use dates from 1811 and comes from Hooper’s Medical Dictionary: “Placebo – an epithet given to any medicine adapted more to please than benefit the patient.” And then this one, from the New York State Journal of Medicine in 1946: “You cannot write a prescription without the element of a placebo. The fact that it is signed by a doctor, that it has to be taken to a drug store to be made up, that it has, perhaps, a bad taste, all of those are placebo elements in a prescription.”
Now we’re getting to it. The OED’s definition is “a substance or procedure which a patient accepts as a medicine or therapy but which actually has no specific therapeutic effect for his condition, or is prescribed in the belief that it has no such activity.” In other words, according to that definition, the physician knows that the pill is a dummy, but the patient thinks it’s real. When the physician gives the patient a placebo, the physician is engaging in deception, even though the physician’s intent is to benefit the patient in some way.
And from the patient’s belief that he or she has been given a bona fide, effective medication or treatment, flows some kind of benefit, by some mysterious process that has been called the placebo effect.
That, at least, is one way of defining the placebo effect, as a deception by the physician and unwitting acceptance of that deception by the patient. But there is another way of describing the placebo effect. Some workers in the field now believe that patients derive a benefit from the experience of being treated in a therapeutic setting, whether or not the specific treatment has a clinical benefit. No deception is intended by the clinician, and no acceptance of deception needs to take place on the patient’s part. We’ll discuss that version of the placebo effect later on.
A warning to citizens of Gumshoeland who hope that despite Doc Gumshoe’s repeated disclaimers that he does not recommend stocks, nonetheless there will be a tiny hint of a pharmaceutical or other company that might somehow cash in by cashing in on the placebo effect. Be it known that there will be no hints, veiled or otherwise. This is not to say that at some point a way to make serious money legitimately from the placebo effect will not be found, and when (and if!) such a way is found, Doc Gumshoe hopes that he will be able to spot it and let you all in on it.
So why should you be interested in the placebo effect? Two reasons. One, because it is difficult if not impossible to assess the efficacy of any treatment or intervention without understanding the placebo effect. And, two, because at some point in our lives, it’s almost certain to affect us personally, and it’s kind of nice to know what’s going on, right?
A bit of background: what put Doc Gumshoe on this topic?
From the first moment that I began to put my toes in the swirling waters of medical writing, I was aware of placebos and the placebo effect. And it has become increasingly clear that the two terms have somewhat different meanings. That is, the placebo effect, as it is discussed in clinical studies of drugs and various types of interventions, is not always caused by the kinds of substances that were traditionally used as placebos. There’s a lot of confusion out there.
It is certainly the case that physicians have, whether knowingly or not, prescribed a lot of placebos. It used to be fairly common that doctors gave some patients “sugar pills” (whether they were really sugar pills or not, they were meant to have no clinical activity). These might be patients whom the doctors suspected of being hypochondriacs – malades imaginaires – or patients who had vague symptoms and felt generally lousy, but for whom doctors had no specific treatment at hand. So the treatment consisted of a bit of soothing talk and a pill of some kind, in the hopes that the patient would indeed feel better. And, lo and behold, a good deal of the time the patient did feel better. In many cases, this was because the malady resolved spontaneously. But sometimes, it was thought that when patients thought they had received a bona fide treatment, they actually responded with a real improvement in their symptoms.
And it is also the case that there were, “in the old days,” a lot of remedies that didn’t really have any clinical efficacy, but definitely had an effect on patients’ mood. Geritol was a hugely popular tonic back in the mid-20th century. It was marketed to the elderly, and it was supposed to combat feelings of fatigue. It actually did have some active ingredients – iron, and Vitamin B, and as such might have delivered some benefit to people with anemia (although iron supplements also lead to a condition called hemochromatosis, which can be dangerous). But the ingredient in Geritol that made patients feel good was alcohol. Geritol was about 12% alcohol, about the same as a robust cabernet sauvignon.
Another such “health tonic” was Peruna, a sweet gingery-tasting concoction, which was about 18% alcohol. Were Geritol and Peruna placebos? I would contend that they were. Some people might have been taking these (and other) concoctions for the alcoholic content alone, but many genuinely took them as tonics, to perk themselves up and feel better. And lots of people swore by them, convinced that there was something in them that helped with whatever symptoms they were experiencing.
And then there’s the case of my mother, in whom a drug that I think was intended as a placebo did not work. She was then in her late 80s, and she began to experience severe pains in her lower back. So she went to her regular physician, and came away with a prescription. After more than a week, she told me that she was feeling no better. I asked her what she was taking, and she told me it was Elavil. Elavil is amitriptyline, a very common antidepressant. When I explained to her what she h