THE PLACEBO EFFECT

Placebo, from the Latin, meaning “I shall be pleasing, acceptable” is defined in Webster as a substance having no pharmacological effect but given to placate a patient who supposes it to be a medicine”. It is also defined as “a pharmacologically inactive substance or a sham procedure administered as a control in testing the effect of a drug or course of action”. An unusual use of the word is “the vespers for the office of the dead”. The placebo effect is defined in Webster as “a reaction to a placebo manifested by a lessening of the symptoms, or the production of anticipated side effects.
The use of a placebo in medicine implies the use of doctor/patient fraud and it is not surprising that the ethics have been questioned. The point of this presentation is to discuss what, if anything, is known about its mechanism. It is clear that if we knew this and how to turn it on in the mind/body relationship of sick people, it would automatically disqualify a huge section of modern medicine. I have so often been told that an unusual observation of improved wellbeing in a patient is “only a placebo effect” as though the observation is itself fraudulent. Yes, we dismiss its potential importance out of hand without thinking about how it works.
A six million dollar study involved comparison of the effects of a pharmaceutical drug used for treatment of depression with that of St John’s Wort, also used for depression. The study was “controlled” by using a third arm with a placebo. The results must have been mystifying to the investigators. The drug and the herbal remedy were about even but the placebo did better than both of them.
This must indeed remind us that the personal approach of a physician to a patient may make a huge difference to the outcome of the illness. There is an opposite effect of a placebo (a nocebo) that can actually do harm, purely by suggestion, as in producing anticipated side effects, or perhaps even hasten death. Thus, when a physician says to his patient,” I am sorry to tell you that you have cancer” it may be by itself a deterrent to recovery, since many people believe that cancer is inevitably fatal. Although this has long been known as “bedside manner”, I am aware that modern scientific medicine too often neglects this vitally important function of a physician, or any person that works in the health field.
The mechanism is still unknown but it is to the credit of Professor Ingvar at the Karolinska Institute that it is being studied. It has long seemed to me to be related to how hypnosis works, since that can have far reaching physical and mental effects. There is an apocryphal story of a young native in Africa who crossed the witch doctor who cursed him while shaking a “magic” bone in front of him. The young man began to lose weight and move toward death. A Western clinic in the vicinity tried to cure him, but failed. The witch doctor was then asked if he would remove the curse. He agreed “for a consideration” and he shook the same bone in the face of his victim, announcing his removal of the curse. The young man promptly recovered.
Mary Baker Eddy was paralysed in her youth. Her father had to carry her everywhere. She sought treatment from Mesmer who was treating people with magnets and she recovered. Later on she relapsed and began reading the New Testament, whereupon she recovered again. She concluded that her recovery was in the hands of Jesus and founded the Church of Christian Science. The cathedral in Boston represents a remarkable success story.
All of this must make us think seriously about the action of the brain/body in maintaining health and the induction of disease. It has seemed to me that the only thing that really matters for the “placebo effect” is the complete and indelible faith of a sick patient in a process that promises cure. A “faith healer” only requires the faith of his patient and he must inject his infallibility through his own belief in his “special” power. It is of considerable interest that Christ said to his patients “Go, thy faith hath made thee whole”.
I was once a pediatric oncologist, a physician that treats cancer. I had a child with a Wilms tumor of the kidney, one of the highly malignant cancers in children. It had metastasized to the abdominal cavity and she was in the state of cachexia that was the herald of death. I told the mother that I had nothing that could possibly touch her severe state. Her answer was simply “If God will not work through you I will find someone who will”. She took the child to Oral Roberts who “laid on his hands”. The tumors vanished and she became healthy again. I had an annual letter from the family doctor for several years, telling me of her complete recovery.
A 6-year old child had a malignant tumor in his cheek that was completely resistant to all available treatment. His father asked if he could bring a faith healer into the hospital and I agreed. His family, unknown to me, were also seeking treatment in Detroit. One day when leaving Cleveland, the car hit a guard-rail and rolled down an incline killing everyone but my patient. He was adopted by an aunt who gave him a lot of TLC. A short time later the child walked into the room to show his aunt something in his hand. He told her that he had found it in his mouth. She had the presence of mind to take it to a pathologist who reported that it was indeed the tumor and that it was necrotic, meaning that the cells were all dead. A miracle is a remarkable event for which we have no explanation. As soon as a mechanism is found for the event, it ceases to be a miracle. We would all benefit from a discovery of the mechanism of this much scorned placebo effect!
The effect cannot be forced on anyone; it must come from the brain of the person in whom it operates. Religion, if used properly in inducing a faith in God, is the ideal method of acquiring a mechanism that transcends self. To me, it seems that any ritual that might be loosely called religiosity, is quite useless unless it has true meaning for an individual practicing it. As a physician, I am only too well aware that my “success” in helping a patient might be attributed to the patient. The only thing that I do is to apply nutrients to recruit cellular energy so that healing can begin within the brain/body. But the body is merely a chassis that carries the brain and the healing process must be guided by that complex organ. Perhaps “energy medicine” has discovered at least part of the mechanism that turns on the placebo effect. Its safety and relative cheapness will eventually make the public force it to become mainstream.