Placebo in history

Placebo in history is the account of the changing understanding of the phenomena of the placebo effect and term "placebo".

The word was first used in a medicinal context in the late 18th century to describe a "commonplace method or medicine" and in 1811 it was defined as "any medicine adapted more to please than to benefit the patient". Although this definition contained a derogatory implication[1] it did not necessarily imply that the remedy had no effect.[2]

Etymology

The word placebo itself originated from the Latin for I shall please.[3] It is in Latin text in the Bible (Psalm 116:9, Vulgate version by Jerome, “Placebo Domino in regione vivorum”, “I shall please the Lord in the land of the living”). Jerome translated as "I shall please" (placebo), the Hebrew word "ethalech", "I shall walk with" as in "I shall be in step with".

In Chaucer's Canterbury Tales, Placebo is the name of the sycophantic brother of January in The Merchant's tale.

This word gave its name, placebo, to the Office of the Dead church service. From that, a singer of placebo became associated with someone who falsely claimed a connection to the deceased to get a share of the funeral meal, and hence a flatterer, and so a deceptive act to please.[1]

Early medical usage

Doctors and surgeons such as Ambroise Paré traditionally emphasized the importance of consoling the patient through the use of 'placebos'. This is the title page to one of Paré's works.

In the practice of medicine it had been long understood that, as Ambroise Paré (1510–1590) had expressed it, the physician’s duty was to "cure occasionally, relieve often, console always" ("Guérir quelquefois, soulager souvent, consoler toujours"). Accordingly, placebos were widespread in medicine until the 20th century, and were often endorsed as necessary deceptions.[4]

According to Nicholas Jewson, eighteenth century English medicine was gradually moving away from a model in which the patient had considerable interaction with the physician – and, through this consultative relationship, had an equal influence on the physician’s therapeutic approach. It was moving towards a paradigm in which the patient became the recipient of a more standardized form of intervention that was determined by the prevailing opinions of the medical profession of the day.[5]

Jewson characterized this as parallel to the changes that were taking place in the manner in which medical knowledge was being produced; namely, a transition from "bedside medicine", through to "hospital medicine", and finally to "laboratory medicine".[6]

The last vestiges of the "consoling" approach to treatment were the prescription of morale-boosting and pleasing remedies, such as the "sugar pill", electuary or pharmaceutical syrup; all of which had no known pharmacodynamic action, even at the time. Those doctors who provided their patients with these sorts of morale-boosting therapies (which, whilst having no pharmacologically active ingredients, provided reassurance and comfort) did so either to reassure their patients whilst the Vis medicatrix naturae (i.e., "the healing power of nature") performed its normalizing task of restoring them to health, or to gratify their patients’ need for an active treatment.

In 1811, Hooper’s Quincy’s Lexicon–Medicum defined placebo as "an epithet given to any medicine adapted more to please than benefit the patient". In 1903 Richard Cabot said that he was brought up to use placebos,[4] but he ultimately concluded by saying that "I have not yet found any case in which a lie does not do more harm than good".[7]

Placebo effect

Metallic Tractors. Caricature of a quack treating a patient with Perkins Patent Tractors by James Gillray, 1801.

The first to recognize and demonstrate the placebo effect was English physician John Haygarth in 1799.[8] He tested a popular medical treatment of his time, called "Perkins tractors", which were metal pointers supposedly able to 'draw out' disease. They were sold at the extremely high price of five guineas, and Haygarth set out to show that the high cost was unnecessary. He did this by comparing the results from dummy wooden tractors with a set of allegedly "active" metal tractors, and published his findings in a book “On the Imagination as a Cause & as a Cure of Disorders of the Body.”[9]

The wooden pointers were just as useful as the expensive metal ones, showing "to a degree which has never been suspected, what powerful influence upon diseases is produced by mere imagination".[10] While the word placebo had been used since 1772, this is the first real demonstration of the placebo effect.

John Haygarth was the first to demonstrate the placebo effect in 1799.

In modern times the first to define and discuss the "placebo effect" was T.C Graves, in a published paper in The Lancet in 1920.[11] He spoke of "the placebo effects of drugs" being manifested in those cases where "a real psychotherapeutic effect appears to have been produced".[12]

At the Royal London Hospital in 1933, William Evans and Clifford Hoyle experimented with 90 subjects and published studies which compared the outcomes from the administration of an active drug and a dummy simulator ("placebo") in the same trial. The experiment displayed no significant difference between drug treatment and placebo treatment, leading the researchers to conclude that the drug exerted no specific effects in relation to the conditions being treated. [13] A similar experiment was carried out by Harry Gold, Nathaniel Kwit and Harold Otto in 1937, with the use of 700 subjects.[14]

In 1946, the Yale biostatistician and physiologist E. Morton Jellinek described the "placebo reaction" or "response". He probably used the terms "placebo response" and "placebo reaction" as interchangeable.[15] Henry K. Beecher's 1955 paper The Powerful Placebo was the first to use the term "placebo effect", which he contrasts with drug effects. [16] In 1961, Beecher found[17] that patients of 'enthusiastic' surgeons experienced greater levels of chest pain relief than those receiving treatment from skeptic surgeons.[7]

In 1961 Walter Kennedy introduced the word nocebo to refer to a neutral substance that creates harmful effects in a patient who takes it.[4][18]

The word obecalp, "placebo" spelled backwards, was coined by an Australian doctor in 1998 when he recognised the need for a freely available placebo.[19] The word is sometimes used to make the use or prescription of fake medicine less obvious to the patient.[20]

It has been suggested that a distinction exists between the placebo effect (which applies to a group) and the placebo response (which is individual).[21]

Quotations

Some statements about the role of placebos in doctor patient relationship are:

References

  1. 1 2 3 4 Shapiro AK (1968). "Semantics of the placebo". Psychiatr Q 42 (4): 653–95. doi:10.1007/BF01564309. PMID 4891851.
  2. Kaptchuk TJ (June 1998). "Powerful placebo: the dark side of the randomised controlled trial". Lancet 351 (9117): 1722–5. doi:10.1016/S0140-6736(97)10111-8. PMID 9734904.
  3. Jacobs B (April 2000). "Biblical origins of placebo". J R Soc Med 93 (4): 213–4. PMC 1297986. PMID 10844895.
  4. 1 2 3 de Craen AJ, Kaptchuk TJ, Tijssen JG, Kleijnen J (October 1999). "Placebos and placebo effects in medicine: historical overview". J R Soc Med 92 (10): 511–5. PMC 1297390. PMID 10692902.
  5. Nicholas Jewson (1974). "Medical Knowledge and the Patronage System in 18th Century England". Sage journals. Retrieved January 2014.
  6. Nicholas Jewson (1976). "The Disappearance of the Sick-Man from Medical Cosmology, 1770–1870". Sage journals: 227. Retrieved January 2014.
  7. 1 2 David H. Newman. Hippocrates' Shadow. Scribner (2008). pp. 134–159. ISBN 1-4165-5153-0.
  8. Booth, C. (2005). "The rod of Aesculapios: John Haygarth (1740-1827) and Perkins' metallic tractors". Journal of medical biography 13 (3): 155–161. doi:10.1258/j.jmb.2005.04-01. PMID 16059528.
  9. Haygarth, J., Of the Imagination, as a Cause and as a Cure of Disorders of the Body; Exemplified by Fictitious Tractors, and Epidemical Convulsions , Crutwell, (Bath), 1800.
  10. Wootton, David. Bad medicine: Doctors doing harm since Hippocrates. Oxford University Press, 2006.
  11. T. C. Graves (1920). "Commentary on a case of Hystero-epilepsy with delayed puberty". The Lancet 196: 1135. doi:10.1016/s0140-6736(01)00108-8. Retrieved January 2, 2014.
  12. Michael D. Yapko (2012). Trancework: An Introduction to the Practice of Clinical Hypnosis. Routledge. p. 123.
  13. Evans W, Hoyle C (1933). "The comparative value of drugs used in the continuous treatment of angina pectoris". Quarterly Journal of Medicine. Retrieved January 2, 2014.
  14. Gold H, Kwit NT, Otto H (1937). "The Xanthines (Theobromine and Aminophyllin) in the treatment of cardiac pain". Journal of the American Medical Association 108: 2173. doi:10.1001/jama.1937.02780260001001. Retrieved January 2, 2014.
  15. Jellinek, E. M. "Clinical Tests on Comparative Effectiveness of Analgesic Drugs", Biometrics Bulletin, Vol.2, No.5, (October 1946), pp. 87–91.
  16. Henry K. Beecher (1955). "THE POWERFUL PLACEBO". Journal of the American Medical Association 159: 1602–6. doi:10.1001/jama.1955.02960340022006. PMID 13271123. Retrieved January 2, 2014.
  17. Beecher HK (July 1961). "Surgery as placebo. A quantitative study of bias". JAMA 176 (13): 1102–7. doi:10.1001/jama.1961.63040260007008. PMID 13688614.
  18. Kennedy, W P., "The Nocebo Reaction", Medical World, Vol.95, (September 1961), pp. 203–5.
  19. Axtens, Michael (1998-08-08). "Letters to editor: Mind Games". New Scientist.
  20. E.g. see Gulf War Veteran Gets Placebos Instead Of Real Medicine or BehindTheMedspeak: Obecalp.
  21. Hoffman GA, Harrington A, Fields HL (2005). "Pain and the placebo: what we have learned". Perspect. Biol. Med. 48 (2): 248–65. doi:10.1353/pbm.2005.0054. PMID 15834197.
  22. Cochrane, Archie: Effectiveness and Efficiency: Random Reflections on Health Services. The Nuffield Provincial Hospitals Trust 1972, (1972) p. 31.

See also

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