What is now emerging as ‘placebo science’ has its roots in an influential 1955 paper entitled ‘The Powerful Placebo’ by Henry K. Beecher which proposed that placebo effects were clinically important. This remains the most commonly-cited placebo reference.
Henry Knowles Beecher (February 4, 1904 – July 25, 1976) was a pioneering American anesthesiologist, medical ethicist, and investigator of the placebo effect at Harvard Medical School, which now, fittingly enough, co-convenes the Program in Placebo Studies & Therapeutic Encounter (PiPS) with the Beth Israel Deaconess Medical Center.
The prestigious Beecher Prize, named in his honor, is awarded annually by Harvard Medical School to a medical student who has produced exceptional work in the field of medical ethics.
Like the word dirge, placebo has its origin in the Office of the Dead, the cycle of prayers traditionally sung or recited for the repose of the souls of the dead. The traditional liturgical language of the Roman Catholic Church is Latin, and in Latin, the first word of the first antiphon of the vespers service is placebo, “I shall please.” This word is taken from a phrase in the psalm text that is recited after the antiphon, placebo Domino in regione vivorum, ”I shall please the Lord in the land of the living.” The vespers service of the Office of the Dead came to be called placebo in Middle English, and the expression ‘sing placebo’ came to mean “to flatter, be obsequious.” … Placebo eventually came to mean “flatterer” and “sycophant.”
The term entered medical history in the late 18th century, with a few British doctors that can claim to be the originator. For one, there is Alex Sutherland (born before 1730 – died after 1773) a doctor living and practicing in Bath, Summerset, who used the term to describe certain types of doctors keen to prescribe fashionable medicines such as waters with healing power, which he called “placebo” (doctors) in a popular book published in 1763. About the same time, William Cullen (1710 – 1790) from Edinburgh, Scotland, used it for the first time in a textbook, his Clinical Lectures: He gave a patient mustard powder as a remedy noting “… that I did not trust much to it, but I gave it because it is necessary to give a medicine, and as what I call a placebo,” summarizing today’s entire discussion in a single sentence: Placebos are to please the patient and improve symptoms because of that – what we call the placebo effect. And the third gentleman is John Coakley Lettsom (1744-1815), a doctor from London who resumed a similar position to Cullen; they used placebos of ineffective doses of what were popular medicines of their time.
More on this fascinating history, including the inclusion of placebo in the earliest forms of homeopathic practice, here.
Pain is something of a mystery. While we all experience it, and experience it in degrees, there’s no ‘gold standard’ for estimating the degree of pain. It seems to be a ‘subjective’ experience. In some of the research literature, such as this study, the placebo effect is given a credible place in the landscape of pain and pain management.
“Placebo effects that arise from patients’ positive expectancies and the underlying endogenous modulatory mechanisms may in part account for the variability in pain experience and severity, adherence to treatment, distinct coping strategies, and chronicity. Expectancy-induced analgesia and placebo effects in general have emerged as useful models to assess individual endogenous pain modulatory systems.”
Meantime, in the category of ‘Out There But Maybe Not As Out There As You Might Think’ virtual reality may have the capacity to harness the placebo effect in pain management.
“Recently, Cedars-Sinai also published research on the clinical utility of a virtual reality intervention in the Inpatient setting. The results of the study were overwhelmingly positive with most patients receiving pain and stress relief from the VR experience.”
You know that something’s popular when it pops up in the Reader’s Digest. This article comments on the “growing scientific interest in the placebo effect”, and notes:
Because placebos are believed to work only on condition of expectation of positive relief, they were considered to be good only for psychosomatic ailments and not real physical ailments.
But this does not seem to be borne out by recent studies, nor by years of experience of many people around the world. Placebos have been shown to result in the real cure of physical ailments such as a broken heel or torn ligament, not only psychological ones.
Researchers at the University of Colorado-Boulder studied 40 recently jilted volunteers and found they displayed less physical pain and felt better emotionally — even after receiving a fake drug.
“Breaking up with a partner is one of the most emotionally negative experiences a person can have, and it can be an important trigger for developing psychological problems,” said the study’s lead author, Dr. Leonie Koban.
“In our study, we found a placebo can have quite strong effects on reducing the intensity of social pain,” she said.
‘Cognitive enhancers’? Oh, do us a favour. Highly hyped and highly price energy drinks like Red Bull are all about the sugar and the caffeine, that’s all. Lots of sugar and caffeine. So why pay the premium, the enormous mark-up? It’s marketing, probably one of the shiniest examples of the placebo effect in marketing. Some science on this over here.
‘VR Placebo interventions’ …! We do indeed live in a time of wonders. Research is being undertaken into the value of the emerging Virtual Reality technologies in treatment of mental illness. It’s early days, but the results so far are promising. Read more here.
‘There is now evidence showing some people, known as “placebo responders”, do feel or get better after unwittingly, or even wittingly, taking a placebo – and it’s not just psychosomatic. Several studies are pointing to a biological basis for the placebo effect, with the latest research focused on a region of the brain known as the mid-frontal gyrus, which runs along the frontal lobes just above the eyes.’