Placebo, a historical perspective
Introduction
The term placebo defines a therapy which is used for its non-specific psycho-physiological or presumed effect, but is without actual effect on the condition being treated. Placebo response is the difference between the non-specific beneficial response and that attributed to the natural history. Placebo effect is the (beneficial) effect which is derived from the context of the encounter – the rituals, the settings, and the clinician/healer-patient relationship – which is common to all treatments, as distinguished from therapeutic benefits, produced by the specific or characteristic pharmacological or physiological effects of an active compound or intervention. The first mention of “placebo” is in St. Jerome's mistranslation of the first word of the ninth line of Psalm 116. The Hebrew for “I will walk before the Lord”, was translated by him into “Placebo Domino in regione vivorum” (“I shall please the Lord in the land of the living”) (Jacobs, 2000). Pleasing has a central meaning to the notion of placebo: placebo is associated with the pleasing of the patient by the therapist, of the therapist by the patient, or both.
Since very few treatments with recognized and consistent beneficial effects have existed until the beginning of the 20th century, the history of medicine is the history of placebo. Effective placebo remedies have been ubiquitous in all societies and cultures, from the ancient Egypt (Shapiro and Shapiro, 1997) to today's multi-billion-dollar alternative medicine (Singh and Ernst, 2008). From crocodile dung poultices, practiced by ancient Egyptians, to acupuncture, practiced today at the top medical centers all over the world, the placebo effect continues to be a trusted ally to the practicing clinician and an unavoidable hindrance to the clinical investigator.
Section snippets
Ancient times (B.C.)
Dating back to 2100 B.C, In Babylonia and Assyria, we find that the modus operandus of the sorcerer (ashipu) and the physician (asu) was based on providing patients with empathy and comfort along with the “specific” remedy, thus taking full advantage of the placebo effect (Shapiro and Shapiro, 1997). The Egyptians were pioneers in writing medical texts, using medical terminology, exploring anatomy, and keeping records of procedures such as applying splints and bandages (Estes, 1989, Majno, 1975
The first eighteen centuries
Galen's Pharmacopeia, with its 820 remedies, has dominated treatment for 1500 years and disappeared only in the 19th century, under pressure from the emerging scientific approach to medicine. Galen's Pharmacopeia included any substance and mixture made of plants, bacteria, worms, reptiles, fish, human organs, tissue, bones powder, excretion, or extract in any phase, with or without the involvement of force majeure, magic, witchcraft, or any other intentional or unintentional action. Faulty
The 19th century—a few steps closer to modern medicine
Enter the 19th century and the medical dictionary. Robert Hooper in Quincy's Lexicon-Medicum, defined placebo as “an epithet given to any medicine adapted more to please than benefit the patient” (Hooper, 1811). The century was marked by several scientific developments, beginning with the study of pathological anatomy and of physiology, and the birth of modern pharmacology (Modell, 1976).
Despite these scientific advances, in 1858, in a grotto near by Lourdes, France, a 14-year-old peasant girl
The 20th century—placebo and medicine as we know it
Surgery on the battlefields of WWII provided the anesthesiologist Henry Beecher with the opportunity to observe that when the supply of morphine has run out, plain saline solution might be an effective substitute to control pain. He summarized his observations on the placebo effect in a series of articles published in the 50s and 60s, claiming that up to 40% of the therapeutic effect of any intervention is due to the placebo effect (Beecher, 1955, Beecher, 1961, Lasagna et al., 1954). He
Placebo-good or bad? real or fake?
Since the 14th century, placebo has been associated with fakery, as demonstrated in the Latin prayers for the dead. Singers of placebo are paid mourners, or mourners falsely claiming a relation to the deceased in the hope of getting a share of the funeral meal (Aronson, 1999). In the Canterbury Tales, the sycophantic servant is called Placebo (Shapiro, 1968). It was Voltaire who pointed out how physicians employing the placebo effect took credit for the healings, which were the outcome of the
Role of the funding source
The Joseph Sagol Neuroscience Center at Sheba Medical Center Israel.
Contributors
None.
Conflict of interest
Authors report no financial interests or conflicts of interests in this research.
Acknowledgment
Safra Nimrod for the language editing.
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