The Placebo Effect - An Overview
‘I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.’ Hippocratic Oath (1)
There is a large and burgeoning literature on the phenomenon of the ‘placebo effect’, that is, the tendency of people experiencing illness to improve through an engagement with a medically inactive remedy, ranging from sham surgery to administration of an inert injection or oral medication.
Most recently this literature is inspired by the increasing use of antidepressant medications in the treatment of major depressive disorders (MDD’s), where ‘fewer than half of the depressed patients who receive active medications in psychiatric trials show clinically significant improvement’ and where placebo medication has been shown to be effective in up to 70% of cases. (2)
Apart from MDD’s, people taking placebos often report reduction in pain, healed ulcers, eased nausea and even disappearing warts. The literature rarely denounces the existence of a placebo effect; disagreement and controversy arises most often in understanding how it comes about, and more importantly, how it might be used.
It can be argued that the foundation of modern western medicine resides in the distinction between ‘mind’ and ‘body’, the former understood as a philosophical construction which places it outside the realm of medical practice (unless seen, in the psychiatric model, as a function of the brain and nervous system), the latter as a kind of sophisticated machine. This machine can ultimately be understood analytically, through an understanding of its functional components and their complex interactions.
The placebo effect disrupts this assumption of a mind-body boundary, especially where conventional medicine relates it dismissively to complementary and alternative medicines (CAM’s): ‘You may think that such-and-such was effective, but it was only a placebo effect.’ This misses the point. To dismiss, say, homeopathy as ‘merely a placebo’ is not to dismiss it at all, since there is a tacit recognition that there is in fact a placebo effect, that in a greater or lesser degree, the thing actually works.
The fact that it works outside the reductionist and analytical paradigm is the real issue. Put this way, it is not an argument about therapies, but an argument about prestige and power, played out socially, culturally, politically and economically.
(1) Hippocratic Oath
(2) Richard Entsuah, Phil Vinall, Potential Predictors of Placebo Response: Lessons From a Large Database. Drug Information Journal. Ambler: 2007. Vol. 41, Iss. 3; pg. 315, 16 pgs