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Little Pink Pills: A History of Placebos
Item Type text; Electronic Thesis
Authors Wagstaff, Jessica
Publisher The University of Arizona.
Rights Copyright © is held by the author. Digital access to this materialis made possible by the University Libraries, University of Arizona.Further transmission, reproduction or presentation (such aspublic display or performance) of protected items is prohibitedexcept with permission of the author.
Download date 18/05/2018 09:26:58
Link to Item http://hdl.handle.net/10150/244843
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LITTLE PINK PILLS: A HISTORY OF PLACEBOS
By
JESSICA WAGSTAFF
A Thesis Submitted to The Honors College
In Partial Fulfillment of the Bachelors Degree With Honors in
Physiology
THE UNIVERSITY OF ARIZONA
MAY 2012
~~1 V
Dr. Zoe Cohen Department of Physiology
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Last updated: Nov 15, 2009
Abstract
Why is it that folk remedies have endured the test of time? This review of the placebo effect
begins with definitions of placebo and placebo effect. It delves into the history of the placebo
and the placebo effects, from Cro-Magnon times up through current advances in medicine.
Placebos were present in Ancient Rome and Greece, the Bible, Renaissance Europe. Many
difference substances were used as placebos, including boiled dung, lizard blood, mold and
unicorn hom. Current studies on depression and Parkinson's disease have shown the powerful
responses placebos can produce. Future research is need to unveil the mechanisms and mediators
involved in the placebo effect.
According to Plato, Socrates once said, "[The cure for the headache] was a kind of leaf,
which required to be accompanied by a charm, and if a person would repeat the charm at
the same time that he used the cure, he would be made whole; but that without the charm
the leaf would be of no avail" (Moerman and Wayne, 471).
Socrates was referring to the idea of the placebo effect. The "charm" was most likely a
prayer or a chant, which was thought to "activate" the leaf s healing power. However, does it
exist physiologically? This has been an age-old question regarding the placebo effect.
Observations, studies, and clinical trials tell us yes, the placebo effect does exist. The next
question is, why and how does the placebo effect exist? First, we need to define some terms.
Merriam-Webster dictionary defines placebo as "a usually pharmacologically inert preparation
prescribed more for the mental relief of the patient than for its actual effect on a disorder"
("placebo"). A placebo does not have to be a drug, it can also be surgery or psychotherapy. It can
be inert or active. An active placebo may be an ineffective substance or a substance given at an
insufficient dose. An inert placebo contains no active ingredients, and is often termed a "sugar
pill". A placebo effect, then, can be defined as a response to a placebo, "the nonspecific
psychological or psychophysiological therapeutic effect" (Shapiro and Shapiro, 1-2). There can
be different kinds of placebo effects, positive responses, negative responses or no responses. A
negative effect from a placebo is referred to as a "nocebo" (Moerman, 14). Placebos and placebo
effects have been around for centuries. This paper will delve into the history of the placebo
effect, as well as discuss its significance today and possible research opportunities in the future.
The word "placebo" is a Latin word that translates to "I will please". The word was first
seen in the Hebrew Bible as the word ethaJekh, which was later translated to Latin. In the
thirteenth century, the word placebo appeared in the King James version of the bible, in the
sentence "Placebo Domino in regione vivorum," which means, "I will please the Lord in the land
of the living" In the fourteenth century, the meaning of placebo became secular and took on a
derisive meaning. Placebo was used to describe one who was servile or flattered in order to gain
favors. The word was also understood to mean parasite or "one who servilely echoes another, a
toady." The medical definition of a placebo did not come about until 1803. In Fox's New
Medical Dictionary, a placebo was "an epithet given to any medicine adopted more to please
than to benefit the patient" (Shapiro and Shapiro, 28-29). The idea of the placebo appeared much
earlier in history though.
It is believed by some that the first placebo effect occurred during the Cro-Magnon era,
which dates to approximately 40,000 s.c. Skulls with holes are thought to be the first evidence
of brain surgery, more specifically psychosurgery to relieve mental illness symptoms. This
technique is called trepanning and it involved drilling a 2.5 to 5 cm diameter hole into the skulL
The patients were alive and awake because there was no anesthesia, and the procedure was 30 to
60 minutes in length. Evidence of trepanning has been found in all parts of the world, in Egypt,
Greece, Rome, the Middle East, China, Brazil and North America. There are several theories that
may explain the reason for trepanning. One thOUght is that the surgery was done to free "bad
spirits" from the body, another was that it used to cure diseases, which are now thought to have
been epilepsy and blindness. Trepanning was used up until the 18th century, when it was used as
a technique for bloodletting, which rid of body of "bad fluids" (Sabbatini). It is also thought that
as early as 20,000 s.c., psychological placeboes were used. Most likely, these were some kind
of patient-physician relationships, which played a role in healing because there is no evidence of
substances or medications (Shapiro and Shapiro, 3, Jospe, 1). A Sumerian medical tablet made of
baked clay from 2100 B.C. was found to contain fifteen remedies, which today are viewed as
placebos. Some substances are mentioned, most of which are vegetable based. Wines, lotions,
plasters and fumigations are also mentioned as ways of application of medicine to cure problems
like boils and gastric pains. During Babylonian and Assyrian times, to remedy someone's head
sores, boiled dung was used as well as shaving the person's head until the patient bled (Shapiro
and Shapiro, 3).
The Egyptian Ebers Papyrus from 1500 B.c. is a written document that contains 842
prescriptions and details 700 substances made from different vegetables, animals and minerals,
very few of which had true medicinal value. The Ebers Papyrus discussed how to remedy the
bowels, evacuate the belly, cure a headache and help the bowel movements in a constipated
child. Some of the more serious diseases that plagued the Egyptians were smallpox, dysentery,
typhoid, leprosy, tuberculosis, pneumonia and arthritis (Dollinger). Some medicinal materials
included dirt, lizard blood, hippopotamus fat, grated human skull, pig teeth, donkey hooves,
mold, urine and dung. These ingredients were administered as lotions, pills, capsules, powders,
potions, ointments and suppositories, among other methods. Bloodletting started in Egypt in
1000 B. C. as well. Illness was seen as evil, and bloodletting was thought to get rid of the evil
from the body. This idea may have influenced the Greek idea of humors. There are four basic
humors of the body, blood, phlegm, yellow and black bile, and mucus. Each humor is secreted
by a different organ, and each had its own color, temperature and humidity. Each humor is also
associated with a temperament, and each person had a dominant humor. For example, a sanguine
person is dominated by blood, which is hot and moist. These people were believed to be obese
and full of laughter. A healthy person had all their humors balances, while an unhealthy
individual contained improperly mixed humors. This humor imbalance led to bloodletting, which
was believed to help restore the body's proper ratio of humors. (Shapiro and Shapiro, 4-7).
In Greece, incubation in a temple was believed to rid one's body of disease. Patients first
washed themselves, then lay down in the temple and waited to fall asleep. They were told to
dream of Asclepius, the healing son of Apollo. As they slept, a priest would enter and rub
ointment and herbs on the patient's diseased body parts. In the patient's dream or dream state,
Asclepius's serpent or dog would follow the priest and lick the ointment off the patient and
whisper remedies into the patient's ears. Patients would also be given advice for future
treatments (Shapiro and Shapiro, 6). It is unclear how patients were able to "see" Asclepius, but
one thought is that they were given sleep aids or hallucinogenic substances. One cure on record
was the delivery of a woman who was pregnant for five years (Retief and Cilliers, 841).
According to myth, when her child was born, he was four years old. After leaving the womb, the
child walked over to a fountain and started washing himself off As we know today, it is not
possible for a woman to be pregnant for five years. It is most likely that the woman did have a
long pregnancy, maybe a few weeks longer, and that as time passed, her story was exaggerated.
If the woman's pregnancy was longer than normal, it is possible that her child was more
developed than most newborns of the time, but he certainly would not have been able to walk or
bathe himself (Dillon, 242, 257). The Father of Medicine, Hippocrates, was working in Greece at
the same time people were visiting the Asclepian temples (Shapiro and Shapiro, 7). He believed
that medicine was an art, rather than a science (Jospe, 5). He produced the Hippocratic Corpus,
which was made up of about seventy essays on medicine and detailed over 100 vegetable-based
substances. His observational, common-sense theories were very different from the religious
theories based on temple visits and prayer as forms of treatment. Treatments usually included
fresh air, a good diet and bloodletting (Hippocrates believed in the idea of the four humors).
Medications were often administered as pills, ointments, inhalations and oils (Shapiro and
Shapiro, 7). He believed that diseases came from a natural cause, and he often used plants as
remedies. White hellebore was used as an analgesic, for pain management. Squirting-cucumber
juice was used to treat heart problems, rheumatism, paralysis and shingles. Dauke was used to
soothe the digestive tract and contract the uterus, delaying menstruation. Stinging nettle was
thought to treat anemia, heavy menstrual flow, arthritis, gout, sciatica and hemorrhoids. Mustard
seed was an antibacterial and an antifungal ("Hippocratic Use of Substances"). Modem science
has found that some of these natural remedies do have medicinal effects. According to WebMD,
white hellebore is used to treat cholera, gout, high blood pressure and herpes outbreaks ("White
Hellebore ... ").
The Roman Galen believed in the principle of opposites, "if a substance that causes or is
thought to cause fever, it can be used to treat chills~ if a substance causes emesis, it can be used
to treat constipation" (Shapiro and Shapiro, 11). During Galen's time, he used many different
techniques and medications (placebos). One infamous substance was theriac, which contained
more than thirty ingredients and took six months to produce. Its main ingredient was viper flesh,
and it usually contained opium. It was first produced as an antidote to poisons because it was
thought to draw poisons out of the body. As time passed though, theriac was used "as a remedy
for' almost every human ailment--chronic headache, hardness of hearing, dimness of sight,
blackout and giddiness, epilepsy, shortness of breath, spitting of blood, indigestion, nausea, liver
trouble, the stone; it strengthens the tongue, soothes delirium, is an excellent soporific, calms the
worries and stresses of the mind, is the only cure for tetanus'" (Shapiro and Shapiro, 12). The
end of the Galen era came with the popularization of cinchona. Cinchona bark was introduced to
Europe in the seventeenth century by Spanish Jesuits who brought it back from Peru. It was an
actual drug (it contains quinine, which is still used today to treat malaria) and was used to treat
malaria. It was first used as a treatment for any type of fever, but was later discovered to treat
only fevers caused by malaria. "Cinchona can be considered the first drug that was not a placebo
because it was specific for the treatment of malarial fevers and not useful for other fevers"
(Shapiro and Shapiro, 21).
Ideas of medicine varied in different parts of the world, but they also contained
similarities. In China, like in Greece, they believed in humors. The Chinese were focused on
symmetries and balance. They based everything on the five-element system, with the five
elements being water, fire, earth, metal and wood, and they strongly believed in yin and yang.
The main treatment techniques were acupuncture and moxibustion (burning ground leaves
placed on sticks or acupuncture needles and held close to the body). Uncomplicated diseases
were treated with five tastes, five kinds of grain, five substances and five flavors. Pungent and
sour flavors helped an ill liver, salty flavors were used for a weak heart, and sweet flavors were
used to drain the heart. People with ulcers received acupuncture with flint needles, while people
with internal diseases were treated with acupuncture with "poison medicine". Those exposed to
cold were treated with moxa, those with muscle numbness and tight muscles received fine
needles during acupuncture. Chinese people with chills, fevers or paralysis were massaged and
taught breathing routines. Acupuncture is still a large part of treatment in China today, though
not for the same illnesses. In India, main treatments were for lesions that could be physically
seen. Indian doctors would amputate limbs, repair ear lobes, stop bleeds with hot oil and suture
cuts with ant heads. Treatments also included mantras, dieting, the ability to "pull" one's mind
from bad thoughts, abstinence from sex and enemas (which used to be called clysterizations, and
were a way to remove evil bowl contents) (Shapiro and Shapiro, 9, 13).
Stories of unicorns existed in ancient China and Indi~ the Bible, and in the Western
world. Ground unicorn hom was believed to cure fevers, while hom jelly was thought to restore
strength in ailing people. This mythical creature's hom was also supposed to identify and protect
against poisons in wines and foods. The hom was seen as a cure for "poisons, fevers, bites of
mad dogs and scorpions, worms, fluxes, the plague, the falling sickness, memory loss, and all
other complaints; and was believed to assist the memory, fortify the animal spirits, and prolong
youth" (Shapiro and Shapiro, 14). People believed the hom came from a unicorn, but in reality,
the "hom" was the left, upper incisor tooth from a male narwhal. Unicorn hom was the most
expensive placebo in history, and during the sixteenth century, it sold for ten times its weight in
gold. Even after the true nature of unicorn hom was revealed, people still bought it and used it
(Shapiro and Shapiro, 15). Babylonians, Hebrews, Greeks and Romans used the mandrake as a
sedative, purgative, aphrodisiac and hallucinogenic. It was first referred to as an aphrodisiac in
the Bible. According to legends, the plant had magical characteristics. It looked like a man, and
would scream if pulled from the ground. Hearing the scream of a mandrake was believed to
cause insanity or death, so a loud hom was played to drown out the shrieking while the plant was
being collected. Shakespeare mentioned the mandrake in his plays, and in Romeo and Juliet he
wrote '" And shrieks like mandrakes tom out of the earth! That living mortals hearing them, run
mad'" (Shapiro and Shapiro, 15). Today, people may know of mandrakes from lK. Rowling's
Harry Potter series, in which they are used as a cure for those who are petrified.
"The most powerful element underlying these therapeutic procedures was the placebo
effect, possibly enhanced by the emotionally charged and elaborate ritual" (Shapiro and Shapiro,
6). When people could not explain their suffering or illness, they made up ways to make it go
away. The only reason people could think of to explain pain and suffering was God, that they did
something wrong. Sickness was a punishment. "From humanity's earliest beginnings, the
appearance of disease had an inseparable link with religious feelings and thoughts" (Jospe, 1).
People prayed to the gods for cures, they used magic incantations and they sacrificed to the gods.
Relief from pain and suffering could not happen without divine intervention (Jospe, 2). This idea
can be seen in many different, ancient cultures. One of the oldest, and possibly most well known,
treatments is the laying of the hands. According to the Bible, this was first practiced by Jesus
Christ. His touch was able to heal people, and it is believed that he cured "blindness, dropsy
(edema), leprosy, stroke and insanity" (Shapiro and Shapiro, 17). Christ was also able to perform
exorcisms, to rid people of demons possessing them, by touching them. Many after Christ used
to power of touch, Roman emperor Vespasian, Norse King Olaf, King Clovis of France, King
Edward the Confessor and King Charles II. The royal touch was done by marking a cross on the
patient, and it cured the King's Evil (any disease of the time). King Charles II supposedly healed
the most people with his touch, some 100,000 people. It is believed that to reduce the risk of
failure, patients were screened and carefully selected before they were touched. There is
documentation that the touch seldom worked, and people would return to the king many more
times for treatment. Later some commoners believed they had the healing touch. The most
famous of these was Bridget Bostock who was known as the "healer of Coppenhall". She
touched seven hundred people a day, including those suffering from "hysteria, dyspnea, palsy,
and almost everything else, never accepting remuneration for her ministrations" (Shapiro and
Shapiro, 18).
In the seventeenth century, medicine made huge advances but is still considered
primitive. The act of bloodletting was still practiced. The dean of faculty at the University of
Paris bled his wife from the chest twelve times to cure her fluxion (excess fluid), he bled his son
twenty times for a fever, he bled himself seven times for a cold, he bled one friend thirty-six
times for a fever and he bled another friend sixty-four times for rheumatism. Mistletoe from oak
tree was thought to cure falling sickness (epilepsy), edema, impotence, leprosy and syphilis
(Shapiro and Shapiro, 23-24). The eighteenth century has been described as '''laying the
foundations for modem or scientific medicine'" (Shapiro and Shapiro, 24). The small pox
vaccine was discovered, as was a study showing that citrus fruits prevented scurvy. The 1700s
were not without placebos though. Clysters (enemas) were a popular procedure and the "doctrine
of infarctus" stated that constipation was the cause of most human illnesses. When George
Washington had a cold and a tonsillar abscess, he was bled 2.5 to 2.8 quarts, injected with
calomel (thought to be a purgative), given emetic tartar (also believed to induce vomiting), he
inhaled vinegar water vapors, his extremities were blistered and a plaster mixture of bran and
vinegar was spread on his throat over an existing blister. This treatment would have severely
dehydrated George Washington, and it is believed this is what killed him. With the nineteenth
century came allopathy, homeopathy and eclecticism. Allopathy used selected substances to
produce effects opposite to symptoms of the disease. For example, to treat malaria and
dysentery, purging with colonies were used until the patient collapsed. Homeopathy was based
on the Latin principle of similia similibus curantur ("like curses like"), or the idea that the power
of medicine depended on the likeness between the symptoms produced by the medicine and the
symptoms of the disease. Homeopathy also believed that drug action was effected by dilution,
and the recommended dosage was at the thirtieth potency. Similar to homeopathy was the
principle of signature of drugs, which was based on astrology and stated that "the stars impress
the 'signatures of disease' on drugs, and that the signatures are manifested by the form and color
ofthe plant from which a drug is obtained" (Shapiro and Shapiro, 26). Nutmeg, which resembles
the shape of a brain, was used to treat diseases of the brain. Eclecticism was the idea of adopting
whatever substance was found beneficial, essentially taking any combination of seemingly useful
substances, which usually ended with overtreatment and toxic effects. Towards the end of the
nineteenth century, doctors were skeptical about medical treatment and were very pessimistic
about drug treatment. The "New School of Medicine" was developed at the end of the 1800s and
was characterized as having "frrm faith in a few good well-tried drugs, little or none in the great
mass of medicines still in general use ... It is more concerned that a physician shall know how to
apply a few great medicines which all have use, such as quinine, iron, mercury, iodide of
potassiu~ opium and digitalis, than that he should employ a multiplicity of remedies the action
of which is extremely doubtful" (Shapiro and Shapiro, 27, 24-27).
Throughout the history of medicine, progress shifted from treating spirits and demons to
treating symptoms. The collective, nonspecific "illness" that could affect anyone and everyone
no longer existed. Instead, doctors focused on maladies and specific organs and sites of infection.
Nineteenth century pathologist Virchow said, "'There are no general diseases, only diseases of
organs and cells '" (Jospe, 6). Diagnoses were based on order, and diagnostic categories were
created. Sicknesses were traced back to their origin and were diagnosed based on the category
that best described them. Once this was completed, doctors needed a treatment plan that was
specific to each case (Jospe, 6). "Sickness was not something that attacked the whole person, but
merely an organ, or a few cells" (Jospe, 6). Therapy became more rational and effective. There
were fewer medications for psychological treatments, so inert substances were used instead. The
idea of psychological factors playing a role in illness and disease exploded onto the scene with
the introduction and success of Christian Science, homeopathy, hypnotism and psychotherapy.
Inert substances may have been popular to differentiate a prescriber from a homeopathist. The
idea of an inert placebo came about in the 1890s, but placebos were not medically inert until
years later (Shapiro and Shapiro, 34). Increases in technology allowed for better microscopes,
surgical sophistication, and overall, diagnosis (Jospe, 6). Medical journals began publishing
more controlled trials than uncontrolled trials. Inert placebos were given as the control on single
blind studies. Double-blind studies evolved from inadequate single-blind studies, which allowed
for more control. "The rationale was that the inert placebo, under double-blind conditions, would
provide a control for spontaneous change and psychological and other variables and would
permit clear-cut differentiation between active and inactive treatments" (Shapiro and Shapiro,
34). Double-blind placebo controls played an important role in tuberculosis studies in the 1940s
and poliomyelitis studies in the 1950s. Today, a placebo is "any therapy that is intentionally or
knowingly used for its nonspecific, psychological or psychophysiological, therapeutic effect, or
that is used for a presumed specific therapeutic effect on a patient, symptom, or illness but is
without specific activity for the condition being treated" (Shapiro and Shapiro, 41).
During the nineteenth century, the definition of "placebo" was limited to medicine. In the
first half of the nineteenth century, nondrug treatments were not popular and not often used. This
was reflected in treatments used by quacks, who used drugs. Quacks often exploited legitimate
areas that were developed by scientific medicine, so the nineteenth century was "the great age of
the patented, secret preparation, or nostrum, and the predominant quack activity during that
period was the use of these drugs" (Shapiro and Shapiro, 33). The word "quack" comes from
"quacksalver", which means one who boasts about the virtues of salves and ointments. The term
came about when using mercury became popular in Europe and non-doctors started using it.
These non-doctors were called quacksalvers and they were very unethical. They would
incorporate illegal drugs or alcohols into their "medicines" to develop and sell fake treatments.
Quacks have been around as long as physicians have. Francis Bacon was quoted as saying, '''The
weakness and credulity of men is such that they often prefer a mountebank, or a cunning woma",
to a learned physician ... For in all times, witches, old women, and imposters, have, in the vulgar
opinion stood competition with physicians'" (Shapiro and Shapiro, 43). Health quackery is
dangerous because it relies on "exploitation fear in the patient; the promise of painless treatment
and good results; claims of miraculous scientific breakthrough; the proposal of one cause and
one therapeutic system to end confusion and doubt to make a complexity simple and
comprehendible to the untutored mind" (Shapiro and Shapiro, 44). Quacks are still around today.
Many can be seen trying to sell diet pills or weight loss wraps on television commercials and in
popular magazines.
Religious treatments have been and will be ever prevalent in our society. As mentioned
earlier, during the Middle Ages, the Catholic Church promoted the healing power of Christ.
Early Christians thought that diseases and plagues were punishments from God, for bad
behavior. Laying of the hands and exorcisms are still used today (Shapiro and Shapiro, 45).
Exorcisms had become a "persuasive tool for demonstrating apostolic authority" (Kaptchuk,
Kerr and Zanger, 2); they were miracles. In 1599, in a small French town, King Henri VI wanted
to find out if people were really being possessed by demons and if exorcisms really worked. A
local family claimed their daughter was possessed by the deviL Henri VI sent someone to
perform an exorcism, but not a public exorcism that was common practice, a private ritual. It is
thought that the public aspect of exorcisms lead to coercion and false testimony from patients. In
the private exorcism, the girl was secretly administered real holy water for several days, with no
effects. Then she was given regular, non-holy water from a special flask and she seethed in pain
when the water touched her skin. She was touched with a regular piece of iron in the shape of a
cross (not a true cross), taken out of an adorned case, and she fell over in agony. The priest read
to her in Latin, telling her he was reading from the Holy Scripture when actually, he was reading
from Virgil's Aeneid, and the girl twisted in discomfort (Kaptchuk, Kerr and Zanger, 2).
Benjamin Franklin and Antioine Lavoiser used the first ever placebo-controlled
experiment to disprove the healing practice of mesmerism in 1784. Mesmer was a physician who
developed a curative healing technique after determining that he could obtain results similar to
those of an exorcism, but without using the power of Jesus and the church. During this time,
exorcisms were only successful when done by priests. Mesmer alleged the invention of "animal
magnetism" (called mesmerist), which was a fluid analogous to gravity. Objects were
mesmerized, which gave them the ability to heal those who touched the object. Placebo
controlled experiments were completed by Franklin and Lavoiser using either "bogus"
mesmerized objects, in which patients believed non-mesmerized objects to be mesmerized, or
secretly mesmerized objects, in which patients did not know an object they touched was
mesmerized. The results of the experiment were that <"this agent, this fluid has no existence' and
any effects were due to 'imagination'" (Kaptchuk, Kerr, and Zanger, 1). Franklin referred to
these placebo-controlled trials as "trick trials". Much like exorcisms and laying hands is the idea
of the therapeutic touch.
Therapeutic touch is the belief that the "physical body is surrounded by an aura (energy
not visible to normal vision) and is penetrated and kept alive by a universal energy called prana
(a Sanskrit word meaning vitalforce) that flows through the body and is transformed by chakras
or non-physical vortices" (Aghabati, Mohammadi, and et ai, 376). The term was first used in
1973. The idea is that energy imbalance leads to illness, so one always needs to be in balance.
People give off energy fields by way of wave patterns; rhythmic energy waves are the best for
re-ordering the body's field. Some symptoms that occur when one is imbalanced are energy
blockages, congestion and dysrhythmias. Therapeutic touch is a technique that is learned;
sensitivity to energy is learned. We do not have any technologies that can detect human energy
fields. "One is able to develop this sensitivity through a process called 'centering', the attainment
of a mental state in which the practitioner quiets the mind, detaches from inward and outward
distractions, and focuses full attention and intention on helping the patient" (Aghabati,
Mohammadi, and et aI, 376). Therapeutic touch is believed to relax patients, decrease anxiety
and depression, decrease pain and boost the immune system (Aghabati, Mohammadi, and et ai,
379). The placebo effect is thought to be present in therapeutic touch. It is suggested that because
some people believe in the healing power of the therapeutic touch, they feel better. Therapeutic
touch research is controversial because some studies have shown it is beneficial, while others
have disproved its methods.
Another controversial topic involving the placebo effect is snake handling. Snake
handling in the South-Eastern United States began in Tennessee in 1910. George W. Hensley
observed a man handling a poisonous snake without being bitten and after thinking about what
he saw, he came to the conclusion that the snake handler was acting just as Mark did when
instructed by Jesus before the Ascension. Hensley believed that Mark 16: 18, which stated, "They
shall take up serpents", was a command. From that point onward, Hensley thought in order to be
worthy of life after death, he had to take risks. The risks he took were handling snakes. After this
realization, he caught a rattlesnake in the mountains. His followers believed that "God granted
Hensley a strange power that day to render the reptile harmless. And from that hour, Hensley
was to become a voice crying in the wilderness" (Kimbrough, 40). If one was truly faithful to
God, he/she would not be harmed by a poisonous snake. If someone were bitten, they were not
really faithful. Hensley established a church, which he called the "Church of God" (Kimbrough,
40). People still practice the act of snake handling today. The placebo effect and snake handling
deals more with religion than science, so it's difficult to disprove its effects. A believer can say
they were not bitten because they believe in God and his powers. This belief is difficult to argue
with and disprove using science. Scientists may feel that believers who do not actually touch the
snakes maybe still believe in the powers of the handlers (and ultimately, God) because of the
placebo effect; they believe it to be true, so it is true.
Placebos and the placebo effect have survived thousands of years and have become
especially important today. Placebo responses have been seen in studies of the endocrine system,
the immune system, the respiratory and cardiovascular systems and the brain. In one study,
researchers presented patients with flower allergies with "fake" flowers (artificial flowers with
no pollen), and the patients showed allergic reaction symptoms. Immune placebo responses have
also been present in studies with a paired solution of sodium saccharin and immunosuppressive
drug cyclophosphamide. Mice have been conditioned with this pairing. Then, when patients were
presented with just the sodium saccharin, their immune systems responded as if the
immunosuppressive drug was present. This study was done with patients with lupus
erithematosus and multiple sclerosis. Similar results have been seen in hormonal responses
(Price, 580).
Postoperative patients were given buprenorphine, an analgesic, to mildly reduce lung
ventilation. A placebo was found to mimic this response of decreased ventilation. This placebo
effect can be completely blocked by naloxone, which is an opioid (an inhibitor), indicating that
this response is mediated by endogenous opioids. In experimental ischemic arm pain, an
analgesic placebo decreased heart rate. "Both the placebo analgesic effect and the concomitant
heart rate decrease were reversed by the opioid antagonist naloxone, whereas the P-blocker
propranolol antagonized the placebo heart rate reduction but not placebo analgesia" (Price, 581).
There are two possible mechanisms for this effect. The response is a consequence of the pain
reduction itself, or the placebo-activated endogenous opioids might inhibit the cardiovascular
system directly (Price, 581).
In a recent Parkinson's disease study, patients were given a placebo (inert substance) and
told that the substance was an anti-Parkinsonian drug that would improve motor function.
Patients did respond to the placebo treatment and showed improved motor function. Using
positron emission tomography, endogenous dopamine levels were evaluated. The results showed
that placebo-induced expectation of motor improvements activated dopamine in the striatum of
Parkinson patients. In Parkinson patients who had electrodes implanted deep in their brain for
stimulation, hand movement was found to be faster when patients expected good motor
performance. Depression is another area of recent study. Depressed patients given placebos
showed electrical and metabolic changes in the brain. In patients with unipolar depression,
increase metabolic changes were seen in several different areas of the brain after placebo
treatment. These same areas of the brain were affected by selective serotonin reuptake inhibitor
fluoxetine, suggesting that a possible role of serotonin in antidepressant placebos (Price, 582)
There are other factors that play into the placebo effect, including patient attitude
toward a therapy or drug, doctor attitudes about the treatment, and doctor/patient relationships.
Patients who believe a therapy or drug will work are more likely to have a placebo response.
Patients who trust their doctor's decisions will more likely have a positive placebo effect and
respond to placebo treatment. Physicians who are likable, physically attractive and competent are
associated with favorable placebo results (Shapiro and Shapiro, 22 I -223). The placebo effect is a
real occurrence. Many, many studies completed over time have proven this fact. In the future,
placebo studies will be very important in finding cures for depression, Parkinson's disease and
other illnesses.
"Implicit in the placebo effect is the recognition that patients bring to the healing process
their own attitudes and belief systems, which can be stronger than the specific action of the drug"
(Shapiro and Shapiro, 237). There is still research left to be done. We still don't know about the
mechanisms or mediators that contribute to the placebo effect. "The future challenges for
placebo research encompass neuroscience, clinical practice and social psychology" (Colloca and
Benedetti, 551). There are several techniques that can be used to find relationships between the
brain and the placebo effect, including in vivo receptor binding, recording neurons in awake
patients and using imaging with electrophysiological techniques. New clinical trial designs are
also necessary, to try to find out the mechanisms behind the placebo. "Research in this
area is still in its infancy and many questions remain unresolved ... However, there is compelling
reason to believe that, in light of the rapid advances in placebo research in recent times, the
coming years will be characterized by a real attempt to place the placebo effect in an emerging
science of mind-brain-body interactions. (Colloca and Benedetti, 545).
Appendix
Posted completed for thesis. Presented at the Spring 2012 Physiology Poster Session for
Undergraduates at the University of Arizona.
40,000 B.C. - 1500 B.C.
Placebo effect i ! I!
occurred during CrO-Magnon times. Skulls were trepanned, which involved drilling a 2.5 -5 centimeter diameter hole into the skull. The surgery was
thought to free "bad spirits" from the body. TIlis technique was used until
the 18th cenhlry,
2100 B.C., Sumerian clay tablet containing 1 5 remedies, today viewed
as placebos. TIlese included lotions. wines and plasters. Most of the remedies were vegetable based.
Jessica Wagstaff and Zoe Cohen. Ph.D. Department of Physiology
University of Arizona 1000 B.C. - 300 B.C.
1000 B.C., Blood letting started in Egpyt and may have influenced the idea of Greek humors, Bloodletting
released evil from the body.
100 A.D. - 1700s
100/200s-A~r:5:. 'G~len· believed in the principle of opposites. If a substance
was thought to cause fever. it could be used to treat the chills.
1800s - Future ,
"placebo" appeared in Fox's New A1edjcal[)lctiona~
1900s. Snake handling became 400s B.C.. The word "placebo' first 1200s. "Placebo" appeared in the King I popular in the South-Eastern United
appears in the Hebrew Bible as James version of the bible in the phrase States. It's believed that if one has true etlzalekh "Placebo Domino in regione vivol1lm" , :1 faith, he/she can handle poisonous
TIle theory of humors was started by which translates to "1 will please the snakes without being bitten. the Pythagoreans, and later influenced lord in the land of the living". . 1940s/50s. Double-blind placebo
Hippocrates and Galen. J .: studies played an important role in Chinese medicine was also built on the f Laying of the hands was a very popular Li tuberculosis and poliomyelitis studies.
. theory of humors. % treahn~nt. for many diseas~s. It was first ~,:1 1970s. Therapeutic touc~ was HIppocrates, the Father of Medicine, practiced by Jesus Chnst. Many ~j developed. It's based on the Idea that
1500 B.C., Egyptian Ebers PapYl1ls produced the Hippocratic Corpus, emperors and kings b~lieve~ they had ~ the body has am energy aura that can • . documented 842 prescriptions and which contained 70 essays on the power to heal WIth theIr hands, '. be altered and become imbalanced.
700 substances made from vegetables, medicine I called the royal touch. animals and minerals. '111e documents Future. Research is needed to find the detailed how to cure a headache, how 300s B.C .• Patients slept in a temple 1700s, Clysters were used to treat ,J relationship between the placebo .
to evacuate the belly and how to and w~re told to dream of Asclepius, ,', constipation, which wa.s th~ught to il,j effect and mechanisl~s/mediators in remedy the bowels. the healmg son of Apollo, to heal them. ! cause most human Illnesses. 'I:f the bram .
.... _ ... Priests l1lbbed ointment on patients as 1784 •. Benjamin Franklin and Antioine Double-blind studies will be they slept. LaVOlser used the fIrst ever placebo- important in finding cures for diseases
controlled experiment to disprove the such as Parkinson's disease or ' effects of exorcism. ~, depression.
=
w
~
'"" , .......... v. TIlcrapeutic Touch on Fain and Fatigue of Cancer Patients Fntler&oJng Chemofherapy.' Evidcnt't: -Ba.flt!d (70mp!eIIk.'nlluy IlJld Allcnllffivc Akdk..';'m .. ', 7 3 (:lOOJ3} 37:)-381 , Wch. 27 ,\tar. 2012 . DoIli.H~er , Andre .• Ancient t~l)twi Medicine.' An introduL:ti,w to!he IU:ftOry and culture of Pho.nlOlIK 1«>7,t ~V. , Janltary 2000. Wen. I .\'ov :,w i l <http.f!ww"w.n:sha.fim.orgjljKdiC'·gyplftimdincs!topit.:~jmcdicinc .h lm> _. Kltptchuk Too J. Cuthcrlne [Kerr , and Abhy i'..angcr 'rhu;coo Conl rois. [xord.snu alkl the. Devil: LsJKW 3 7·t~)(';97 (.l009). l - ~ \Veh. 2 1 Feb. 20 12. . Price. Donald P . el " L . A Compreht!nsi"c Review of the r~oo rlfoct. Recent .'\d\'tln1..'cs lUid CUJTC nt nlOIl~ht: AmllltU Rel'1f:w of PJ)'t"ho/ogy 5~) . (l OOS). Gi; ~ - 5 ~)Q . Well. " Apr. 20 12" Sclblxll ini. Re n.tIO M,t; .. r hl). · " t.ak in~ Hole;:.., in Iltt: Skull, Andcnl Psychosllixery't ' !lrai" "( ,\1ind .' fJl,J?IVJ nl;.'. ,I uI IC 1 ~97, Weh 8 0 d 201 1 < http .jfv.rv.,"V,fcc rehro ll"!lltc .o r)l; .l'rJlIOl .lhistonu.ltn.:pan .hlm> " SIu.\ \i l'O. :o-.\ D. Arthur t:. .. and I]aine Shl.lpi l"O . Ph () 11", fo\Nt'rfu l P1tic..--..:.ho. lla\timore. :\ H\ TIle Johns Hopkins l' ni\"c rsit)' !'rc~ 1 ~)97 . rrilll. [!luxes, i::l i' .~'.: ,:, 11<('1 \ ,'In, !!: ',; :'1 .>" j. i' ~'~ \ ~ ! In hi ti d. ;:'!:' d'h !i ::. h: 'l ,; - :. S \ ..... <. , !" 1"'·I;·f 1' .. \1 ' I'.' :111111 r" -1', f i ' l'~
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