Читать книгу Placebo: Mind over Matter in Modern Medicine - Dylan Evans - Страница 7

In the closing years of World War II, while the Allies were fighting to liberate Europe from German occupation, morphine was in great demand at the military field hospitals. When casualties were particularly heavy, demand would outstrip supply and operations had to be performed without analgesia. On one such occasion, Henry Beecher, an American anaesthetist, was preparing to treat a soldier with terrible injuries. He was worried; without morphine, not only would the operation be extremely painful – it might even induce a fatal cardiovascular shock. But then something very strange happened, something that was profoundly to alter Beecher’s view of medicine for the rest of his life. In desperation, one of the nursing staff injected the patient with a harmless solution of saline. To Beecher’s surprise, the patient settled down immediately, just as if he had been given morphine. Not only did the soldier seem to feel very little pain during the subsequent operation, but the full-blown shock did not develop either.¹ Salt water, it seemed, could be just as effective as one of the most powerful painkillers in the medical arsenal. In the following months, when supplies of morphine again ran low, Beecher repeated the trick. It worked. Beecher returned to America after the war convinced of the power of placebos, and gathered around him at Harvard a group of colleagues to study the phenomenon.

Around the same time, others were also beginning to take an interest in the placebo response. Harry Gold, at Cornell University, had been working on the topic independently since before the war. His work on angina had convinced him, like Beecher, that placebos could exert powerful therapeutic effects. In 1946, Gold led a discussion about the use of placebos in therapy at a conference at Cornell.² Soon after, Beecher’s team at Harvard embarked on a series of studies comparing the effectiveness of analgesics with that of placebos. By 1955 interest in the placebo response had grown to such an extent that one of Beecher’s colleagues, Louis Lasagna, was even invited to write about the topic in Scientific American.³

The scientific interest in placebos was new. Although doctors had been quietly using sugar pills and water injections as sops to placate desperate patients for many years before Beecher started running his studies, few regarded the practice as worthy of serious research. Quite the contrary; physicians often felt rather uneasy about the whole business. It smacked of quackery and fraud. Doctors justified the practice of handing out placebos on the grounds that it could do no harm, but did not think for a moment that it actually helped patients to get better. An article in the Lancet in 1954 summed up this old-fashioned view of the placebo as ‘a means of reinforcing a patient’s confidences in his recovery, when the diagnosis is undoubted and no more effective treatment is possible’. The article went on to note that ‘for some unintelligent or inadequate patients life is made easier by a bottle of medicine to comfort their ego; that to refuse a placebo to a dying incurable patient may simply be cruel; and that to decline to humour an elderly “chronic” brought up on the bottle is hardly within the bounds of possibility’.⁴

This view of the placebo as a ‘humble humbug’, as the Lancet article was so aptly titled, echoes the etymology of the term. Placebo is Latin for ‘I will please’. In the Latin translation of the Bible that was used throughout the Middle Ages, the word occurs as part of Psalm 116 – the part that was used in the Catholic vespers for the dead. People who wanted these prayers sung for their recently-deceased loved ones would be charged exorbitant fees by the priests and friars who performed the sacred rites. The priests, we may suppose, did not share the same sense of loss as those in mourning, and so the expression placebo came to stand as a pejorative shorthand for any form of words that was insincere but perhaps consoling nonetheless. This is the sense in which Chaucer used the term in the fourteenth century, when he wrote that ‘flatterers are the devil’s chaterlaines for ever singing placebo’. Over two hundred years later, Francis Bacon also had flatterers in mind when he advised kings to beware of their advisers:

A king, when he presides in counsel, let him beware how he opens his own inclination too much, in that which he propoundeth; for else counsellors will but take the wind of him, and instead of giving free counsel, sing him a song of placebo.

In the eighteenth century, placebo entered the medical lexicon as a term for fake remedies. When the physician thought nothing was wrong with a patient, he might give him a bread pill or some other innocuous substance just to keep him happy. This way, the patient would at least be spared the danger of taking a real treatment when nothing was wrong with him. In 1807, the American President Thomas Jefferson wrote in his diary that one of the most successful physicians he had ever known had assured him that ‘he used more bread pills, drops of coloured water and powders of hickory ash than all other medicines put together’. Jefferson added that he considered this practice ‘a pious fraud’ – a phrase which nicely captures both aspects of the original use of the term placebo. Just like a prayer for the dead sung by monks who never knew the deceased, a bread pill was both deceptive and consoling, a white lie to cover up a nasty fact.

All this changed after World War II. The studies conducted by Beecher, Gold, Lasagna and other elite medical researchers revolutionised the way doctors thought about placebos. By the mid-1950s, the medical profession was beginning to think that handing out placebos might not be such a fraudulent practice after all. Experiments had shown that inactive substances could induce similar effects to those of caffeine and alcohol when people were fooled into thinking that the innocuous liquids they were given contained coffee or wine. Perhaps equally powerful effects could be produced by the bread pills given out by physicians. Perhaps placebos could really heal people.