Placedo provides a sometimes tortuous way or path to a better understanding of the principles and practices of using placebos for health and wellbeing.
Transliterally placebo means ‘I will please’. In the Middle Ages placebo singers attended funerals to assist the departure of souls. Since the eighteenth century the term placebo effects or placebo responses has described patients’ psychological, physiological, emotional and spiritual effects and experiences resulting from certain treatments, remedies and healthcare practices though placebos do not have any direct specific effects on pathology, disease, disability or illness.
In 469 BC Socrates said ‘The cure itself is a certain leaf, but in addition to the drug there is a certain charm - but without the charm there is no profit from the leaf.’ More recently Arthur Shapiro advised: ‘The history of medicine is largely the history of placebo effects. The placebo may be an inert sugar pill, an active drug, or any treatment no matter how potentially specific or by whom administered…which is ineffective or not specifically effective for the symptom or disease.’ (The Powerful Placebo 2000).
Dr. Archie Cochrane said: ‘The effect of placebos has been shown by randomised controlled trials to be very large. Their use in the correct place is to be encouraged ...’ The Cochrane Collaboration was named to recognise his work promoting evidence-based medicine and systematic reviews of scientific and medical articles and publications. The Collaboration believes that effective health care is created through equal partnerships between researcher, provider, practitioner and patient and its work is internationally recognised as the benchmark for high quality information about the effectiveness of health care.
Placebos work by stimulating the release of neurotransmitters, of which there are more than fifty including: amino acids, peptides, monoamines, opioids, cannabinoids, endorphins, and particularly, where pleasure is concerned, dopamine. In his seminal paper The Powerful Placebo (JAMA 1955); Dr. Henry Beecher taught ‘To array a man’s will against his sickness is the supreme art of medicine.’
Placebos work by harnessing the imagination, stimulating response expectances and through the power of suggestion. So does hypnosis. Placedo contends that since both placebo and hypnotic effects are achieved by the same mechanism, mediated by the same neurochemicals and both have the same objects of giving pleasure and satisfying patients – placebo effects may be regarded as resulting from hypnosis, whether auto or practitioner facilitated. Both methods and effects comprise facilitated focussed concentration, imaginative experiences and patients or subjects receptive to suggestions. Those who study and utilise these effects may be termed placebists.
As Professor Irving Kirsch, Director of Placebo Studies, Harvard University puts it: ‘Hypnotic inductions are expectancy modification procedures that produce placebo effects without the use of placebos. In fact, it is possible to produce all of the suggested effects of hypnosis by giving subjects a placebo and telling them that it produces a hypnotic state.’
There are no molecules demonstrably affecting any pathological process in homeopathic remedies; no ‘subluxations’ which, if ‘adjusted’, result in benefit to any specific somatic disorder; no points or meridians which, if stimulated by needles, result in any greater benefit than can be achieved by placebo techniques; no unidentified ‘vital forces’ in herbal preparations other than chemicals as analysed by orthodox pharmacologists; no ‘auras’, ‘energies’ or occult esoteric forces which may ‘heal’ after hand positioning, touching, or thoughts; no ‘healing forces’ in crystals and other substances not known to conventional science. All these practices, remedies, techniques and methods may induce placebo responses and so benefit patients as evidenced by declared experiences of ‘feeling better’.
Placebists offer consolation for present suffering, hope for the future and love at all times.
Placedo is offered as a benefit to practitioners and patients who seek to further their understanding of placebo effects and responses. In preparation is Beyond the Syringe: Secrets of Alternative Medicine Exposed which sets out these themes more comprehensively, if not comprehensibly. The author is Dr. Richard Rawlins MB BS MBA FRCS, a Consultant Orthopaedic Surgeon, former Chairman of the UK Consultants Conference, of the BMA’s Clinical Audit Committee and of the Health Quality Service’s Advisory Council. Richard is an Expert Witness for the Courts, a Freeman of the City of London, a Member of the Worshipful Society of Apothecaries and a Member of the Magic Circle. Qualified in medicine, he brings the insights and intuition of a magician to a consideration of contemporary health care practices.