The Powerful Placebo : From Ancient Priest to Modern Physician

297 Pages·1997·22.086 MB·English

by  Arthur K. Shapiro, Elaine Shapiro

The Powerful Placebo
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The Powerful Placebo
From Ancient Priest to Modern Physician
ARTHUR K. SHAPIRO, M.D.
and
ELAINE SHAPIRO, PH.D.
The Johns Hopkins University Press
Baltimore and London
1997 The Johns Hopkins University Press
AH rights reserved. Published 1997
Printed in the United States of America on acid-free paper
06 05 04 03 02 01 00 99 98 97 5 4 3 2 1
The Johns Hopkins University Press
2715 North Charles Street
Baltimore, Maryland 21218-4319
The Johns Hopkins Press Ltd., London
A previous version of Chapter 2 was published in A. K, Shapiro,
"Semantics of the Placebo" Psychiatric Quarterly 42:653—95,
Portions of chapter 11 also appear in The Placebo Effect, edited
by Anne Harrington (Cambridge: Harvard University Press, 1997).
Library of Congress Cataloging-in-Publication Data will be
found at the end of this book,
A catalog record for this book is available from the British Library
ISBN 0-8018-6675-8
To our children, Peter, Moira, and Kaethe,
and their children, Laura, Eiisa, and Paige
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Contents
Preface and Acknowledgments ix
1 The Placebo Effect in Medical History 1
2 The Semantics of the Placebo 28
3 Fraud, Faith, and Fads 43
4 The Placebo Effect in the Twentieth Century 74
5 Psychiatry and Other Psychotherapies 86
6 The History of Clinical Trials 123
7 The History of the Double-Blind Procedure 137
8 Ethical Controversies about the Use of Placebos,
the Double Blind, and Controlled Clinical Trials 175
9 How Blind Is Blind? 190
10 Predicting Placebo Response 217
11 Summary and Conclusions 228
References 239
Index 273
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Preface and Acknowledgments
In 1953, while a second-year medical student with time on my hands be-
cause of a hospitalization for infectious mononucleosis, I began to study the
psychiatric literature. I became intrigued by the frequency with which new
treatments were announced with enthusiasm and fanfare, followed by sev-
eral supporting papers, only to disappear from the literature and eventually reap-
pear in a new guise. I saw the same phenomenon in the frequent announcements
of crucial discoveries in the treatment of psychiatric and other disorders.
My readings revealed numerous references to the work of Henry Beecher*
Stewart Wolf, and Harry Gold. My pursuit of their writings opened up for
me a whole new area of interest and amazement, the powerful placebo effect.
This phenomenon also stimulated my interest in the importance of controlled
methodology, especially the double-blind procedure, a method to control the
placebo effect of treatment. The double-blind procedure was used in many stud-
ies of antipsychotic, antidepressant, and antianxiery agents and drugs introduced
in the 1950$, and eventually in studies of psychotherapy The development of re-
liable and valid methods of evaluating such studies became major areas of re-
search in the 1950$, 1960$, and 19705.
I continued my interest in the placebo effect during my residency at the
Boston Psychopathic Hospital (now the Massachusetts Mental Health Center),
notably with the excellent guidance and support of Harry C. Solomon, M.D.,
chair of the Mental Health Center, and Milton Greenblatt, M.D., director of re-
search. Dr. Daniel Levinson (also of the department}* and Dr, Greenblatt pub-
lished an article on the placebo effect with which I assisted, and I was very grat-
ified to find they had included my name as one of the authors, Dr, Greenblatt
encouraged my research by providing facilities, including a separate research
office and patient volunteers to assist in typing the very large reference file that
I had by then collected about the placebo effect,
I wrote a paper about the history of the placebo in medical treatment, which
was accepted by the American Journal of Psychiatry before I completed my resi-
dency. Other papers were accepted by various journals. Most gratifying to me
was the publication of a long scholarly article* "A Contribution to the History