Placebo

Definition


Placebo refers both to the inert substances used in biomedical research to determine the effectiveness of pharmacological agents and to the impact of belief, ritual and other social aspects of healing on an individual’s recovery from illness Placebo Response: A positive medical response to taking a placebo a sham medication as if it were an active medication. Up to one-third of patients given a placebo may respond with a reduction in symptoms, depending on the condition. This phenomena is often laid to patients believing their symptoms have improved when in fact they have not. Evidence is beginning to emerge that actual physiological changes can result from believing that one is receiving medical treatment.

Placebo Effect: Placebo effect occurs when a treatment or medication with no known therapeutic value (a placebo) is administered to a patient, and the patient's symptoms improve. The patient believes and expects that the treatment is going to work, so it does. The placebo effect is also a factor to some degree in clinically-effective therapies, and explains why patients respond better than others to treatment despite similar symptoms and illnesses.

In anthropology placebos are almost always culturally bound as placebos are as they do not exist in a vacuum. Their effects always depend, to some degree, on wider context of cultural beliefs, expectations, assumptions, and norms as well as on certain economic realities in which they occur. Placebos depend on their context as the context validates the healing powers of the nocebo and that of the person who is administering the medication. Placebos and the nocebo effect are subject to cultural relativism as one placebo may have effect in one cultural group but not in another.

History


"The fifteen remedies described in the oldest Sumerian medical tablet, dating to 2100 B.C.—the treatments of the ashipu (sorcerer) and the asu (physician)—were, as were all the remedies of the ancient cultures, placebos." Medicines and therapeutic techniques were proffered seemingly at random by healers endowed with a mystical, unimpeachable authority, and there is much to suggest that whatever they may have contributed to the recovery of a person's health was merely in the faith they evinced: A person's will to believe in their power in effect created its own power. As the medical historian W.R. Houston wrote, doctors themselves "were the therapeutic agents by which cures were effected.
  • The Byzantine scribe Alexander of Trallers said gout should be treated by mixing myrrh with the nipple-like projection from a young pig's cecum, which would then be wrapped in wolf or dog skin and worn as an amulet during the waning of the moon.
  • The sanctuary of Asclepius (son of Apollo) in Pergamom, the ancient equivalent of our modern New Age spas, elaborate rituals of fasting, fumigation, sea baths, incubation (sleeping in the temple), sacrifices, and various ointments and herbal infusions were said to be responsible for a range of remarkable cures, including a woman giving birth after five years of pregnancy and a bald man waking up to find himself with a full head of hair.
  • Mental illness was combated with such elaborate dramas as the "surprise bath," in which patients were unexpectedly thrown into the sea or plunged through a trapdoor into a stream below, or the human centrifuge, oriented vertically or horizontally depending on the illness in question.
  • The 12th-century philosopher Maimonides recommended in his Treatment of Sexual Disorders urinating into a hollow carrot as a cure for impotence.
  • The London Pharmacopoeia (as much of an authority as existed then) listed among its medicinal agents such things as the saliva of a fasting man, lozenges of dried viper, fox lungs, shed snake's skin, swallow's nest, and "the triangular Wormian bone from the juncture of the sagittal and lambdoid sutures of the skull of an executed criminal."

**Only by the 1950s did the placebo become safely ensconced in the cold language of the clinical trial, the valiant sugar-water agent of honest deception, the hero of the double-blind experiment, gamely revealing when one of the new wonder drugs was not ready for market[1] .


Case Studies


A study by Daniel Moerman looked at 117 studies of ulcer drugs from 1975 to 1994 and found that the drugs may interact in a way you might not expect: culturally, rather than pharmacodynamically. Cimetidine was one of the first anti-ulcer drugs on the market, and it is still in use today. In 1975, when it was brand new, it eradicated 80% of ulcers, on average, in various different trials. But as time passed the success rate of cimetidine - this very same drug - deteriorated to just 50%. This deterioration seems to have occurred particularly after the introduction of ranitidine, a competing and supposedly superior drug. One possible explanation is that the older drug became less effective after new ones were brought in, because of deteriorating medical belief in it[2] .

2) Mothers in Manila Mothers in a poor area of Manila give medicines to their children when they suffer from coughs or colds. After discussing the mothers' ideas about coughs and colds and how they should be treated (quite different from biomedical knowledge), the chapter points at ideas that underlie these narratives of causation and therapy; that is concerns about the vulnerability of children. Children need protection and parents should be responsible. If children are ill often, people tend to talk about their mothers as negligent. Cough, as Tan observes, is considered undesirable and blameworthy in the urban poor communities. He cites a young mother who describes this graphically: '..if the cough is continuous, (the child's) father is disturbed. When he comes back from work, and is hot headed, then he hears the child coughing... Because I am the mother, if the child is sick, I am blamed.' Tan argues that it is not surprising that the manufacturers of cough and cold medicines emphasize a hacking dry cough in their advertising. The dry cough conveys not just the image of lungs bursting from the strain, but also the potential of social disruption.The idea that children usually recover without medicines has no chance in such a situation. The social context demands the use of medicines. The effects of those medicines are therefore manifold:[3]

• They may help to cure the child faster.
• They confirm to the mother that she is a good mother.
• They send a message to the child that the mother cares.
• They communicate that same message to the husband, neighbours and others.
• And all these messages together reinforce the health restoring effect on the sick child.

In conclusion, the medication itself may or may not be the causal factor for symptom improvement in patient.



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Resources


Goodwin Jennifer, Placebo Pill Gives Boost to Some Women's Sex Drive
Papenfuss, Mary, Magic Mushrooms Ease Cancer Anxiety
Placebo Healing the Body with the Mind, 5 part series.
Willis, Melinda, Study: Placebo Alters Brain Function. ABC News Boston

National Public Radio, December 23, 2010: This 'Placebo' Could Be The Drug For You
National Public Radio (Richard Knox), December 23, 2010: Even Knowingly Taking A Placebo Seems To Help
National Public Radio (Alix Spiegel), January 3, 2008: Hotel Maids Challenge the Placebo Effect
The Strange Powers of the Placebo Effect: http://www.youtube.com/watch?v=yfRVCaA5o18

TED: Ideas Worth Spreading, October 2009: Eric Mead: The Magic of the Placebo




Works Cited


Shapiro, Arthur K. and Shapiro, Elaine. 1997. The Powerful Placebo: From Ancient Priest to Modern Physician. Baltimore, MD: John Hopkins University Press.
  1. ^ Oh, Vernon. 1998. Review: The Powerful Placebo: From Ancient Priest to Modern Physician, Arthur K. Shapiro and Elaine Shapiro, John Hopkins University Press. BMJ 316(7141):1396.
  2. ^ Moerman, Daniel E. 2002. Meaning, Medicine, and the "Placebo Effect". Cambridge: Cambridge University Press.
  3. ^ van der Geest, Sjaak and Hardon, Anita. 2006. Social and Cultural efficacies of medicines: Complications for antiretroviral therapy. Journal of Ethnobiology and Ethnomedicine 2:48.