Placebo Effects: Rare Insights

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Placebo response is now generally well accepted. So much so that it is now said – ‘Placebo response’ is the friend of the clinician and enemy of disease’.

A placebo is an inert substance or procedure used to treat a patient. A patient’s response to the placebo is called the ‘placebo effect’.

How many of us are aware that the word placebo has a ‘divine’ origin?

It all started with St Jerome's mistranslation of the first word of the ninth line of Psalm 116, “I will walk before the Lord”. The good saint wrote “Placebo Domino in regione vivorum” which translated means, “I will please the Lord in the land of the living”.

Placebo in Latin means – I will please.

By the 13th century, hired mourners began to be referred to “placebos” to describe their fake lamenting.

In the The Canterbury Tales, we have been familiarized with the sycophantic, flattering of the courtier, Placebo.

The introduction to placebo controls took shape with the Catholic Church when the “possessed” were given false holy objects and their reactions observed. If they contorted or reacted violently to these false objects it was concluded that their possession was a figment of their overactive imagination.

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Placebos began to be used as controls in medical experiments in 1784 with the Franklin commission’s efforts to debunk the role of psychic forces involved in mesmerism.

From the 18^th century onwards placebos began to be used in a medical sense, to placate patients. But they continued to harbor a tarnished image until after the World War II, when it began to be observed, through randomized controlled trial (RCT) that the health of people, who belonged to the ‘placebo- control’ group, sometimes did dramatically improve.

Very often pioneers who worked with placebo gave a larger than life description of the placebo and its uses not taking into account other factors that controlled patient recovery.

Over the last decade there has been a lot of interest in placebo and this has led to a lot of research in this field.

Placebo response is now generally well accepted. So much so that it is now said – ‘Placebo response’ is the friend of the clinician and enemy of disease’

Placebo & Placebo Effect

A placebo is an inert substance or procedure and a patient’s response to the placebo is called the ‘placebo effect’.

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Placebo effects that are observed in RCTs are confusing in that it is merely a reaction to the natural course of the disease and not a psychosocial response to the treatment simulation.

Placebo effect is now considered to be a psychobiological event that occurs in a therapeutic context believed to be affecting the patients’ brain, body and behavior.

To better understand placebo effect it is vital to shift the focus from clinical trials and see what the placebo actually does to the patient in a psychosocial context. This includes taking into account the interactions between clinician, patient and the environment.