Number of words: 992

Over long centuries, doctors have been educated by their patients to observe the prescription ritual. Most people seem to feel their complaints are not taken seriously unless they are in possession of a little slip of paper with indecipherable but magic markings. To the patient, a prescription is a certificate of assured recovery. It is the doctor’s IOU that promises good health. It is the psychological umbilical cord that provides a nourishing and continuing connection between physician and patient. The doctor knows that it is the prescription slip itself, even more than what is written on it, that is often the vital ingredient for enabling a patient to get rid of whatever is ailing him. Drugs are not always necessary. Belief in recovery always is. And so the doctor may prescribe a placebo in cases where reassurance for the patient is far more useful than a famous- name pill three times a day.

This strange-sounding word, placebo, is pointing medical science straight in the direction of something akin to a revolution in the theory and practice of medicine. The study of the placebo is opening up vast areas of knowledge about the way the human body heals itself and about the mysterious ability of the brain to order biochemical changes that are essential for combating disease.

The word placebo comes from the Latin verb meaning, “I shall please.” A placebo in the classical sense, then, is an imitation medicine–generally an innocuous milk-sugar tablet dressed up like an authentic pill–given more for the purpose of placating a patient than for meeting a clearly diagnosed organic need. The placebo’s most frequent use in recent years, however, has been in the testing of new drugs. Effects achieved by the preparation being tested are measured against those that follow the administration of a “dummy drug” or placebo.

For a long time, placebos were in general disrepute with a large part of the medical profession. The term, for many doctors, had connotations of quack remedies or “pseudo-medicaments.” There was also a feeling that placebos were largely a shortcut for some practitioners who were unable to take the trouble to get at the real source of a patient’s malaise. Today, however, the once lowly placebo is receiving serious attention from medical scholars. Medical investigators such as Dr. Arthur K. Shapiro, the late Dr. Henry K. Beecher, Dr. Stewart Wolf, and Dr. Louis Lasagna have found substantial evidence that the placebo not only can be made to look like a powerful medication but can actually act like a medication. They regard it not just as a physician’s psychological prop in the treatment of certain patients but as an authentic therapeutic agent for altering body chemistry and for helping to mobilize the body’s defenses in combating disorder or disease. While the way the placebo works inside the body is still not completely understood, some placebo researchers theorize that it

activates the cerebral cortex, which in turn switches on the endocrine system in general and the adrenal glands in particular. Whatever the precise pathways through the mind and body, enough evidence already exists to indicate that placebos can be as potent is-and sometimes more potent thin–the active drugs they replace.

“Placebos,” Dr. Shapiro has written in the American Journal of Psychotherapy, “can have profound effects on organic illness, including incurable malignancies.” One wonders whether this fact may be the key to the puzzle of those cancer sufferers who, according to documented accounts, have recovered after taking Laetril, even though many of the nation’s leading cancer research centers have been unable to find any medicinal value in this particular substance. It is obviously absurd to say that doctors should never prescribe pharmacologically active drugs. There are times when medication is absolutely essential. But the good doctor is always mindful of its power. No greater popular fallacy exists about medicine than that a drug is like an arrow that can be shot at a particularized target. Its actual effect is more like a shower of porcupine quills. Any drug–or food, for that matter–goes through a process in which the human system breaks it down for use by the whole.

There is almost no drug, therefore, that does not have some side-effects. And the more vaunted the prescription-antibiotics, cortisone, tranquilizers, anti-hypertensive compounds, anti-inflammatory agents, muscle relaxers–the greater the problem of adverse side-effects. Drugs can alter or rearrange the balances in the bloodstream. They can cause the blood to clot faster or slower. They can reduce the level of oxygen in the blood. They can prod the endocrine system, increase the flow of hydrochloric acid to the stomach, slow down or speed up the passage of blood through the heart, impair the blood-making function of the body by depressing the bone marrow, reduce or increase blood pressure, or affect the sodium-potassium exchange, which has a vital part in the body’s chemical balance.

The problem posed by many drugs is that they do these things apart from the purpose intended by the physician. There is always the need, therefore, for the doctor to balance off the particularized therapy against the generalized dangers. The more powerful the drug, the more precarious his balancing act.

Complicating the doctor’s dilemma about drugs is the fact that many people tend to regard drugs as though they were automobiles. Each year has to have its new models, and the more powerful the better. Too many patients feel the doctor is lacking unless a prescription calls for a new antibiotic or other miracle drug that the patient has heard about from a friend or read about in the press.

Because of the very real dangers associated with powerful new drugs, the prudent modern physician takes full advantage of this freedom of choice, specifying potent drugs when he feels they are absolutely necessary, but disregarding them, prescribing placebos or nothing at all, when they are not.

Excerpted from ‘Anatomy of an Illness’ by Norman Cousins, pg 55-59