The Romans had a word for it
Steve Ainsworth traces the origins of a termÂ now in everyday parlance
The word â€œplaceboâ€, Latin for â€œI will pleaseâ€, has been heard in Britain for more than 2,000 years. It was probably first spoken in 55 BC by the Standard Bearer of Julius Caesarâ€™s 10th Legion. No doubt he muttered the Latin equivalent of â€œI will please Caesarâ€ just before famously jumping into the waves to single-handedly face the horde of woad be-daubed ancient Britons opposing the Romansâ€™ landing in Kent.
How the word placebo travelled down the centuries to become a harmless drug substitute is, however, a convoluted tale. The Roman occupation of Britain lasted fewer than 400 years, yet their Latin legacy lingered. Not least in the Latin Bible. A thousand years after the Roman legions left Britain, mourners at medieval funeral services sang the first nine verses of Psalm 114 from the Bible.
The most enthusiastic amongst the congregation would very loudly repeat the last verse: â€œPlacebo Domino in regione vivorumâ€™ â€“ â€˜I will please the Lord in the land of the living.â€
Chaucer was unimpressed by such exaggerated grief. In the late 14th century, he wrote in the Parsonâ€™s Tale: â€œFlatterers be the Devilâ€™s chaplains that singeth ever Placebo.â€
As a result of Chaucerâ€™s immense popularity, placebo eventually came to mean any kind of empty flattery. In 1697, a doctor named Robert Pierce picked up the word. He wrote complaining that he was losing patients to a nearby colleague to whom he gave the name â€œDr Placeboâ€.
Pierce wrote enviously of Dr Placebo that â€œhis wig was deeper than mine by two curlsâ€. An expensive wig was a clear indication that there was more money to be made by dispensing flattery than medicine. Thanks to Dr Pierceâ€™s popularisation of the word â€œplaceboâ€ amongst his medical colleagues, it would, over the course of the next two centuries, acquire a variety of uses: not least â€œplacebo doctorsâ€, â€œplacebo pillsâ€ and â€œplacebo effectâ€.
The placebo effect was first identified and investigated by another English doctor, John Haygarth. In 1799, Haygarth tested â€œPerkins Tractorsâ€, a popular but expensive (five guineas a time) medical treatment. These were metal pointers claimed to be able to draw or â€˜ex-tractâ€™ disease from the body.
Haygarth tested their efficacy by comparing the results from using fake painted wooden â€œtractorsâ€ with a set of the five guinea ones. Haygarth published his findings in a book â€˜On the Imagination as a Cause & as a Cure of Disorders of the Bodyâ€™. Unsurprisingly he found no difference in results between the false and the real â€œtractorsâ€.
By the early years of the 19th century, the word â€œplaceboâ€ had become firmly established. Robert Hooper, in his medical dictionary or â€˜Lexicon-Medicumâ€™ published in 1811, defined placebo as â€œ...an epithet given to any medicine adapted more to please than benefit the patientâ€.
Even novelist Walter Scott managed to make use of the word in his 1823 work â€˜St Ronanâ€™s Wellâ€™ in which he wrote: â€œThere is nothing serious intended â€“ a mere placebo â€“ just a divertisement to cheer the spirits, and assist the effect of the waters.â€
The first to define and discuss the â€œplacebo effectâ€ in modern terms was T.C Graves. In a paper published in The Lancet in 1920, Graves wrote of â€œthe placebo effects of drugsâ€ being manifested in those cases where â€œa real psychotherapeutic effect appears to have been producedâ€.
William Evans and Clifford Hoyle experimented with 90 subjects at the Royal London Hospital in 1933. In what was probably the first drug trial of its kind, they compared the outcomes from the administration of an active drug and a placebo.
By 1950, the Journal of Clinical Investigation could report that â€œit is customary to control drug experiments on various clinical syndromes with placebos, especially when the data to be evaluated are chiefly subjectiveâ€.
Today, the use of placebos in drug trials remains standard practice. But are placebos still being regularly prescribed? In one area they certainly are.
Back in 2010 the Parliamentary Committee on Science and Technology reported: â€œIn the Committeeâ€™s view, homeopathy is a placebo treatment and the government should have a policy on prescribing placebos. The government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception.
Prescribing of placebos is not consistent with informed patient choice â€“ which the government claims is very important â€“ as it means patients do not have all the information needed to make choice meaningful.â€
The strange thing is, of course, that placebos do have real effects: a placebo can fill a patient with a genuine sense of increased well-being. Just how much pharmacological effect some OTC remedies have may be debatable. But as long as the patient is pleased with the product then who would deny them that benefit.
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