Steve Ainsworth traces the origins of a term now in everyday parlance
The word “placebo”, Latin for “I will please”, 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 Caesar’s 10th Legion. No doubt he muttered the Latin equivalent of “I will please Caesar” just before famously jumping into the waves to single-handedly face the horde of woad be-daubed ancient Britons opposing the Romans’ 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: “Placebo Domino in regione vivorum’ – ‘I will please the Lord in the land of the living.”
Chaucer was unimpressed by such exaggerated grief. In the late 14th century, he wrote in the Parson’s Tale: “Flatterers be the Devil’s chaplains that singeth ever Placebo.”
As a result of Chaucer’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 “Dr Placebo”.
Pierce wrote enviously of Dr Placebo that “his wig was deeper than mine by two curls”. An expensive wig was a clear indication that there was more money to be made by dispensing flattery than medicine. Thanks to Dr Pierce’s popularisation of the word “placebo” amongst his medical colleagues, it would, over the course of the next two centuries, acquire a variety of uses: not least “placebo doctors”, “placebo pills” and “placebo effect”.
The placebo effect was first identified and investigated by another English doctor, John Haygarth. In 1799, Haygarth tested “Perkins Tractors”, a popular but expensive (five guineas a time) medical treatment. These were metal pointers claimed to be able to draw or ‘ex-tract’ disease from the body.
Haygarth tested their efficacy by comparing the results from using fake painted wooden “tractors” with a set of the five guinea ones. Haygarth published his findings in a book ‘On the Imagination as a Cause & as a Cure of Disorders of the Body’. Unsurprisingly he found no difference in results between the false and the real “tractors”.
By the early years of the 19th century, the word “placebo” had become firmly established. Robert Hooper, in his medical dictionary or ‘Lexicon-Medicum’ published in 1811, defined placebo as “...an epithet given to any medicine adapted more to please than benefit the patient”.
Even novelist Walter Scott managed to make use of the word in his 1823 work ‘St Ronan’s Well’ in which he wrote: “There is nothing serious intended – a mere placebo – just a divertisement to cheer the spirits, and assist the effect of the waters.”
The first to define and discuss the “placebo effect” in modern terms was T.C Graves. In a paper published in The Lancet in 1920, Graves wrote of “the placebo effects of drugs” being manifested in those cases where “a real psychotherapeutic effect appears to have been produced”.
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 “it is customary to control drug experiments on various clinical syndromes with placebos, especially when the data to be evaluated are chiefly subjective”.
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: “In the Committee’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 – which the government claims is very important – as it means patients do not have all the information needed to make choice meaningful.”
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.