"Humble Humbug"

Placebo (Latin: I shall please): A medicine, especially an inactive one, given merely to satisfy a patient.

--Webster's New Collegiate Dictionary

"Until lately," said last week's Lancet of London in its lead editorial, "the placebo has never been regarded as quite respectable. In the family of drugs it has always been the flea-bitten mongrel dog, kicked into the kitchen when company calls but uncommonly useful for dealing with undesirables at the back door . . . But the spread of scientific methods to the study of materia medica has led to a remarkable improvement in the status of what [Philadelphia's Dr. Oliver Hazard Perry] Pepper called 'this humble humbug.' The placebo is now dignified with the title of 'research tool.' "

In research, a placebo is used as a "control," i.e., in test comparisons with a new drug. But the placebo itself (usually a sugar pill colored to match the real drug), no matter how pharmacologically inert it may be, is often psychologically active (TIME, Dec. 14). Patients improve, partly because of the attention they are getting, partly because they think they are receiving an active medicine. In this way, a placebo may give the impression that a useful drug is less potent than it actually is. So far, doctors have found no handy way to tell in advance whether a patient will be a "placebo reactor" or not. But they have noted that most of the reactors are "more emotional and gushing, more grateful for and impressed by hospital care . . . more cooperative with the nursing staff, and they talked more than the nonreactors, who by contrast tended to be critical, unbending and emotionally controlled."

Is it right for a doctor deliberately to prescribe placebos? Yes, says the Lancet, to reinforce a patient's faith in his recovery when the diagnosis is unquestioned and no better treatment is possible. Also, to refuse a placebo to a dying, incurable patient "may be simply cruel."

The doctor who prescribes semi-placebos (such as vitamins) may only deceive himself, Los Angeles' Dr. Alan Leslie wrote recently, and the Lancet concurs. It concludes : "If deception there must be, let it be wholehearted, unflinching and efficient. A placebo medicine should be red. yellow or brown . . . The taste should be bitter but not unpleasant. Capsules should be colored, and tablets either very small (on the multum in parvo principle) or impressively large." And even more to the point: "No method of administration can equal 'the needle' for effect."

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