The strange power of fake pills

I have been sorting through unpublished Gifford-Jones columns. Among them, I found a dusty clipping from a Reader’s Digest article by Robert A. Siegel and a rough draft of this week’s column. In it, we find a glimpse into a lecture hall at Harvard Medical School 75 years ago, and the teachings of Dr. Henry Beecher, the Harvard anesthetist who challenged the medical establishment’s views about truth and healing.

Beecher had stunned his class of medical students when he asked, “Is it ethical for doctors to prescribe a dummy pill – a pill that does no harm, never causes addiction, and yet often cures the patient?” He was speaking of a placebo. The lecture shocked his students who had been taught that honesty was an unshakeable tenet of medical ethics. Yet, Beecher showed that sometimes, deception can be powerful medicine.

Siegel’s Reader’s Digest story echoed this point. He described meeting Dr. John Kelley, a psychology professor at Endicott College who studies the placebo effect at Harvard. Curious, Siegel asked whether a “phony pill” might help him overcome his chronic writer’s block, insomnia, and panic attacks. Kelley obliged with a prescription: 100 gold capsules (Siegel’s favourite colour) costing $405. Each one contained nothing but cellulose, and yet, Siegel found that the more expensive they seemed, the better they worked. The gold capsules helped him focus and stay calm. Even when drowsy, another capsule kept him writing.

“Is it ethical for doctors to prescribe a dummy pill?”

Beecher published his groundbreaking paper “The Powerful Placebo” in 1955. He argued that all new drugs should be tested in double-blind trials so neither doctor nor patient knows who receives the real drug.  The results were unsettling. Hundreds of supposedly effective drugs were found to be little more than expensive illusions. Many were pulled from the market.

Placebo therapy itself is ancient, and there is proof that belief predates biochemistry. In the medical lore, we are told doctors once prescribed crocodile dung, or powdered donkey hoof, and sometimes they worked! Later, physicians injected sterile water to relieve pain, and to their surprise, many patients improved.

One study in 1959 found that when surgeons tied off an artery to increase blood supply as a treatment for angina, some patients reported relief. When surgeons merely made a skin incision and did nothing else, the results were just as good. Ethics boards today would never allow such sham surgeries, yet they taught medicine an unforgettable lesson. The mind can profoundly influence the body.

Even more astonishing was later research at Queen’s University in Kingston, Ontario. Placebo pills improved urinary flow in men with enlarged prostates. Some of these same men also developed side effects so real that they had to stop taking the dummy pills altogether.

There is a popular account of a 26-year-old man who swallowed many capsules thinking they were antidepressants, but he was actually in the placebo arm of a trial. His blood pressure plummeted, his heart rate soared, but he stabilized when told the pills were placebos.

How do placebos work? The colour of the capsule, the cost, the trust in the physician, all play a role. Our expectations can spark real physiological change, from heart rate to pain relief.

Beecher’s lecture appalled some medical trainees. Others were intrigued, but all got the lesson. The placebo didn’t deceive patients; it revealed the self-deception of medicine itself.

Of course, no placebo will mend a ruptured appendix or stop internal bleeding. In an era when so many unnecessary prescriptions are written, perhaps it’s time to remember the wisdom of Voltaire, who wrote, “The art of medicine consists of amusing the patient while nature cures the disease.”

This column offers opinions on health and wellness, not personal medical advice.