Anatomy of an Illness as Perceived by the Patient Read Online Free PDF

physician loses no time in mobilizing all the scientific resources and facilities available, but he is careful not to slow up the natural recovery process of those who need his expert reassurance even more than they need his drugs. He may, for such people, prescribe a placebo—both because the patient feels more comfortable with a prescription in his hand and because the doctor knows that the placebo can actually serve a therapeutic purpose.
    The placebo, then, is not so much a pill as a process. The process begins with the patient’s confidence in the doctor and extends through to the full functioning of his own immunological and healing system. The process works not because of any magic in the tablet but because the human body is its own best apothecary and because the most successful prescriptions are those filled by the body itself.
    Berton Roueché, one of America’s most talented medical reporters, wrote an article for the New Yorker magazine in 1960 in which he said that the placebo derives its power from the “infinite capacity of the human mind for self-deception.” This interpretation is not held by placebo scholars. They believe that the placebo is powerful not because it “fools” the body but because it translates the will to live into a physical reality. And they have been able to document the fact that the placebo triggers specific biochemical changes in the body. The fact that a placebo will have no physiological effect if the patient knows it is a placebo only confirms something about the capacity of the human body to transform hope into tangible and essential biochemical change.
    The placebo is proof that there is no real separation between mind and body. Illness is always an interaction between both. It can begin in the mind and affect the body, or it can begin in the body and affect the mind, both of which are served by the same bloodstream. Attempts to treat most mental diseases as though they were completely free of physical causes and attempts to treat most bodily diseases as though the mind were in no way involved must be considered archaic in the light of new evidence about the way the human body functions.
    Placebos will not work under all circumstances. The chances of successful use are believed to be directly proportionate to the quality of a patient’s relationship with a doctor. The doctor’s attitude toward the patient; his ability to convince the patient that he is not being taken lightly; his success in gaining the full confidence of the patient—all these are vital factors not just in maximizing the usefulness of a placebo but in the treatment of illness in general. In the absence of a strong relationship between doctor and patient, the use of placebos may have little point or prospect. In this sense, the doctor himself is the most powerful placebo of all.
    A striking example of the doctor’s role in making a placebo work can be seen in an experiment in which patients with bleeding ulcers were divided into two groups. Members of the first group were informed by the doctor that a new drug had just been developed that would undoubtedly produce relief. The second group was told by nurses that a new experimental drug would be administered, but that very little was known about its effects. Seventy percent of the people in the first group received sufficient relief from their ulcers. Only 25 percent of the patients in the second group experienced similar benefit. Both groups had been given the identical “drug”—a placebo.
    How much scientific laboratory data has been accumulated on placebo efficacy? The medical literature in the past quarter-century contains an impressive number of cases:
    The late Dr. Henry K. Beecher, noted anesthesiologist at Harvard, considered the results of fifteen studies involving 1,082 patients. He discovered that across the broad spectrum of these tests, 35 percent of the patients consistently experienced