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December 18, 2008
When Placebos Were All There Were
Yesterday's discussion of how to deal with various forms of pseudoscientific hoo-hah naturally brought up several mentions of the placebo effect. And that prompts me to bring in the late Lewis Thomas's The Youngest Science, his memoir of a life in medicine. We should never forget that there was a time, not all that long ago, when drug therapy was almost all placebos. Here's a description of the way Thomas's father practiced in the 1920s:
Nevertheless, despite his skepticism, he carried his prescription pad everywhere and wrote voluminous prescriptions for all his patients. TThese were fantastic formulations, containing five or six vegetable ingredients, each one requiring careful measuring and weighing by the druggist, who pounded the powder, dissolved it in alcohol, and bottled it with a label giving only the patient's name, the date, and the instructions about dosage. The contents were a deep mystery, and intended to be a mystery. The prescriptions were always written in Latin, to heighten the mystery. The purpose of this kind of therapy was essentially reassurance. . .They were placebos, and they had been the principle mainstay of medicine, the sole technology, for so long a time - millennia - that they had the incantatory power of religious ritual. My father had little faith in the effectiveness of any of them, but he used them daily in practice. They were expected by his patients; a doctor who did not provide such prescriptions would soon have no practice at all. . .
That's the world as it was. Thomas later recounts the profound shock he experienced as an intern when sulfanilamide was introduced: patients given up for dead got up out of their hospital beds and asked for something to eat. It was then, he says, that he realized that the medical profession he was entering might be turning into something different from what his father knew.
We should never forget: it's our job to make our children look back on today's medicines with the same mixture of pity and alarm. To cure disease, stop the damage, make people given up for dead stand up and walk out of the room to see their families. Things aren't going very well for us now in this business, because these are all very hard things to do, and the amount of time and money needed to do them is nearly unbearable. But not quite. We can see that such things are possible, and it's up to us to figure out how to make them real.
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