Just a Spoonful of Sugar

Get out the megavitamins, grab those acupuncture needles and call your psychic healer--now is the time to visualize your way toward a state of perfect health and to realize that the power of suggestion still remains one of the most fundamental components of the delicate art of medicine and modern therapeutics. If you think sugar pills and saline injections are no longer in vogue, look no further than Harvard History of Science professor Anne Harrington's The Placebo Effect: An Interdisciplinary Exploration for a panoramic view of the current proliferation and efficacy of the humble sugar pill's descendents.

At first glance, The Placebo Effect bears a daunting resemblance to a hardcover sourcebook for a cognitive neuroscience course, with its nine MLA-referenced essays and smattering of graphs. Based upon materials presented at a three-day conference that was sponsored at Harvard in 1994 by the Mind, Brain, and Behavior Initiative, the collection would certainly function well as a supplement to the coursework of any History of Science concentrator. For students of the humanities, Harrington delivers just enough of the promised interdisciplinary exploration to illuminate the placebo mystery without drowning the reader in technical terminology.

Harrington's introduction immediately gives an intriguing definition of the term placebo, which, in addition to being Latin for "I shall please," actually originates in the opening phrase of the Catholic vespers for the dead. This irony alone is enough to sustain the casual reader's curiosity through Harrington's brief historical summary of placebo usage and experimentation that also introduces each of the contributing essayists, who range from Howard Spiro of the Yale School of Medicine to University of California neurobiology professor Howard L. Fields.

Journeying through centuries of placebo usage, the first essay of the book aims to determine whether or not the placebo is "much ado about nothing"; co-authors Arthur Shapiro and his wife Elaine present the reader with a flurry of esoteric yet entertaining historical tidbits. Though the knowledge that the 17th-century drug called "Vigo's plaster" was made of viper's flesh, live frogs, and worms may not necessarily be the best conversation-starter, such detail paints an elaborate portrait of the blind, haphazard healing practices of prescientific medics at which even the least scientifically-inclined person can gasp and chuckle.

The next three essays reflect increasingly focused arguments concerning the validity of the placebo effect and its growing popularity in the realm of modern medicine. Among the topics pinpointed are the clinical bases of the placebo effect and the "nocebo phenomenon," in which the mere expectation of sickness may cause the angst-ridden patient to hurtle towards death. Even though the articles start to resemble entries in a medical journal, compelling statistics--such as the 12 percent increase in "normal" U.S. suicide patterns following Marilyn Monroe's suicide in 1962--snatch the reader's attention whenever the discussion of endogenous opioids approaches the threshold of human tolerance.

After learning that placebos can range from inert pills to actual doctors, after discovering the distinctions between "disease" and "illness," "healing" and "curing," one can venture into the last half of the collection, where a veritable alphabet soup of terms lurk and psychosomatic explorations abound. Abandon all hope, ye who wrestled with the QRR and plan to enter here: inverse relations and normalized sets of data concerning placebo efficacy literally pepper the pages. Authors Donald D. Price and Howard L. Fields even include an exponential function describing the placebo effect (Feeling intensity = Desire x Expectation^2).

A welcome divergence arrives in the ninth essay, David B. Morris' "Placebo, Pain, and Belief: A Biocultural Model," which departs from the heavily clinical investigations of preceding chapters to reestablish the broader, sociological approach utilized by the Shapiros. Linking human behavioral biology to cultural conceptions which range from early Native American culture to present-day society, Morris' argument discusses the resurgence of placebo research and the role of endorphins with vivid allusions to historical and religious conceptions of pain. The capstone of the essay section of the book, Morris' work also prepares the reader for the long-awaited highlight of Harrington's concoction: an interdisciplinary dialogue.

The simple knowledge that information of the final portion of Harrington's book arose from candid conversation between doctors and divinity professors, neurologists and national health program directors, causes the reader to cling to every word of the last 40 pages. Some dialogue is amusing--Professor Spiro of Yale speaks of "feeling like a knight, very macho" when treating acute pain--and other comments are slightly disturbing: Professor Fields of California asserts that "part of what we do as physicians is to scare people" to add to placebo effectiveness. Anne Harrington herself contributes to the discussion of the placebo and each discipline's interpretation of its origin. After a lively exchange of philosophies, the end result is one of measured synthesis and little surprise, as each speaker eventually acknowledges both the reality of the placebo effect and the still unknown source of its influence.

Covering a topic simultaneously entertaining and enigmatic, The Placebo Effect is simple to swallow but difficult to digest. By incorporating a variety of specialized glimpses into the nature of human psychosomatic response alongside broader, interdisciplinary anecdotes and assertions, The Placebo Effect provides a well-balanced yet inconclusive view of "how symbols, settings, and human relationships literally get under our skin."