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THE POWERFUL PLACEBO
Spiro (1986) defines the placebo as, 'a substance or a procedure that is administered with suggestions that it will modify a symptom or sensation, but which, unknown to the recipient, has no specific pharmacological impact on the reaction in question'.
Until recent times the success of medicine depended very largely on the placebo. Spiro (1986) believes that since medicine has become more scientific the placebo effect has been undervalued and even something of an embarrassment to clinicians, who he thinks '. . . regard any deviation from the strictly scientific objective approach almost as religious thinkers regard sin'.
Engel (1977) agrees that scientific medicine has gained the status of a dogma and Lown (1985) believes that 'a pretentious "scientism" mars the physicians' perception of the power of the placebo'. The 'scientific fallacy' has, according to Spiro (1986), led to considerable resistance to the placebo on the part of clinicians. He urges them to consider how much their perceptions have been restricted by science and contends that, 'truth in medicine has moved from what the patient says to what the physician finds' and consequently, 'the more medical science does for disease, the less physicians do for patients'. Despite this resistance to placebos, Benson and McCallie (1979) remind us that they are safe and effective and, unlike most therapies, have stood the test of time. It is important to note, however, that there is little evidence at the present time that placebos affect the actual disease process. We cannot assume that just because symptoms are relieved that the underlying pathology has altered.
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