MEDICINE
Magic touch
JOHN ROWAN WILSON
There is a story of an Englishman who visited Poland before the war to stay with some friends who were Catholics. While he was there they asked him to solve a prob- lem that was baffling the village. There was a new priest at the local church—a Scotsman—and when he carried out the usual ceremony of spraying holy water over the congregation before Mass, he delivered a special incantation in a language that none of them had heard before. It was not Latin, it was not Polish, it was not Eng- lish. The Englishman went to church that Sunday and listened very carefully. When the service was over his friends asked him what the Scotsman had said. 'Well,' said There is a story of an Englishman who visited Poland before the war to stay with some friends who were Catholics. While he was there they asked him to solve a prob- lem that was baffling the village. There was a new priest at the local church—a Scotsman—and when he carried out the usual ceremony of spraying holy water over the congregation before Mass, he delivered a special incantation in a language that none of them had heard before. It was not Latin, it was not Polish, it was not Eng- lish. The Englishman went to church that Sunday and listened very carefully. When the service was over his friends asked him what the Scotsman had said. 'Well,' said
the Englishman. 'it sounds to me like "If it'll nae do ye guid. it'll nae do ye harm"'.
The priest was, in fact, enunciating a sound medical principle—the principle of the placebo. A placebo can be detined as an inert substance presented to the patient as a form of effective medication. It may not be totally inert, but if it has any acti- vity, this is of a minor nature and more or less irrelevant to the disease, if any. from which the patient is suffering. The use of coloured aspirins, rubbing liniments, and most cough mixtures fall into this category.
The use of placebos is a very ancient practice. It springs, not from a particular tendency of doctors towards deceitfulness. but from the fact that in a matter so im- portant to them as their own health, patients are unwilling to accept the idea that there is no known treatment for what is wrong with them. Like holy water, placebos may not be scientific but they are an essential part of the ritual of healing.
The administration is something of an art in itself. Since any feeling of benefit from them must presumably be psycho- logical, some degree of mumbo-jumbo is considered justifiable. Medicine can be pre- sented as very rare and hard to get hold of. Foreign names are a help, and so are com- plicated instructions about taking the medi- cine before or after meals, with or without water, and so on. The preferred method of administration of placebos varies from country to country. The British have tradi- tionally gone for the bottle of medicine, preferably with a nasty taste to it. The Americans are more addicted to pills and capsules. In the Mediterranean countries it simply has to be an injection to be con- sidered of any value at all. And as for the French . . . Well, there's no accounting for tastes, I suppose.
In recent years the attention of the scientists has been attracted towards place- bos. This is because of the technique of carrying out comparative experiments to test out drugs, in which one group of patients receives the drug, and a similar group is treated with an inert substance which is indistinguishable by the patient from the drug itself. The scientists dis- covered that in many cases the inert placebos produced surprisingly good results. even in diseases which were not thought to be psychological in origin. Since one of the principles of scientific investigation is that if you can't explain something. the next best thing is to give a name to it, this phenomenon was duly classified as 'the placebo effect.'
General practitioners who had been in the way of curing rheumatism with a mix- ture of acetylsalicylic acid. magnesium carbonate, and a spot of tincture of rose water for luck. found themselves rather in the position of the man who discovered that he had been writing prose for years without knowing it. and Mr Brian Inglis wrote articles saying that the placebo effect was a very significant thing and we ought to do more research on the subject. instead of wasting so much time trying to find new drugs. Certainly it would be helpful to know how or why it occurs. We know something. of course. It has been established for a long time that many physical symptoms have, either partially or completely, a psychological origin and arc responsive to suggestion. We even have an outline of the nervous and hormonal mechanisms by which these so-called psychosomatic effects
can occur. But a detailed explanation, which could be used in a specific manner for treatment, still eludes us.
In the meantime, placebos are still widely used in treatment, in the age-old haphazard manner. When they are used as a substi- tute for an effective treatment, or to cheat people out of their money, they are obviously an evil and discreditable device. But this is not usually the case. The more common situation is that there is simply no other form of treatment available. Scienti- fic medicine has achieved a great deal, but there are still large areas in which it is powerless to help. It is all very well to say to the doctor that he must be completely honest with his patients, and tell them their disease is in- curable or that their bodies are worn out and they should accept the fact philosophi- cally. Patients need more than that. They need hope and encouragement; they need, if you like, a little magic. The magic changes, of course, from generation to generation. At one time it may be a prayer. at another a poultice, at another a pill or an injection. It may not do much good, but it'll nae do ye harm. Which is more than can be said, when you come down to it, for some of the more positive treatments.
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