PLACEBOS: Fooling the Body to Heal Itself.

• Author: BROWN, WALTER A.

Even though they do not contain active pharmaceutical ingredients, placebos often are beneficial in alleviating stress-induced ailments.

CENTURIES of clinical experience show that placebos benefit a wide range of afflictions. Indeed, research over the past few decades has identified some of the mechanisms behind the placebo effect. Yet. the placebo response--or. more descriptively, a response to the treatment situation--continues to be disparaged by the health care community and patients.

How did placebos come by their dubious reputation? The centuries-old term "placebo" comes with historical baggage. Latin for "I shall please." the word had by the 14th century become a pejorative term meaning flatterer, sycophant, or toady. In the 19th century, when placebo entered medical terminology, its negative connotations persisted. It was defined as a medicine given to please patients, rather than benefit them. Today, the word continues to imply deception. fakery, and ineffectiveness,

True, people shy away from what they don't understand, and many don't fully understand how placebos work, Neither, however, do they always comprehend the mechanisms of traditional medical treatment. Some studies of modern medical remedies, including one by the U.S. Office of Technology Assessment, suggest that only about 20% of medical treatments in common use today have been scientifically proved to be effective. The remainder have not been subjected to empirical trials to determine whether they work or, if they do, how. Nevertheless, most of these treatments are beneficial and, and some cases, the benefit may come from the placebo effect.

Placebo usually are mistakenly defined in terms of what they are not. They are called inactive, but placebo agents are clearly active. They are described as nonspecific, presumably because they relieve multiple conditions and because their exact mechanism is not fully understood. Placebos, though, are no less specific than such remedies as aspirin or certain tranquilizers. Most narrowly, a placebo is defined accurately as a pharmacologically inert capsule or injection, although this does not take into account the extent of the procedures that have a placebo effect.

Placebos most likely work as does much of alternative medicine. Including such therapies as homeopathy, imagery, therapeutic touch, and herbal remedies, alternative medicine offers, to a greater extent than conventional care, the healing ingredients of the treatment situation. These elements include healing rituals and symbols--for example, a thorough physical evaluation and the healer's enthusiasm and commitment, encouragement, attention, positive regard, and high expectation lot improvement. Like most treatments of the past and many conventional treatments of today, most alternative therapies probably have no intrinsic therapeutic value. Their benefit comes from the placebo effect.

People most often receive placebos during double-blind clinical trials. In such research studies, one group of individuals is given an active drug; the other, a placebo pill. Neither group knows which agent is given. These studies most often are done to investigate the effects of the active drug. It turns out that the patients who are given a placebo receive much...