The origin of the Legend of Placebo

• Jun 22, 2022 • by Paul Ingraham
Get posts in your inbox:

A weekly nugget or two of pain science news and ideas for patients and pros, usually 400–1000 words. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I’ve been reading old scientific papers. This is the bottom line of the 1955 paper that launched the Legend of Placebo:

Screenshot of a the abstract from a 1955 by Beecher. It reads in full: “It is evident that placebos have a high degree of therapeutic effectiveness in treating subjective responses, decided improvement, interpreted under the unknowns technique as a real therapeutic effect, being produced in 35.2 ÷ 2.2% of cases. This is shown in over 1,000 patients in 15 studies covering a wide variety of areas: wound pain, the pain of angina pectoris, headache, nausea, phenomena related to cough and to drug-induced mood changes, anxiety and tension, and finally the common cold, a wide spread of human ailments where subjective factors enter. The relative constancy of the placebo effect over a fairly wide assortment of subjective responses suggests that a fundamental mechanism in common is operating, one that deserves more study. The evidence is that placebos are most effective when the stress is greatest. This supports the concept of the reaction phase as an important site of drug action.”

Dr. Henry Beecher reported that 35% of 1000 patients were “satisfactorily” treated with a placebo alone. His conclusion catapulted placebo to lasting fame… and that wasn’t really questioned for a long time.

In 1996, Kienle and Kiene published a strong criticism of Beecher’s findings, but no one took much notice.

In 2001, Hróbjartsson and Gøtzsche made a much bigger splash: they reported in the New England Journal of Medicine that they “found little evidence in general that placebos had powerful clinical effects” and concluded that there is “no justification for the use of placebos” outside clinical trials. (Notably, Hróbjartsson and Gøtzsche updated their paper in 2004.)

The topic has been hotly debated ever since, but few experts still believe that placebo is “powerful.” Interesting, certainly. Potent, not so much.

I’ve updated my main placebo article with this historical perspective: Placebo Power Hype. This post is just one small piece of the extensive work I am doing this year on the theme of the mind in pain. The alleged power of placebo is one of the biggest reasons that people believe that there might be relief in psychology. If you can be fooled into a cure, then sure you can psychologize your way into one, right? Or meditate? Or de-stress?

But all that hope is based on the crumbling foundation of the Legend of Placebo! Ruh roh.

For much more about Beecher and how this all started, see The Legend of the Wartime Placebo.