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sixty years of age, all of whom lived under approximately the same village conditions, were divided into three groups of 50 each. The first group received nothing. The second group received a placebo. The third was given regular treatment with the new drug. Year by year, all three groups were carefully observed with respect to mortality and morbidity. The statistics for the first group conformed with those for other Romanian villagers of similar age. The second group, on the placebo, showed a marked improvement in health and a measurably lower death rate than the first group. The third group, on the drug, showed about the same improvement over the placebo group as the placebo group showed over the first.
    If the placebo can do a great deal of good, it can also do a great deal of harm. The cerebral cortex stimulates negative biochemical changes just as it does positive changes. Beecher stressed as long ago as 1955, in the Journal of the American Medical Association , that placebos can have serious toxic effects and produce physiological damage. A case in point is a study of the drug mephenesin’s effect on anxiety. In some patients, it produces such adverse reactions as nausea, dizziness, and palpitation. When a placebo was substituted for mephenesin, it produced identical reactions in an identical percentage of doses. One of the patients, after taking the placebo, developed a skin rash that disappeared immediately after placebo administration was stopped. Another collapsed in anaphylatic shock when she took the drug. A third experienced abdominal pain and a build-up of fluid in her hips within ten minutes after taking the placebo—before she had even taken the drug.
    It would be reasonable to conclude from the foregoing that the placebo effect applies to all drugs in varying degrees. Indeed, many medical scholars have believed that the history of medicine is actually the history of the placebo effect. Sir William Osler underlined the point by observing that the human species is distinguished from the lower orders by its desire to take medicine. Considering the nature of nostrums taken over the centuries, it is possible that another distinguishing feature of the species is its ability to survive medication. At various times and in various places, prescriptions have called for animal dung, powdered mummies, sawdust, lizard’s blood, dried vipers, sperm from frogs, crab’s eyes, weed roots, sea sponges, “unicorn horns,” and lumpy substances extracted from the intestines of cud-chewing animals.
    Pondering this grim array of potions and procedures, which were as medically respectable in their day as any of the vaunted medicines in use today, Dr. Shapiro has commented that “one may wonder how physicians maintained their positions of honor and respect throughout history in the face of thousands of years of prescribing useless and often dangerous medications.”
    The answer is that people were able to overcome these noxious prescriptions, along with the assorted malaises for which they had been prescribed, because their doctors had given them something far more valuable than the drugs: a robust belief that what they were getting was good for them. They had reached out to their doctors for help; they believed they were going to be helped—and they were.
    Some people are more susceptible to placebo therapy than others. Why? It used to be assumed that there was some correlation between high suggestibility and low intelligence, and that people with low IQs were therefore apt to be better placebo subjects. This theory was exploded by Dr. H. Gold at the Cornell Conference on Therapy in 1946. The higher the intelligence, said Dr. Gold on the basis of his extended studies, the greater the potential benefit from the use of placebos.
    Inevitably, the use of the placebo involved built-in contradictions. A good patient-doctor relationship is essential to the process, but what happens to that relationship when