YJHM: Ed Cohen, "The Placebo Disavowed: Or Unveiling the Bio-Medical Imagination"

The May 24, 2001, issue of The New England Journal of Medicine contained a provocative article by two Danish researchers Asbjorn Hrobjartsson and Peter Gotzsche entitled “Is the Placebo Powerless?” Based on a meta-analysis of 130 clinical trials for a wide range of treatments (including pharmacologic, physical, and psychological protocols) that provided comparisons of placebo with non-treatment results, the authors concluded: “We found little evidence in general that placebos had powerful clinical effects. . . . Outside the setting of clinical trials, there is no justification for the use of placebos.”[i] Proclaiming the “newsworthy-ness” of this conclusion, Gina Kolata, science correspondant for The New York Times, published a first section assessment of the responses to the article that began: “In a new report that is being met with a mixture of astonishment and sometimes disbelief, two Danish researchers say the placebo effect is a myth.”[ii] While the characterization of the placebo effect as “myth” in order to distinguish it from “real science” might at first glance seem a consequence of poetic—or at least journalistic—license, it in fact recapitulates the frame offered by John C. Bailar III, M.D., Ph.D., in the editorial comment introducing Hrobjartsson and Gotzsche’s piece. Pointedly entitled “The Powerful Placebo and the Wizard of Oz,” Bailar’s commentary opens with the following rhetorical gambit: “Some myths really ought to be true.”[iii] Recasting as fiction an idea that had circulated as a scientific fact for the preceding half a century, Bailar preemptively disqualifies the placebo as “myth,” figuratively ostracizing it from the domain of bio-medical “truth.” He then succinctly describes what he takes to be the placebo’s main conceptual difficulty: “Is the improvement in patients given a placebo a result of the placebo itself, or of natural fluctuations in the progression of the disease, or of how the patient responds to the symptoms?”[iv]