Born Liars

by Ian Leslie

  It would appear that you can enjoy the amazing benefits of laser heart surgery without once coming into contact with a laser.

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  Placebo is Latin for ‘I will please’. The words Placebo Domino (I will please the Lord) are in Psalm 116 in the Latin translation of the Bible that was used throughout the Middle Ages, and the phrase formed part of the Catholic Vespers for the dead. Perhaps because priests charged fees for performing the rites in which these prayers were sung, the word came to be used pejoratively, to mean an insincere consolation, or an act of sycophancy.22 The seventeenth-century philosopher Francis Bacon used it in the course of issuing a warning to rulers not to express their own opinions too openly when taking advice, lest their subordinates tell them only what they think they want to hear: a king’s advisers might ‘sing him a song of placebo’. The first known use of placebo in a medical context occurs in 1785: the second edition of George Motherby’s New Medical Dictionary defines it as ‘a commonplace medicine or method’. Already there is a hint of disparagement, and it soon became a byword for treatments that, rather than being based on sound scientific principles, were dispensed merely to please patients.

  Modern physicians know that they can relieve the symptoms of an anxious patient by offering a fake treatment. But most feel uncomfortable about curing with lies. Not only is it seen as morally dubious, but some still regard it as close to nonsensical, in scientific terms. Today’s medical establishment was founded on a hard-won separation between science and superstition, a distinction closely related to that between physical and mental phenomena, which the so-called placebo effect seems to resist. In the words of Edzard Ernst, a professor of medicine at Exeter University, placebo effects are the ‘ghosts that haunt the house of scientific objectivity’. As a consequence, they have been dismissed as illusory, unreal and unworthy of study. It wasn’t until the second half of the twentieth century that the healing power of deception began to be taken seriously, following a discovery made by a doctor in the frenzy of battle.

  Henry Beecher’s Epiphany

  On 22 January 1944, British and American troops swarmed ashore a fifteen-mile stretch of Italian beach near the old resort town of Anzio. In a perfectly executed operation that took the Axis powers by surprise, the Allies established a beachhead from which they prepared to break out and advance. Within a week, however, German troops surrounded them in large numbers and began the task of excising what Adolf Hitler called the ‘Anzio abscess’. The next four months saw some of the most savage fighting of World War II. Nearly five thousand Allied troops were killed, and eighteen thousand wounded.

  Henry Beecher was among those who landed in Italy that day. Beecher wasn’t a soldier. He was a doctor and a Harvard professor of medicine who volunteered to join his country’s war effort. He specialised in the science of pain relief. In a makeshift hospital on the beach he tended to wounded American soldiers awaiting evacuation to the safety of Allied territory. Medical supplies were limited, however, and on days when casualties were particularly heavy, the demand for painkillers would outstrip supply. One day, a soldier with particularly horrific injuries arrived just as the morphine ran out. Beecher worried that without it the operation required would be so unbearably painful it might induce cardiovascular shock. But he could see no other option. In desperation, one of the nurses injected the soldier with diluted salt water, allowing him to think it was an anaesthetic.

  What Beecher observed next changed his view of medicine forever. The patient, who had been in agony, settled down immediately following his injection, reacting in exactly the same way Beecher had observed previous patients respond to morphine. During the operation his patient seemed to feel very little pain, and displayed no symptoms of full-blown shock. Beecher was amazed. The nurse’s benign deception had worked as effectively as one of the most powerful painkillers in the medical arsenal. In the following months, as the battle raged on, Beecher and his team repeated the trick whenever morphine supplies were exhausted. It worked again and again.

  Beecher returned home convinced that what a patient believed about his treatment could profoundly affect his physical reaction to it. Back at Harvard, he gathered his colleagues and proposed a rigorous investigation of the phenomenon. The papers that Beecher and his colleagues went on to publish, which were based on reviews of clinical drug trials, contended that placebo effects were far more widespread than had been acknowledged. Beecher forced the medical world to confront what it had long tacitly recognised but hadn’t, until then, attended to: the real benefits of imaginary medications.

  If people’s bodies responded to treatments that existed only in their minds then it followed that there was probably an imaginary component to the effects of genuine medical interventions. In a 1955 paper entitled ‘The Powerful Placebo’, Beecher argued that clinical trials of new drugs were incomplete and inaccurate unless they took the placebo effect into account. Even with drugs that worked, patients improved partly because of the therapeutic effect of the very act of taking a pill from a clinician. To test a new drug, it was therefore necessary to subtract the improvements in health due to placebo effects from the actual effects of the medication. Beecher proposed trialling every new medicine on two groups of patients: one which received the drug, and one which received what they thought was a drug, but was in fact inert – a sugar pill or similar.

  Beecher’s work was the catalyst for a fundamental change in clinical practice in America and across the developed world. Now, to win government approval, a new medication has to beat a placebo in two authenticated trials. What’s more, the trials must be double-blind. Since the placebo effect seems to be affected by what people believe about the drug, neither doctors nor patients are meant to be able to discriminate between the placebo pill and the real pill. The double-blind clinical trial represents an attempt to strip out the effects of deception and self-deception from the actual effects of a treatment.

  Beecher showed that placebo drugs had objectively measurable physiological effects, sometimes matching or exceeding those of powerful drugs. Even so, there remained a sense within the medical profession that such effects were an aberration from the norm, and somehow illegitimate. Explanations were sought in the personalities of the individual patients. Medical researchers, confident as ever in their own vice-like grip on reality, speculated that ‘placebo reactors’ were unusually suggestible people – delusional, neurotic, or simply not that bright. A 1954 paper in the Lancet remarked that the placebo effect was useful in treating only ‘unintelligent or inadequate patients’. But no substantial evidence has ever been found to support the idea that certain individuals are more prone to placebo effects than others.

  In the 1980s, advances in brain science started providing hard, ‘biochemical’ explanations for the power of placebos. A psychiatrist called Robert Ader administered saccharin-flavoured drinking water to rats, and at the same injected them with a chemical that suppressed their immune system and made them ill. When a group of the same mice were fed the same flavoured water but without the injections, they reacted the same way. The drink, because originally associated with the injections, now triggered the same illness as the poison. Ader had created a placebo with undeniable physiological effects (strictly speaking he had created a ‘nocebo’ – an inert drug or otherwise benign event that triggers illness. Nocebo means ‘I shall harm’).

  Later studies confirmed the strange ability of placebos to create real physical changes in the human body. Fabrizio Benedetti, a neuroscientist at the University of Turin, has been experimenting with placebo treatments for nearly twenty years, and observed them alleviate physical pain, digestive illnesses, depression, and even Parkinson’s disease (by telling a Parkinson’s sufferer, falsely, that a surgically implanted electronic module in their brain had been switched to ‘on’, he found he could relieve their symptoms, albeit only temporarily). He has closely mapped the biochemical responses of his patients’ bodies to their diffe
rent beliefs about the treatment. According to Benedetti, placebos act as a catalyst for the body’s own internal healthcare system. If you hear a fire alarm and see smoke, your adrenalin shoots up and your heart rate increases, preparing you for a quick escape. Similarly, when the act of taking a placebo sends a signal to the brain that it’s time to start getting better, the body’s healing chemicals go to work.

  The placebo effect has its limits. There’s no evidence to suggest it can stop the growth of cancerous tumours, for instance. It seems to work particularly well for conditions involving physical pain, or those related to higher-level mental functions, like depression. In those cases, if we expect to feel better, we are more likely to get better, even if this expectation is based on a lie. The pharmaceutical industry now treats placebo effects as significant, and the research of Benedetti and others has gone some way towards establishing that placebo effects involve real physiological actions. Nonetheless, such effects are for the most part still studied through the lens of biology, because this is the sole context in which medical science traditionally thinks about human bodies. But perhaps placebo effects ought to be taken as a hint to broaden the scope of modern medicine. If a lie heals it’s because it has meaning – and meaning is made between people, not inside them.

  The Seeds of a New Science: Franklin vs Mesmer

  On 22 May 1784, a group of the most eminent thinkers in France gathered in the elegant gardens of the American ambassador’s residence at Passy, just north of Paris. The distinguished gentlemen were there to witness a spectacle that the uninformed visitor might have taken for a bizarre initiation rite or obscure theatrical performance. A twelve-year-old boy wearing a blindfold was being guided from tree to tree by an older man. Each time they stopped by a tree, the boy would embrace it for two minutes. At the first tree, he began to sweat, cough, and foam at the mouth. At the second, he complained of dizziness. At the third, his symptoms worsened, and by the time he touched the fourth he collapsed, moaning, to the ground. The man picked the boy up and laid him out on the lawn in front of the spectators. The boy contorted into a series of strange shapes, before he abruptly rose to his feet, dusted himself down, and declared himself cured. The gentlemen did not applaud. Perhaps one or two of them nodded gravely, or wrote a note. Among them was the ambassador himself. Benjamin Franklin, we may assume, was experiencing a somewhat weary satisfaction in being proved right again.

  This scene wasn’t a rite, it was a test; although the man whose ideas were being tested wasn’t present. The dis-coverer of ‘animal magnetism’ would have nothing to do with any investigation of his methods.

  Other than being immortalised in the word ‘mesmerise’, if Franz Anton Mesmer is remembered at all today it’s as a quack, a fraud and a showman. But Mesmer, German by birth, regarded himself as an enlightened man at the vanguard of science. As a young physician at Vienna University he became fascinated by the medical implications of Newton’s discovery of gravity and set out to find whether human bodies were in harmony with celestial bodies. Mesmer experimented with passing magnets over and around his patients’ bodies. His (mostly female) subjects reported strong sensations of energy rippling across them as he did so; some succumbed to violent convulsions, and afterwards felt much invigorated.

  Mesmer then discovered he could derive the same effects by simply waving his hands over the patient’s body. This was the apple falling from the tree. He concluded that he had discovered a form of magnetism that was exerted by all living bodies upon one another through the medium of an invisible fluid that flowed from the stars, surrounding and penetrating everyone. Sickness resulted when its flow through the body was blocked by an obstacle; health was restored when the fluid was set free. Since the universe tended towards harmony anyway, the physician’s role was merely to assist and augment natural healing. It was an art which only Mesmer and select disciples were qualified to practise. Mesmer, who was sceptical of the established church, had done nothing less than reframe the religious art of exorcism for a more secular, scientific age – and made himself a priest.

  A man of few words, Mesmer cut a commanding figure; tall with piercing eyes and a broad, blank screen of a forehead. His colleagues in Vienna were hostile to his radical ideas, and so in 1778, aged 44, he moved to Paris, the centre of Europe’s intellectual ferment. With the help of his wife’s money, he rented a grand apartment on Place Vendome, laid down heavy, sound-muffling carpets, and filled the main room with various exotic objets. The room’s centrepiece was an impressive-looking, if bizarre, apparatus: a ten-foot tub made of oak, filled with bottles of ‘magnetised water’. The tub had holes in the lid, out of which protruded jointed iron rods. When everything was in place, the mysterious doctor from Vienna announced that he was open for business.

  Mesmer favoured communal healing sessions. They soon became the hottest ticket in town. With the curtains drawn, Mesmer’s fashionably attired patients sat cross-legged in concentric circles around the tub. Holding hands in the dim light, and bound to one another by a rope cord, they formed a ‘chain’ through which the fluid could flow, like electricity through a circuit. Ethereal, other-worldly music floated in from the next room. When the last whispering died away, Mesmer entered. Dressed in a lilac taffeta robe, he moved slowly amongst his patients, gently prodding them with an iron wand. Now and then he might sit directly opposite a patient, foot against foot, knee against knee, place his hand on their head or shoulder, and stare directly into their eyes. His subjects sighed, shrieked, fell into trances or collapsed, writhing, on the floor, at which point an assistant would carry them to a special, mattress-lined ‘crisis room’ to restore their composure. When Mesmer’s patients walked out, blinking, into the light of a Parisian afternoon, they declared themselves miraculously cured of ailments ranging from ennui to asthma to gout and epilepsy.

  Mesmer had arrived in Paris in the year of Voltaire’s death, when the city’s chattering classes, already bored with the dry old Enlightenment strictures of reason and scepticism, were falling in love with a new enchantment: popular science – and barely-examined pseudo-science. The world was full of mysterious, wonderful forces: Newton’s gravity, Franklin’s electricity, Lavoisier’s oxygen, the gases of the Montgolfiers that – did you see? – could transport men through the air. Who was to say that Mesmer’s invisible fluid was less real than these or the countless other substances (ether, miasma, phlogiston) said to be permeating the world?

  In these hothouse conditions Mesmerism quickly become a sensation, and Mesmer one of the most talked-about men in Europe. He grew wealthy from a steady stream of rich patients, and by franchising his methods to secret societies. Mesmer’s practice was discussed in journals, portrayed in salacious cartoons, parodied on stage, sponsored by Queen Marie Antoinette, and hotly argued over in academies, cafes and salons. There were more pamphlets produced on Mesmerism than on politics during this period, even as the French state creaked and revolution brewed. Mesmer’s followers regarded him as the man who had solved the problem of human suffering. His critics denounced him as a charlatan, and a dangerous seducer who preyed on the women he stroked and excited.

  Mesmer’s popularity was a source of anxiety to conventional doctors and scientists, whose credibility and livelihoods were at stake. In 1784 the king agreed, after considerable lobbying, that it was time to draw a line separating science from superstition, truth from lies. He formed a Royal Commission to establish once and for all whether Mesmer’s treatments worked through the action of animal magnetism, or simply because people were deceived into thinking that they worked. The commissioners included Antoine Lavoisier, now regarded as the father of modern chemistry, the astronomer Jean-Sylvain Bailly, and Dr Joseph-Ignace Guillotin, a professor of anatomy who gave his name to the device that would eventually slice off the heads of Lavoisier and Bailly. Even in this august company, the commission’s most prestigious member was Franklin.

  Given that this was a purely domestic affair it m
ight seem odd that the king should request the involvement of the American ambassador, especially one whose primary job was squeezing loans out of his government in order to underwrite an experiment in republicanism. But Franklin held a special place in the hearts of the French. Back home, he was an admired but distant figure, whose affection for England and France made him suspect in the eyes of some. In France, however, he was revered. Monsieur Franklin was lionised as the man who tamed lightning and founded America. He was esteemed for his devotion to liberty and free-thinking, and adored for his exuberant, lavishly dispensed charm. His image was found everywhere, in paintings and prints, on snuff boxes, rings and coins. Placing Franklin on the commission was a shrewd move on the king’s part: if anyone could convince the public that this investigation wasn’t a cynical exercise in the humiliation of an over-popular foreign celebrity, it was the ultimate foreign celebrity himself.

  Franklin had met the man whose methods he’d been charged with investigating. Oddly enough, their paths had crossed due to a kind of musical placebo: the armonica, a glass-based instrument, known for its healing qualities. It was an instrument that Franklin had invented and Mesmer loved.23 The German had one in his mansion in Vienna and liked to play it for guests, including his friend Leopold Mozart and Leopold’s son, Wolfgang Amadeus, who later composed several pieces for the instrument. Mesmer took it to Paris and in 1779 he invited Franklin and Madame Brillon, a mutual friend, to his home to hear him play. At least, that was the pretext. Mesmer was still angling for the approval of the Establishment at that time, and he spent the evening attempting to engage Franklin in a discussion of his magnetic fluid. Franklin took great interest in his host’s armonica-playing.