Medicine, Meaning and the “Placebo Effect” – Daniel E. Moerman

I picked up this book because David H. Newman mentions it several time in his book Hippocrates’ Shadow. He mentions it to make the point that medicine is not as effective as it seems, and that the human body, through things like the placebo response, does a lot of the healing work that we attribute to medicine.

Daniel E. Moerman is a medical anthropologist who dislikes the term placebo effect, because it is often used pejoratively and because it downplays the breadth of healing initiated by the body. He prefers the term “meaning response”, because our bodies are responding to the meaning we attach to the intervention. If someone is unaware they have been given a placebo, they don’t respond. For instance, studies have shown acupuncture to be effective for pain relief, but acupuncture given while the patient is under general anesthesia for some other reason have no effect on pain.

Moerman observes that the meaning response is so powerful it makes sense for medicine to invoke it as much as possible. Patients who respond to placebos are often seen as gullible or naïve, but he points out that no one has been able to establish any common characteristics of placebo responders. The beliefs of the medical professionals seem to be at least as important as the beliefs of the patient. In one study, patients were told they would be given either placebo, naloxone, or fentanyl for dental surgery pain. Placebo or naloxone would not reduce their pain, but fentanyl would reduce it markedly. The medical professionals were told that because of an administrative mistake, no patients would receive fentanyl in the first week of the experiment – that is no patients would get active medicine. Thereafter, patients might receive any of the treatments. All the patients were given placebo, and the study found that in the first week (when providers thought there was no chance the patients were getting fentanyl), patients had no decrease in pain. But after the first week, patients had significant pain relief from the placebo they received. Somehow the doctors were conveying to the patients that there was now a chance that they would get pain relief, and the patients were responding to that message.

I thought this book was interesting and important for medical professionals and patients, but also for counselors. He has two chapters on the meaning response in psychotherapy. One of the puzzles of psychotherapy is that psychotherapy is more effective than no treatment, but all methods of psychotherapy are about as effective as each other. Moerman argues that psychotherapy is invoking the meaning response, and lays out a framework for understanding it.

This is a more academic work than most books I read, but still very readable. I wish it was more widely read, because I thought it was an important book.

Medicine, Meaning and the “Placebo Effect”
Daniel E. Moerman
2002
Available from Amazon