Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

However, John Haygarth, a retired British physician, became suspicious about the miraculous powers of the tractors. He lived in Bath, then a popular health resort for the aristocracy, and he was continually hearing about cures attributed to Perkins’ tractors, which were all the rage. He accepted that patients treated with Perkins’ tractors were indeed feeling better, but he speculated that the devices were essentially fake and that their impact was on the mind, not the body. In other words, credulous patients might be merely convincing themselves that they felt better, because they had faith in the much-hyped and expensive Perkins’ tractors. In order to test his theory he made a suggestion in a letter to a colleague:

Let their merit be impartially investigated, in order to support their fame, if it be well-founded, or to correct the public opinion, if merely formed upon delusion…Prepare a pair of false Tractors, exactly to resemble the true Tractors. Let the secret be kept inviolable, not only from the patient but also from any other person. Let the efficacy of both be impartially tried and the reports of the effects produced by the true and false Tractors be fully given in the words of the patients.

Haygarth was suggesting that patients be treated with tractors made from Perkins’ special alloy and with fake tractors made of ordinary materials to see if there was any difference in outcome. The results of the trial, which was conducted in 1799 at Bath’s Mineral Water Hospital and Bristol Infirmary, were exactly as Haygarth had suspected — patients reported precisely the same benefits whether they were being treated with real or fake tractors. Some of the fake, yet effective, tractors were made of bone, slate and even painted tobacco pipes. None of these materials could conduct electricity, so the entire basis of Perkins’ tractors was undermined. Instead Haygarth proposed a new explanation for their apparent effectiveness, namely that ‘powerful influences upon diseases is produced by mere imagination’.

Haygarth argued that if a doctor could persuade a patient that a treatment would work, then this persuasion alone could cause an improvement in the patient’s condition — or it could at least convince the patient that there had been such an improvement. In one particular case, Haygarth used tractors to treat a woman with a locked elbow joint. Afterwards she claimed that her mobility had increased. In fact, close observation showed that the elbow was still locked and that the lady was compensating by increasing the twisting of her shoulder and wrist. In 1800 Haygarth published Of the Imagination as a Cause and as a Cure of Disorders of the Body, in which he argued that Perkins’ tractors were no more than quackery and that any benefit to the patient was psychological — medicine had started its investigation into what we today would call the placebo effect.

The word placebo is Latin for ‘I will please’, and it was used by writers such as Chaucer to describe insincere expressions that nevertheless can be consoling: ‘Flatterers are the devil’s chaplains that continually sing placebo.’ It was not until 1832 that placebo took on its specific medical meaning, namely an insincere or ineffective treatment that can nevertheless be consoling.

Importantly, Haygarth realized that the placebo effect is not restricted to entirely fake treatments, and he argued that it also has a role to play in the impact of genuine medicines. For example, although a patient will derive benefit from taking aspirin largely due to the pill’s biochemical effects, there can also be an added bonus benefit due to the placebo effect, which is a result of the patient’s confidence in the aspirin itself or confidence in the physician who prescribes it. In other words, a genuine medicine offers a benefit that is largely due to the medicine itself and partly due to the placebo effect, whereas a fake medicine offers a benefit that is entirely due to the placebo effect.

As the placebo effect arises out of the patient’s confidence in the treatment, Haygarth wondered about the factors that would increase that confidence and thereby maximize the power of the placebo. He concluded that, among other things, the doctor’s reputation, the cost of the treatment and its novelty could all boost the placebo effect. Many physicians throughout history have been quick to hype their reputations, link high cost with medical potency and emphasize the novelty of their cures, so perhaps they were already aware of the placebo effect. In fact, prior to Haygarth’s experiments, it seems certain that doctors had been secretly exploiting it for centuries. Nevertheless, Haygarth deserves credit for being the first to write about the placebo effect and bringing it out into the open.