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Rheuminations: The Power of the Placebo

Simon M. Helfgott, MD  |  Issue: October 2013  |  October 1, 2013

Cetojevic suggested that Djokovic undergo a series of tests. For instance, he asked Djokovic to put his left hand on his stomach, extending his right hand straight out and pushing up while he pressed on it from above. “This is what your body should feel like,” Cetojevic said. Then he gave Djokovic a slice of bread and told him to hold it against his belly, while again straightening his right arm. In Serve to Win, Djokovic writes, “With the bread against my stomach, my arm struggled to resist Cetojevic’s downward pressure. I was noticeably weaker.” Cetojevic concluded, “This is a sign that your body is rejecting the wheat in the bread.” Cetojevic suggested that Djokovic eliminate gluten from his diet.

The program was hard to fathom—his parents owned a pizza parlor! Djokovic was desperate enough to try it, and, once he did, he experienced it as a complete rebirth. As he recalls: “I could tell the moment I woke up each morning that I was different than I had been, maybe since childhood. I sprang out of bed, ready to tear into the day ahead.” One day, as an experiment, he ate a bagel. He writes, “I felt like I’d spent the night drinking whiskey!”

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Novak, I think you should stick to tennis!

A History of The Placebo

The term placebo, derived from the Latin verb placere (to please), has its origin in religion. The fourth century theologian St. Jerome erred in his translation of the verb in the ninth line of the 116th psalm. Instead of translating the Hebrew phrase, “I shall walk before the Lord,” he wrote: “I will please the Lord.” (Placebo Domino in regione vivorum).3 In the Middle Ages, when hired mourners waited for the prayers for the dead to begin, they often chanted this line repetitively, and thus became known as “placebos,” to describe their feigned behavior. Similarly, Chaucer named his sycophantic, flattering courtier in The Canterbury Tales Placebo.3

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The first described use of placebo controls was recorded in the 16th century. At the time, exorcism was widely practiced. In an effort to gain control over this activity and to discredit some of its practitioners, Catholic clergy performed sham exorcism procedures.4

The medical interest in placebo effects did not gain widespread adoption until the end of the Second World War, when clinical investigators adopted the use of randomized controlled trials. This required the drug under study to be compared to an active comparator arm, which generally consisted of a placebo therapy. Study investigators noted something quite unexpected. Regardless of the drug or treatment being studied, about one-third of patients assigned to the placebo arm responded favorably.

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Filed under:OpinionPractice SupportRheuminationsSpeak Out Rheum Tagged with:patient careplaceborheumatology

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