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The placebo remains an ever controversial topic in medical care, and evermore so in its use as a therapeutic tool in the treatment of patients. While contemporary research increasingly acknowledges the existence of a placebo-effect, its ethicality is still questioned.

A placebo is often referred to as an inert pill, that is, a medicinal carrier that resembles a medical drug, but does not contain any active ingredient [1]. It is identical to the actual drug, that is, indistinguishable by the optic, olfactory, gustatory or palpable senses, yet lacks the medicinal component. The ethical controversy exists over the trickery that is undertaken when a patient is, credulously, taking a substance believed to be a medicinal drug aimed at improving his state of health. By giving a placebo, the trust and belief of the patient is raised to the level of a therapeutic intervention whereby the inherent self-healing abilities of the mind and body of the individual are sought to be activated without a medicinal stimulus or interaction. Yet, giving an ill individual an inactive drug, that lacks the therapeutic agent is deemed unethical, therefore its application in healthcare practice is viewed critically.

The placebo was a known and frequently used tool to Hahnemann in his practice of homeopathy. The following is a summary of Hahnemanns description of the placebo taken from the Organon [2]. His postulations leave no doubt of the usage of the ‘unmedicated’ remedy.

The first reference to the placebo is in aphorism 91.Here Hahnemann refers to the complication of cases that have been long-lasting and have in their duration received medicinal treatment. He notes that in such “ protracted cases…the patient may have to be left without medication or may have to receive something unmedicinal. This abstinence from active treatment, so Hahnemann insists, will permit the practitioner to obtain the enduring and unmixed symptom picture. From this the practitioner will then to be able to make out the unmistakable state of illness of the patient, that is then devoid of any prior medicinal impact, and consists only of the pure picture of the original illness.

In aphorism 96 Hahnemann continues that certain states of mind of the patient do not require medicinal interventions and notes that “the so-called hypochondriac, the very sentimental or the grumpy persontend to exaggerate in the account of their complaint; “in order to spur the doctor to help, they describe their suffering with eccentric expressions. In such cases Hahnemann suggests using a placebo to separate the exaggeration from the true state. He further directs to aphorism 77 where he explains that patients may suffer of a state that he describes as ‘vexation’ or ‘chagrin’, which he further defines as self-inflicted sickliness. He states that such ailments will improve on their own when lifestyle is improved.

A more specific mention of the placebo Hahnemann makes in aphorism 281. Here he follows on from aphorism 280 where he speaks of the dosology of a remedy up until the vital force only suffers of the illness created by the remedy, not anymore of the original disease, but only of the “homeopathic aggravationas Hahnemann terms it. In aphorism 281 he therefore continues to describe that a patient should be given a unmedicated medicine for 8-14 days in order to ascertain that healing has taken place and only the symptoms of that artificial ‘remedy’ illness have remained. These symptoms will vanish on their own after a short while following the abstinence of taking further active medication. If no symptoms of the original disease have remained, the patient is cured. Should this not be the case treatment has to be resumed, so Hahnemann concludes.

In particular aphorism 281 suggests that Hahnemann practiced an habitual and broad use of the placebo, of the ‘unmedicated’ remedy. This also indicates that, to him and probably the contemporaries of his time, there was no concern or controversy over the use of placebo in medicinal treatment and patient health care. For us today, the bone of contention and the controversy over the ethicality of giving a placebo remains.

References:

[1] Horn, B., Balk, J. & Gold, J. (2011). Revisiting the sham: Is it all smoke and mirrors?, Evidence-based complementary and alternative medicine, 2011, 4 pages. doi:10.1093/ecam/neq074

[2] Hahnemann, S. (1974) Organon der Heilkunst (2.Auflage) 6B Heidelberg:Karl F. Haug Verlag.

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