Meaning, Medicine and the 'Placebo Effect' (Cambridge Studies in Medical Anthropology) [Paperback]

Daniel E. Moerman (Author)

Book Description

ISBN-10: 0521000874 | ISBN-13: 978-0521000871 | Publication Date: November 18, 2002

Traditionally, the effectiveness of medical treatments is attributed to specific elements, such as drugs or surgical procedures. However, many other factors can significantly effect the outcome. Drugs with nationally advertised names can work better than the same drug without the name. Inert drugs (placebos, dummies) often have dramatic effects on some patients and effects can vary greatly among different European countries where the "same" medical condition is understood differently. Daniel Moerman traverses a complex subject area in this detailed examination of medical variables. Since 1993, Cambridge Studies in Medical Anthropology has offered researchers and instructors monographs and edited collections of leading scholarship in one of the most lively and popular subfields of cultural and social anthropology. Beginning in 2002, the CSMA series presents theme booksworks that synthesize emerging scholarship from relatively new subfields or that reinterpret the literature of older ones. Designed as course material for advanced undergraduates, graduate students, and for professionals in related areas (physicians, nurses, public health workers, and medical sociologists), these theme books will demonstrate how work in medical anthropology is carried out and convey the importance of a given topic for a wide variety of readers. About 160 pages in length, the theme books are not simply staid reviews of the literature. They are, instead, new ways of conceptualizing topics in medical anthropology that take advantage of current research and the growing edges of the field.

Editorial Reviews

Review

"Daniel Moerman's Meaning, Medicine and the 'Placebo Effect' is a lucid, accessible look at the power doctors have to restore patients to health with placebos." London Review of Books

"[A]n interesting exploration of the placebo effect.... Recommended." Choice

Book Description

Traditionally, the effectiveness of medical treatments is attributed to specific elements, such as drugs or surgical procedures, but many things happen in medicine which cannot be accounted for in this way. Drugs with widely advertised names can work better than the same drug without the name; inert drugs (placebos, dummies) often have dramatic effects on people; and effects can vary hugely among different European countries where the 'same' medical condition is understood differently. Daniel Moerman reviews these matters, guiding the reader expertly through a very complex body of literature.

See all Editorial Reviews

Product Details

• Paperback: 186 pages
• Publisher: Cambridge University Press (November 18, 2002)
• Language: English
• ISBN-10: 0521000874
• ISBN-13: 978-0521000871
• Product Dimensions: 8.5 x 6.6 x 0.5 inches
• Shipping Weight: 12 ounces (View shipping rates and policies)
• Average Customer Review: 4.0 out of 5 stars  See all reviews (3 customer reviews)
• Amazon Best Sellers Rank: #651,261 in Books (See Top 100 in Books)

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21 of 21 people found the following review helpful:

5.0 out of 5 stars Meaning, not placebo: Moerman gets it right!, March 20, 2003

By 

Bruce Barrett - See all my reviews

This review is from: Meaning, Medicine and the 'Placebo Effect' (Cambridge Studies in Medical Anthropology) (Paperback)

As a family physician and behavioral scientist with strong interest in the "placebo effect", I can say without reservation that this is one of the best all-around reviews available. The "placebo paradox" has confounded reductionist thinkers for decades: if there is nothing in the pill, then how can it cause health effects? Dan Moerman doesn't have to take us far out of the conventional box to show that - of course - it isn't the inert pills, but instead the meanings attached with them that have influenced outcomes in so many scientific experiments. Meaning, belief and understanding govern how we think and feel, which in turn effect our physical and psychological health. Empty colored pills, sham surgery and suggestion lead to real health effects, even under the most rigorous of settings: randomized, double-blind, controlled trials. While reasonably comprehensive and highly accurate, this book is also accessible, as it is written with a style and flair that should prove attractive to most readers. Highly recommended it is!

Bruce Barrett MD PhD
Department of Family Medicine
University of Wisconsin - Madison

16 of 20 people found the following review helpful:

4.0 out of 5 stars The meaning response, December 24, 2004

By 

David J. Kreiter (Iowa City, Iowa USA) - See all my reviews
(REAL NAME)   

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This review is from: Meaning, Medicine and the 'Placebo Effect' (Cambridge Studies in Medical Anthropology) (Paperback)

Daniel Moerman places the words "Placebo effect" in quotations because he believes that the placebo effect should be redefined. A placebo, he explains is inert. It has no causal effect. A more appropriate definition of the placebo effect he asserts is the "meaning response."

It is because of our beliefs and the meaning we assocate with a placebo that determines its effectiveness. Despite this simple formula for determining who will respond to a placebo, it is not a very good predictor for a given individual at a given time. Studies show that there is no method to determine which individuals will respond to a placebo. Attempts have been made to remove placebo responders from studies. Occasionally, researchers will conduct a precursor trial run with a completely unrelated substance to indentify those who might respond to a placebo in an effort to cull these responders from the "real study". These attempts have been futile.

No reliable indicators have ever been found that identify individual placebo responders. In fact, a person who responds to a placebo in one study has no increased likely hood of responding to a placebo in subsequent studies. More remarkably, if one eliminates the approximately one third of the populace who initially respond to a given placebo, the remaining group will contain about the same proportion of responders in subsequent studies.

Moerman never makes the connection between these facts and the parallels to natual physical laws at the quantum level. And though they might be only coincidental, I think it worth the comparisons.

Note that a placebo has no causal effect, but instead it is meaning that determines the "effect" of a placebo. The late physicist David Bohm asserted that the entire universe is organized at all levels according to meaning. If this is true, then it substantiates Moerman's claim that meaning is operating at the macro level. But the similarites to physical law don't end here.

Moerman observed that when placebo responders are eliminated from a group, the same statistical relationships hold for the remainder of the group--approximately one third of the remaining group will still be responders in the next study.

Simlarities can be drawn with quantum processes such as the jump of the electron in orbit around the nucleus of an atom or the well-known process of nuclear decay. If one knows the half-life of a mass, it is possible to calculate exacly what proportion of the substance will remain after a given amount of time, yet nothng can be said about the transmutaion of any given atom. Divide the mass into two portions, and the half-life of each portion remains the same. As Moerman has shown this is exacly what we witness in placebo studies. It is possible to calculate statistically how many in a group will respond, but nothing can be said about which specific individuals will respond. In both cases, whether dealing with the placebo responders or nuclear decay, the process is determinate for the whole, but indeterminate for the individual person or particle. I have previously described this as a law--"nature conserves meaning".

Moerman documents many studies involving placebos from around the world. He notes that cultural differences, knowledge, and the practitioner all statistically contribute to the meaning response. In particular, it has been demonstrated that the character and personality of the physician has more to do with the outcome of placebo studies than the make up of the patient. Moerman contends that a positive and upbeat clinician or doctor transmits subltle cues to the patient making for a more positive outcome. He states that it is what the doctor "knows" that is important. If the doctor believes his patient has a possibility of getting a powerful drug, patients will do better than if he knows they will only be getting a placebo. The conclusion is sound, but the mechanism, I believe is dubious. I'm doubtful that some sort of "subtle" cues are passed onto the patient in such a consistent mannner. I wonder if it is reasonable once again to find the answer in physical law.

In the famous "double-slit" or "two-hole" experiments, it has been demonstrated that an "observer" is not necessary to change the behavior of particles. In fact, it is the mere possibility that the path or route of the particle can be determined at some point in the future that determines the outcome of the experiment. In experiments done by Marlan Scully at the Universtity of California at Berkeley it was found that it is our knowledge that determines the behavior of particles

"...It is our "potential" knowledge of the quantum system , not our actual knowledge that helps decide the outcome" (Davis, 1996).

Of course these associations with quantum processes are merely conjecture.

Daniel Moerman's book is well documented and it is obvious that much research went into this publication. If one wants a sound understanding of the placebo effect, or the "meaning response", this book is the one to read. Well done.

This book review by David Kreiter, author of "Quantum Reality: a New Philosophical Perspective".

3.0 out of 5 stars Great read for doctors, less interesting for anthropologists, October 4, 2010

By 

Sammy - See all my reviews

This review is from: Meaning, Medicine and the 'Placebo Effect' (Cambridge Studies in Medical Anthropology) (Paperback)

A review of this book must include a discussion of who the writer's audience is.

After reading, I would say that this book is a good read for the general public interested in the topic, or for physicians or others in the biomedical field. Students and scholars of anthopology might find the book less engaging.

For the first group, the book is a great review of research on the "placebo effect" and other psychological and cultural factors of the effects of medical treatments, with added commentary on the importance of understanding humans as cultural beings, and how that factors into how they experience various forms of healing and medical treatment. In his concluding chapter, he makes some very important concluding assertions such as how the cultural variation among our species is more important than genetic/biological variation when considering medical treatment. This makes for a very convincing and important treatise to serve as an introduction for physicians, biologists, and the lay public to engage the idea of culture and meaning and the place they have in medicine.

However, for the anthropologist, the book fails to engage in more than a superficial discussion of culture's place in medicine. Most instances are trite, and often relegated to citations of somewhat outdated, "freshman survey course" references to Levi-Strauss, Mary Douglass, Marvin Harris, etc. The literature on medical anthropology from the past few decades is voluminous, engaging, nuanced, and it is a shame that this body of research is not reflected in this book. In other words, those who have studied anthropology might find this book to give a boring and over-simplified discussion of culture and meaning within its pages.

Other than that, the book has a few problems. Some editorial, such as a few citations missing from the references section, and a few bad interpretations of studies (such a the blue pill, red pill study).

In closing: Great book for clinicians and general public interested in the subject, but maybe a little bit of a bore for anthopologists.