The Symbolic Power of the Modern Personal Physician: The Placebo Response under Challenge

Abstract

The change in a patient's condition that results from the meaning or symbolism of the encounter with the physician, rather than from the pharmacologic properties of the interventions used, constitutes the placebo response. Placebo research suggests that the placebo response forms a part of virtually all healing encounters, and is not limited to circumstances in which a “dummy” pill is used. This suggests, in turn, that the placebo effect has been important in medicine throughout history, and that the modern physician has important elements in common with her “pre-scientific” predecessors. Historical analysis of the meaning of the healing encounter for physician and patient suggests that the personal physician, as symbolizing a human intermediary between the impersonal forces of science and the suffering patient, remains an important ingredient even in modern technological medicine. Contemporary forces toward depersonalization of medical care may threaten this dimension of treatment, but appropriate research may measure those elements of the physician encounter that most effectively promote a positive placebo response.