Social and Cultural Lives of Immune Systems

By James M. Wilce Jr | Go to book overview

Notes
1
Acknowledgments. The research for this paper was supported by NSF grant number SBR-9421128. Barry Bogin and Robert Hahn read the manuscript and improved it significantly. Ton de Craen provided very helpful discussion, especially regarding methodology, and Lynn Payer gave useful counsel on German medicine. The editor and several anonymous reviewers from MAQ provided useful advice. I also wish to acknowledge the unceasing support, financial and moral, of the University of Michigan-Dearborn in my work for a quarter century. For my grandson, Spencer.
2
The negative effects of meaning are called “nocebo effects”; I do not deal with these effects, except in passing, in this article. Anthropologist Robert Hahn has written extensively about the nocebo effect (Hahn 1997).
3
The definition of placebos and the placebo effect is an extremely vexing and difficult matter. Since the essential problem (and promise) of the placebo effect appears to be getting something (healing) from nothing (inert pills), the matter seems inherently paradoxical. For a demonstration (unwitting?) of these paradoxes, see Gøtzsche 1994. The definition adopted here differs from many others in that it differentiates placebo effects from other non-drug elements of the medical process that may account for healing (some things go away by themselves, for example). It posits a cause (meaning). It is not said to be nonspecific, or, as I have said in the past, “general. ” Note that, if placebo effects are said to be nonspecific, and if, subsequently, the mechanisms are identified so that the effects became “specific, ” they would no longer be placebo effects. To specify that something (meaning, mass) has an effect (healing, gravitational attraction) is not to specify exactly what that effect is or how it happens to be.

Ed. Placebo effects might in part be explained by the ability of meaning per se (Moerman and Jonas 2002) to affect immune response. While “Medicine’s symbolic reality is the first principle of medical anthropology” (Moerman), solid evidence about the semiosis (see Introduction to this volume) of placebo effects is still very much needed.

4
It may be worth noting that many are, indeed, intensely skeptical; while the placebo effect is commonplace, it also poses a serious challenge to much of the ideology of biomedicine, in particular, the reductionist notion that disease is a mechanical phenomenon. Much of the literature about the placebo effect is, in effect, an effort to debunk, confuse, or minimize it (Gøtzsche 1994). Even much of the more positive work usually simply suggests that the placebo effect exists, and that physicians should try to enhance its workings in their patients (Chaput de Saintonge and Herxheimer 1994, for example). Efforts to try to actually move forward our understanding of this fundamental human phenomenon are very rare.
5
This is illustrated in a rather complex study of the effect of biofeedback training on migraine headache (Kewman and Roberts 1980). Several different training groups were established along with a group that received no training; all groups kept diaries of their headaches for six weeks. All groups, regardless of the presence or absence or effectiveness of training, had fewer headaches at the end of the study than at baseline. Diary-keeping was quite elaborate and included symptom checklists, impairment ratings, and so on; subjects were reminded with phone calls every ten days or so to continue their diaries. The one thing always associated with improvement in migraines was diary-keeping. A similar three-arm trial of treatment of nausea and vomiting during pregnancy showed that patients wearing acupressure bands, those wearing acupressure bands improperly placed, and an “untreated group” all improved over the study period;

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