NOTES & COMMENT

Better Living Through
the Placebo Effect

It pays to believe

ATE in his life the famous chemist
Linus Pauling devoted himself to cur-
ing the common cold. Perhaps, lying
in bed one day filling paper bags with used
tissues, he calculated just how much suf-
fering this run-of-the-mill virus inflicts
on humanity. Using statistics from stan-
dard medical texts, he would have con-
cluded that over a lifetime the average
person is subjected to some 24,000
hours of coughing, throat pain, conges-
tion, and headache from colds. Though
each cold is, of course, a relatively minor
illness, most people’s total accumulation
of suffering from colds is immense. If he
could cure the common cold, Pauling must
have thought, or even alleviate its symptoms,
he would be doing humanity a great service. At
the age of seventy he claimed to have the answer: in his book
Vitamin C and the Common Cold (1970) he argued that large
doses of vitamin C could prevent the onset of colds or help to
minimize their symptoms.

But there was a problem: Pauling had no real evidence to
support his claim. On the contrary, at least sixteen studies, car-
tied out before and since, have shown that vitamin C does not
prevent colds; at best it may slightly re-
duce a cold’s symptoms, but even this is
widely disputed. Pauling’s own laborato-
ry came up with only the anemic finding that high doses of the
vitamin could reduce the average number of symptomatic
days per cold from 7.8 to 7.1.

Pauling’s colleagues tried to be respectful to the man once
considered the world’s greatest scientist, but in private many
snickered. Pauling must be senile. It was a shame to end such a
brilliant career on a false note.

My brother, a doctor who also has a Ph.D. in neurophys-
iology, offers an alternative explanation. Perhaps Pauling was
neither senile nor misguided. What if he was using psychology,
instead of chemistry, in a culminating act to alleviate human
suffering? He may have been counting on the drug that Steve
Martin touted in one of his early stand-up routines, a pill that

16 Illustration by Christoph Niemann

 

by Marshall Jon Fisher

made Martin feel ecstatic. “It’s called,” Martin
would intone in a dramatic voice, “Plah-
Cee-Bo.”
Vitamin C may have no physiological
effect on colds, but there is evidence for
a strong psychosomatic component in
people’s susceptibility to colds. Re-
searchers have shown that those who
take a placebo in the early stages of a
cold experience milder symptoms.
Some studies have found that the
placebo effect can also palliate symp-
toms of asthma, sciatica, and even con-
gestive heart failure and cancer. Cancer
patients whose disease has spread to the
bones are often treated with radioactive
isotopes, which chemically bind to bone and
alleviate pain, probably by killing adjacent
nerve endings. In numerous studies some patients were inject-
ed with a radioactive isotope and others with a placebo. Ap-
proximately 75 percent of those who got the chemical treatment
reported partial or complete relief from their pain. However,
about 30 percent of the placebo group also reported relief.

In the 1950s, in order to test the effectiveness of a new sur-
gical treatment for angina, surgeons at the University of Kansas
Medical Center performed real operations

on one group of patients and “placebo
operations” on another group. The place-
bo patients were told that they were going to have heart sur-
gery. They were given a local anesthetic, and incisions were
made in their chests. But no therapeutic procedure was per-
formed—the surgeon simply fiddled around a bit in the chest
wall for show. The patients left the hospital with scars and with
pain at the incision sites; they had no reason to believe they had
not undergone the proper surgery. Seventy percent of the pa-
tients who had had the real surgery reported long-term im-
provement; ail the placebo patients did: Many declared them-
selves fully cured and returned to physically demanding jobs.

Pauling would certainly have been aware of the placebo re-
search. He was also undoubtedly aware of the authority he com-
manded as the winner of Nobel Prizes in chemistry (1954) and

OCTOBER 2000
peace (1962). If he declared that vitamin
C prevented colds, people would believe
it. And if they believed it, then it would be
true. And so, my brother’s theory goes, he
pronounced his “discovery,” knowing that
it was false but that it would nonetheless
alleviate an enormous amount of suffering
until a real cure could be found.

Pauling claimed that he himself took
12,000 milligrams of vitamin C a day, and
40,000 whenever he felt a cold coming on
(the Food and Drug Administration’s rec-
ommendation is sixty milligrams a day).
He spent decades defending his theory and
his reputation. He also declared that vita-
min C was effective in treating heart dis-
ease and other serious illnesses. And he
swore that vitamin C had enabled him to
fight off prostate cancer for twenty years.
(He succumbed to the disease in 1994, at
the age of ninety-three.) Most scientists
took all this as a sign of senility. But, one
could argue, Pauling would have had to
feign absolute belief in order to foment
a worldwide placebo effect.

In the end, the fact that Pauling ad-
vocated such high doses of vitamin C—
much higher than needed for a placebo
effect, and so high that dangerous side
effects could occur—casts doubt on this
explanation. It’s more likely, my brother
admits, that Pauling did take leave of
some of his faculties. Still, the Pauling Pla-
cebo, whether intentional or not, has sure-
ly worked. Over the years, Pauling’s dec-
larations have diffused throughout the
public consciousness. Millions of people,
many of whom have never heard of Linus
Pauling, have taken vitamin C to ward off
colds. And many of them have unques-
tionably benefited.

8 a e

Another supposed antidote to the com-
mon cold recently hit the market, in the
form of zinc lozenges. A 1996 study pub-
lished in the Annals of Internal Medi-
cine showed that cold patients who took
zinc lozenges were relieved of symptoms
three days sooner than patients who did
not. A few other studies confirmed this re-
sult, but an equal number found that zinc
had no effect. Many doctors, including
my brother, suspect that the zinc lozenges,
too, are mainly placebos. Not that that di-
minishes their effectiveness. In fact, my
brother starts popping zinc whenever he
feels a sore throat coming on. This may be
the first time someone has deliberately
used a placebo to cure himself. Once |
made the mistake of referring to the refut-

ative studies, and my brother cut me off,
“Don’t talk about that!” he said. “You'll
ruin my placebo effect!”

Those of us unable to get around this
Catch-22—unable, that is, to believe
something that we know will be true only
if we believe it—pay for our clearheaded-
ness. Neither vitamin C nor zinc staves off
our colds; we stay home drinking tea and
mixing and matching antihistamines and
decongestants, cough suppressants and
expectorants, while our more gullible
friends are out enjoying tennis and the
theater. And our pain is not limited to the
physical. For instance, it must be a great
comfort to believe in God. But how can
one believe simply because one knows
that belief would provide comfort?

The placebo-resistant are also less suc-
cessful in life. Most people agree that
self-confidence is an advantage in almost
any endeavor. It helps talented people to
fulfill—and to market—their talent; it also
helps people without much talent to suc-
ceed beyond any reasonable expectation.
Many people, though, the talented and the
untalented alike, are less successful than
they might be, owing to low self-esteem.
They are unable to believe in themselves
just because that belief would be self-
fulfilling. Instead they watch helplessly
as others rise through the ranks above
them, buoyed by robust, if sometimes de-
lusional, self-assurance.

« a s

The last few times I’ve had a cold, it’s
been followed by a cold sore that made
me recall my scratchy throat and stuffed
nose with nostalgia. When I complained
to my brother, he told me about some
studies that have shown vitamin E and
vitamin C with citrus bioflavonoids to
be effective against cold sores. The next
time I saw him, he gave me a bottle of
each. I scrutinized his expression. Was he
on the level? Or was he trying to ease my
suffering by creating a placebo effect? I
had never heard of the studies he’d men-
tioned, but as a layperson, I probably
wouldn’t have. It didn’t seem worth spend-
ing hours in a medical library just to try
to prove the pills useless.

The next time [ got a cold, I took the vi-
tamins. And I didn’t get a cold sore. I start-
ed taking the vitamins whenever I felt the
slightest symptoms of atvold, and I haven’t
developed a cold sore since. Did the vita-
mins work? Did my belief in the vitamins
work? Or have I just been lucky this year?
I don’t know, and I don’t want to know. &

OCTOBER 2006