Many readers of this blog will be agree that the founder of homeopathy invented placebo-therapy. However, few might know that he did this not once but twice (albeit in entirely different circumstances).
Samuel Hahnemann (1755-1843) was the first physician who administrated placebos to his patient on a systematic and regular basis – at least, this is the thesis that a medical historian with a special interest in homeopathy, R Juette, recently published. His study is based upon unpublished documents (e.g. patients’ letters) kept in the Archives of the Institute for the History of Medicine of the Robert Bosch Foundation in Stuttgart. It also profited from the critical examination of Hahnemann’s case journals and the editorial comments which have also been published in this series.
Hahnemann differentiated clearly between homeopathic drugs and pharmaceutical substances which he considered as sham medicine and called ‘allopathic medicine’. Juette’s analysis of Hahnemann’s case journals revealed that the percentage of Hahnemann’s placebo prescriptions was very high – between 54 and 85 percent. In most instances, Hahnemann marked placebos with the paragraph symbol (§). The rationale behind this practice was that Hahnemann encountered many patients who were used to taking medicine on a daily basis as it was typical for the age of ‘heroic medicine’. His main reason for giving placebos intentionally was therefore to please the impatient patient who was used to the regimen of frequent medications of ‘allopathic’ medicine.
Being a proponent of homeopathy, Juette does not mention Hahnemann’s second invention of placebo therapy: in the shape of his very own, highly diluted homeopathic remedies. Hahnemann was, of course, convinced that they differed from placebo. Two hundred years ago, this attitude was perhaps forgivable. Today, we know that a typical homeopathic medicine contains no substance that could have any meaningful health effects, and that the best evidence fails to show that homeopathic remedies produce effects that differ from placebos. In a word, they are placebos.
It follows that Hahnemann invented the routine use of placebo twice over: 1) intentionally to satisfy the demand for medication of patients who, according to his judgement, needed none, and 2) unintentionally in the form of homeopathic remedies which he thought were effective but are, as we know today, pure placebos.