Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
BMJ. 2012 Dec 18;345:e8326. doi: 10.1136/bmj.e8326.
To provide the first quantitative data on the use of the term "placebo" in the 19th century.
Computer search of BMJ's archival database from January 1840 (the first issue) through December 1899 for uses of the words "placebo(s)." Grounded theory was used to categorise the implications of uses of the term.
71 citations contained the term "placebo(s)." Of these, 22 (31%) used the term to mean "no effect" or as a general pejorative term, 18 (25%) portrayed placebo treatment as permitting the unfolding of the natural history (the normal waxing and waning of illness), 14 (20%) described placebo as important to satisfy patients, 7 (10%) described it as fulfilling a physician's performance role, 3 (4%) described its use to buy time, 3 (4%) described its use for financial gain, 2 (3%) used it in a manner similar to a placebo control, and only one implied that placebo could have a clinical effect. Only one citation mentioned telling the patient about his placebo treatment.
Nineteenth century physicians had diverse a priori assumptions about placebos. These findings remind us that contemporary medicine needs to use rigorous science to separate fact from its own beliefs concerning the "provision of care." As in previous generations, ethical issues concerning placebos continue to challenge medicine.
提供 19 世纪“安慰剂”一词使用情况的首批量化数据。
通过计算机对 BMJ 从 1840 年 1 月（第一期）至 1899 年 12 月的档案数据库进行搜索，查找“安慰剂”一词的用法。运用扎根理论对该术语的用法进行分类。
71 条引文包含“安慰剂”一词。其中，22 条（31%）将该词用于表示“无效应”或作为一般性贬义词，18 条（25%）将安慰剂治疗描述为允许自然病程展开（疾病的正常兴衰），14 条（20%）描述安慰剂对满足患者很重要，7 条（10%）描述它满足了医生的绩效角色，3 条（4%）描述它用于争取时间，3 条（4%）描述它用于获取经济利益，2 条（3%）以类似于安慰剂对照的方式使用它，只有一条暗示安慰剂可能具有临床效果。只有一条引文提到告知患者其安慰剂治疗情况。
19 世纪的医生对安慰剂有各种各样的先入之见。这些发现提醒我们，当代医学需要运用严格的科学来区分事实与其自身对“提供护理”的信念。与以往几代人一样，安慰剂相关的伦理问题继续对医学提出挑战。
