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Book Review: Placebos and the Philosophy of Medicine: Clinical, Conceptual, and Ethical Issues

As a revision of the physician-author's doctoral dissertation in philosophy, this book purports to systematically and creatively develop (1) a comprehensive view of placebo effect, (2) a theory of the mindbody relation consistent with what is known about placebos, and (3) an ethical position on the use of placebos in therapy. In the book's first two chapters, Brody examines illustrative cases to derive conceptually rigorous formal definitions of "placebo" and "placebo effect." The next three chapters deal with mind-body issues, in search of a theory that best fits the empirical evidence and the author's formal definition. This section requires three to four complete readings during which sentences trip rather than enlighten and require tedious re-examination to find the stumbling block. Finally, a "capacity theory of the person" is proposed that emphasizes language and symbol usage. The chapter that follows on ethical issues in placebo use affords the reader welcome relief. Arguments for and against placebo use are comprehensively and clearly summarized. Intriguing alternatives to placebo use are presented. Nurses will have little difficulty accepting the author's conclusion that, "If we are concerned about the actualization and not just the mere existence of our human capacities, we seek to maximize responsible behavior; deceptive practices, which deprive us of information we might need to make decisions in a responsible way, are thus to be avoided" (Brody, 1980, p. 114). In the seventh and final chapter, implications for medical research and practice are summarized. The author's effort to identify mutual consistency among theoretical propositions and to harmonize these propositions with considered judgments of clinical experience is commendable and largely successful. It is regretable, however, that no nurses are cited in the bibliography. The author refers to the growing body of medical literature on why clients often fail to comply with regimens of prescribed treatment, but makes no mention of the growing body of nursing research completed in this area (Brody, 1980, p. 119). The value of this book for nurses is uncertain and depends, inpart, on the reader's concern with the placebo effect, background in philosophy, and tolerance for dissertationese. That is, the nurse who reads this book should have a deep interest in placebos and issues concerning their use, be expert in philosophy, and be willing to deal with sentences like the following: