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of neuroimaging—which, like a live sat- ellite feed from inside the human body, permits scientists to track precisely how a person reacts to a drug (or a placebo) as soon as he takes it. An injection of saline, for example, that has been described as a drug not only will reduce symptoms of Parkinson’s disease but can help a pa- tient produce more of the dopamine that the disease destroys. Results like those have provided scientists with chemical evidence of something they had long suspected: simply believing in a treat- ment can be as effective as the treatment itself. In several recent studies, placebos have performed as well as drugs that Americans spend millions of dollars on each year. Transforming interesting laboratory findings into medicine is never simple, however, particularly when those find- ings involve fake pills and sham in- jections. Some people clearly respond better to placebos than others, though we don't know why; some illnesses and afflictions are more amenable to sugges- tion than others; and many of the most intriguing findings are tenuous. Even so, the recent research is difficult to dismiss. Through conditioning techniques, for example, our brain can “learn” different kinds of placebo effects: people first given morphine and then a placebo have one neurochemical response, while people who take ibuprofen followed by a pla- cebo have another. Different “doses” cause different reactions, and studies have demonstrated that people who suffer from headaches and consume as- pirin regularly can associate the shape, the color, and even the taste of a pill with a decrease in pain. The value of treat- ments like those—which have none of the side effects of drugs—would be im- mense, but placebos are not pharmaceu- ticals, and no reputable researcher has suggested that they will soon be for sale at your local pharmacy. Kaptchuk acknowledges that place- bos are not magic potions. “Placebos don’t shrink tumors,” he said. “They don’t make blind people see. If you are paralyzed, they won't help you walk.” He deplores the grandiose claims of alterna- tive medicine and prefers to rely on data. “Ultimately, I am not a zealot or even a true believer,” he said. “I am sure that I do not understand the placebo effect. I ask questions, hopefully valuable questions, and we will see where the research lands.” Kaptchuk practiced acupuncture for half his adult life. But he stopped twenty years ago. Despite the popularity of acu- puncture, clinical studies continually fail to demonstrate its effectiveness—a fact that Kaptchuk doesn’t dispute. I asked him how a person who talks about the primacy of data and disdains what he calls the “squishiness” of alternative med- icine could rely so heavily on a therapy with no proven value. Kaptchuk smiled broadly. “Because I am a damn good healer,” he said. “That is the difficult truth. If you needed help and you came to me, you would get better. Thousands of people have. Because, in the end, it isn't really about the needles. It’s about the man.” or most of human history, placebos were a fundamental tool in any phy- sician’s armamentarium—sometimes the only tool. When there was nothing else to offer, placebos were a salve. The word itself comes from the Latin for “I will please.” In medieval times, hired mourn- ers participating in Vespers for the Dead often chanted the ninth line of Psalm 116: “I shall please the dead in the land of the living.” Because the mourners were hired, their emotions were considered in- sincere. People called them “placebos.” The word has always carried mixed connotations. Thomas Jefferson wrote approvingly of what he called a “pious fraud,” and noted that “one of the most successful physicians I have ever known has assured me that he used more bread pills, drops of coloured water, and pow- ders of hickory ashes, than of all other medicines put together.” But, as increas- ingly specific knowledge about human anatomy emerged, people began to de- mand scientific answers to medical ques- tions. Knowledge displaced faith, and human health improved rapidly. Antibi- otics are real; placebos are not. The first publicly acknowledged pla- cebo-controlled trial—and still among the most remarkable—took place at the request of King Louis XVI, in 1784, under the direction of Benjamin Frank- lin, then the American Ambassador to France. The German physician Franz Anton Mesmer had become famous in Vienna for a new treatment he called “animal magnetism,” and he claimed to have discovered a healing fluid that THE NEW YORKER, DECEMBER 12, 201 3l HOUSE_OVERSIGHT_029926