Skyline Happenings

Thanks to Ed M.

Ed Note: I’ve always been fascinated with the placebo effect, the poorly understood but real connection between mind and body. Click here for my story concerning the placebo effect on one of my own patients.

by Denis Benjamin Jul 17

These two anecdotes occurred in the remote past during my medical training in Johannesburg, South Africa. One of our clinical rotations was to staff a clinic in an adjacent African township. During the day, we were supervised by medical staff, but after 5.00 pm, we were on our own, apart from a group of outstanding nurses.

At Alexandra Clinic, a black township on the northern edge of white Johannesburg, we began noticing young males arriving after work in the early evenings with vague complaints directed to areas below the belt. It soon became apparent that there were two probable diagnoses — gonorrhea or what they considered impotence. Such erectile dysfunction was clearly in the eye of the beholder, as these were young, healthy, virile men for whom any decrease in sexual prowess and performance was a personal concern.

Many cultures have developed ways of dealing with the problem of diminished male performance, employing everything from magic to even more magic. Dozens of herbs, spices, minerals, fragments of animal parts, insects, and various incantations have been tried. Even eating stinkhorn mushrooms, which are penile in appearance, require considerable fortitude for consumption. But anything is possible if one can stomach durian, the foul-smelling, although delicious tropical fruit. The little caterpillar fungus from the Tibetan highlands, Orphicordyceps sinensis, is favored by the colossally rich Chinese, as it is more costly than gold and equally ineffective. The issue is so troublesome and potentially lucrative that it enticed pharmaceutical companies to spend billions of dollars to develop a little blue pill. But that discovery was still years away.

We decided to run a small experiment at the clinic. This was done without sanction from above and long before Institutional Review Boards had to bless any form of medical research. We did not fill out reams of paperwork or ask the subjects for informed consent. These were the wild-west days of clinical research and would not be sanctioned today. We opted for two types of treatment — conventional Western-style psychotherapy or a placebo. In other words, we would either have a long discussion about the problem and how it might be mitigated — stress reduction, no alcohol, no dagga (marijuana) — or get an intradermal injection of sterile water. This was the proverbial dose of a sugar pill, except this water injection was painful. It was a riff on a Chinese aphorism that ‘good medicine tastes bitter.’ (continued)