Most ancient drugs contained no active ingredients that would benefit the patient. There are some exceptions, such as poppy milk given for pain management. At the same time ancient drugs often did contain active ingredients that could harm the patient. For example, highly toxic mercury salts were given for some chronic conditions well into the 20th century.

Given the long history of medicine, science entered medicine only recently, about 200 years ago. Using scientific method we learned to better distinguish between active vs. non-active and beneficial vs. harmful ingredients. The Food and Drug Administration started to require safety tests starting in the 1950s. As a consequence, most ancient remedies were banned from use because of safety concerns and lack of efficacy

When ancient remedies provided a therapeutic benefit, it was most likely placebo effect.

We don’t know when it started exactly, but the deceptive use of pure placebos in medical practice was widespread in the 19th century, when Thomas Jefferson called them ‘pious fraud’. Even the most successful physician he knew commonly used ‘bread pills’ and ‘colored water’ to treat patients. Most doctors considered this use of placebos safe and a ‘necessary deception.’

Today the deceptive use of pure placebo in regular patient care is broadly viewed as not acceptable in the US. I suggest that three underlying forces are responsible for this shift:

  • Entrance and embracement of science into medicine
  • Changing quality of the doctor-patient relationship
  • Trends in medical ethics and medical education

Scientific Method and Placebo

By the late 19th century, drugs with scientifically proven pharmacological properties such as quinine, an antimalarial agent, and aspirin, an anti-inflammatory drug, were discovered. Scientists like Claude Bernard and Robert Koch were one of the first to claim that scientific method should be the basis for new drug discovery and assessment.