Carl Elliott (also via Arts & Letters Daily) writes on Daniel Moerman's Meaning, Medicine and the 'Placebo Effect', which shows

that people who take their placebos diligently do better than those who take them only occasionally; that placebo injections work better than placebo pills; that brand name placebos relieve pain better than generic placebos; and that blue placebos are better sedatives than red ones - except for Italian men, for whom the opposite is true...

The placebo response is highly variable across cultures. Germans with ulcers, for example, respond to placebos at a rate twice that of people in the rest of the world. In fact, the placebo healing rate for ulcers in Germany is almost three times that of the Netherlands or Denmark. Does this mean that there is something about German psychology that makes them extraordinarily responsive to placebos? Not at all, Moerman says. When you look at studies of blood-pressure drugs rather than ulcer drugs, the situation reverses itself. In blood-pressure studies, the Germans have the lowest placebo response rate in the world. Whatever the reason for the contrast, it probably has less to do with individual psychology than with the varying cultural significance of ulcers and high blood pressure...

People who do not respond to placebos at one point in time may well respond later...

The more convinced a doctor is that a drug or a placebo will work, the more likely that it really will...

He also reviews Yolande Lucire's Constructing RSI, about the epidemic of repetitive strain injury in Australia in the 1980s.

Lucire argues that RSI is a mass psychogenic illness without a physical cause. RSI, she claims, was not the result of repetitive work, static strain, ergonomics or poor posture. It was caused by the belief that these things may harm the body. One important source of this belief was the medical profession. Some of these doctors were moral entrepreneurs: public crusaders on behalf of workplace reform. But others were simply well-intentioned practitioners. 'The kindest, most sympathetic physicians,' Lucire writes, 'became vectors of a disabling illness, one caused by the ideas inherent in its name.'..

She believes that RSI is the type of condition that in earlier times might have been called hysteria or, later on, a psychosomatic disorder, but is now more often called somatisation: the experience of anxiety, depression or stress as symptoms in the body. The symptoms of somatisation are usually inconsistent with physical and laboratory tests, inexplicable by known pathophysiological mechanisms, and do not correspond to the symptoms of known medical disorders. Yet somatising patients are not fakers. They really do experience paralysis, blindness or, as Lucire argues in the case of RSI, symptoms of pain and weakness, which can also manifest themselves as redness and swelling.

Lucire does not provide a straightforward rebuttal of the various physical explanations of RSI that have been offered in the medical literature, which is a pity, but in one of the most illuminating sections of the book she does discuss case reports (20 are included in an appendix). At the request of a third party, Lucire interviewed 319 patients in litigation over arm pain. She found little evidence that their symptoms were caused by workplace injuries, but a lot of evidence that the litigants were working under extraordinary levels of personal stress. They were undergoing divorce proceedings, financial trouble, family crisis, pregnancy, miscarriage or the threat of job loss. About a third had other significant health problems. Many were responsible for children or sick relatives.

Should I call my witch doctor? A few days after visiting my senile mother and my father in denial, which was also the weekend before classes started, I got a horrendous backache, and now that classes have started, I'm OK.