The Pharmaceutical Journal
Vol 273 No 7327 p796
27 November 2004

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So how do placebos work? more
Foundation creams used by Romans in London more
Conservation of our heritage: physicists and biologists united more
And I quote… more

So how do placebos work?

An editorial in the BMJ for 23 October offers an interesting discussion about placebos, whether they work in clinical practice, and how they work. And in this issue of The Journal Edzard Ernst debates the ethical issues of using a biologically inert or irrelevant substance in a deliberate therapeutic activity (see p795, PDF 45K). Yet placebos are being used, sometimes to respond to a patient’s unreasonable demand for a medicine, sometimes to allay a patient’s worry, for possible analgesic or tranquillising effects or even as a diagnostic tool.

Different cultures induce different responses to placebos, but research has shown that a placebo-responder need not be unintelligent, uneducated, histrionic or free of serious illness. Moreover, in some instances it has been shown that the nocebo effect, the reverse of the placebo effect, exists. This means that if the recipient expects no benefit from a substance he or she makes a negative response, whereas with a placebo a positive response follows the expectation of an effect.

The usefulness of a placebo other than in relieving pain has been doubted. Nevertheless, it is generally accepted that an idea, a feeling or a relationship can produce a real effect on the body, and the anticipation of benefit can increase resistance to disease. This may stem from the physiological consequences of stress reduction.

We need not regard the placebo response as a piece of deceit on the part of the prescriber. The relief of pain, for instance, does not mean that the placebo is doing nothing because there is no real pain to overcome. After all, psychological procedures such as hypnosis are capable of altering pain perception, by redirecting attention and so reducing its intensity. So, it is misguided to use a placebo to diagnose the reality or otherwise of pain of which a person complains. It should rather be seen as a means of establishing a special relationship between therapist and patient.

Since it obviously works, although we still do not know how it does so, the placebo is something with which we cannot dispense. The one thing we should never do is to tell a patient that he or she is being palmed off with something that has no therapeutic effect at all.

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Foundation creams used by Romans in London

An intriguing account by a group of chemists from Bristol and London is published in Nature for 4 November. It concerns the manufacture of a cosmetic face cream discovered during archaeological excavations in a Roman temple precinct in London. A small tin canister was unearthed, complete with its lid and contents, a most unusual discovery.

A whitish cream was present in the canister, slightly granular and showing 50 per cent carbon and 8 per cent hydrogen on analysis, with no detectable nitrogen or sulphur. This suggested that no protein, such as gelatin, was a significant component. The cream was partially soluble in a chloroform and methanol mixture, the 40 per cent by weight extractive believed to consist of fatty acids of animal origin. The isomers indicated an adipose tissue fat derived from cattle or sheep. There was no evidence of any perfume component such as a monoterpene. The hydrolysed residue showed only glucose as the significant monosaccharide, but there was no free glucose in the cream. An iodine test revealed well preserved starch granules.

More than 80 per cent of the cream was of such organic constituents. Further gravimetric analysis after heating to 850C revealed an inorganic moiety constituting 15 per cent by weight of the material. This proved to be a tin compound, indicating deliberate addition of stannic oxide or native cassiterite.

The whole preparation was evidence of a sophisticated technology. When the discovered ingredients were used experimentally to make a cream, it had a pleasant texture, though initially slightly greasy. The use of stannic oxide instead of the usual lead acetate found in classical cosmetics may represent an error of the Romano-British chemists in choosing the mineral constituent meant to confer whiteness to the skin. There is no evidence that the Romans had any intention of adding it for therapeutic effects.

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Conservation of our heritage: physicists and biologists united

Sculptures and other elements of our heritage in Europe are constantly subject to the ravages of pollution, natural decay processes and even the close interest of tourists. It now seems that funding for their conservation is getting harder to come by.

According to a report by Alison Abbott in Nature for 9 September, the Centre for Sustainable Heritage based at University College London has recently declared that the financial support of governments and the European Commission, is diminishing. At present the European Commission is the only source of funding in Europe that is specifically earmarked for generic research into the maintenance of this aspect of our cultural heritage, although there may be small grants from other sources.

One project has led to the development of monitors of inorganic and organic atmospheric pollutants, including the carbon widely responsible for blackening the surfaces of buildings. Unobtrusive monitors may be sited at key sites, and have detected the influence of tourist rush hours on buildings in Florence and Seville.

A sequel has been that local authorities in Seville have restricted traffic flow past the main cathedral, which is undergoing cleaning. Another project is investigating the role of lasers to clean sensitive stone such as that of the Parthenon.

Biologists are joining the physicists by analysing the colonies of bacteria developing in caves and catacombs where tourist visits have disturbed previously stable conditions of light and air, causing damage to fundamental structures and works of primitive art. One project is investigating organisms that build calcite into hard layers in place of salty crusts.

Much is yet to be learnt about such procedures, which attempt to arrest attacks on the surfaces of important monuments that should be preserved for our descendants. Current approaches are tentative and cautious, for fear of doing more harm than good as the result of ignorance.

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And I quote…

Human rights
“The first duty of a state is to see that every child born therein shall be well housed, clothed, fed and educated till it attain years of discretion.”
—John Ruskin: ‘Time and tide’ (1867).

Time to spare
“To be able to fill leisure intelligently is the last product of civilisation.”
—Bertrand Russell: ‘The conquest of happiness’ (1930).

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