There鈥檚 a medical myth with which a friend of mine and I have become obsessed: this idea that scientific research into the 鈥減lacebo effect鈥� began in earnest during World War II. As I鈥檝e written before, the classic story is that Dr. Henry Beecher, a Harvard graduate transported to a military base hospital during the darkest days of the 20th century, ran out of morphine while treating soldiers in pain.
What did he do? He injected them with saline (a solution of salt and water to match the body鈥檚 own fluids, with no medication inside) and noticed that the soldiers鈥� pain went away just the same. After the war, he dedicated his research time to studying this apparently powerful placebo effect鈥攁lthough showed no evidence of a healing, 鈥渕ind over body鈥� placebo effect.
As with any myth, this World War II story changes in the telling. Sometimes, the saline injection is deliberate, whereas other times it鈥檚 an accident. Some say Beecher did it; others, that it was a crafty nurse. The whole discovery takes place in Italy鈥� unless it really was Northern Africa, or perhaps a Pacific Island. In one book, I saw that it was cigarettes that had been handed out in lieu of morphine!
At the time of writing, I have not seen any primary source confirming that this ever happened. Author Shannon Harvey spent days going through Beecher鈥檚 own archive at Harvard to no avail. Whenever a scientific paper mentions this story, it cites a reference that is itself citing another indirect quote, creating a tangled mess of storytellers pointing at each other when asked where they heard this bit in the first place. The earliest mention of this story I was able to find is published in 1969: 鈥淏eecher (1959), for example, has shown that in battlefield situations saline solution by injection has 90 per cent of the effectiveness of morphine in alleviating the pain associated with acute injury,鈥� wrote the author, Martin Orne. That 1959 reference? Yeah, there is no such demonstration in it, but publication of the myth in 1969 established that, contrary to one hypothesis, this entire affair was not simply misremembered from , where a contaminated box of morphine vials is temporarily replaced by pills stuffed with sugar scraped off of doughnuts. That being said, we can鈥檛 dismiss the impact that this episode of the famous TV show may have had on shaping the myth as we know it today. More on that later.
This was the state of affairs when, in December of last year, my friend hosted a livestream meetup from Liverpool that I attended virtually and during which we learned that this whole 鈥渟aline replacing morphine鈥� business might be traced back not to the Second World War鈥� but to the first one.
And given that Beecher was barely a teenager at the time, he would not have played a role in this version of the story.
A Jesuit鈥檚 deceit
Mike Hall has been, it鈥檚 fair to say, obsessed with placebo effects鈥斺�攆or many years, dissecting the near-magical claims made in their service on the podcast he co-hosts, . Placebo effects are many: they are the reasons why a medical intervention may look like it has a benefit when it fact it doesn鈥檛. It鈥檚 why clinical trials typically have a placebo arm, so that any benefit seen in those people can be subtracted from what is seen in the intervention arm, to see if the intervention has any actual benefit.
After Mike鈥檚 livestream last December, a listener who had followed both Mike鈥檚 and my commentary on placebo effects over the years and who had chatted with us during the virtual event let us know that he had found an early mention of this 鈥渟aline replacing morphine鈥� story that we might have missed. David McConnell, who is a retired IT worker with an interest in skepticism, shared a link to 聽which featured an article called 鈥淭he History of the Placebo,鈥� written by Robert J眉tte. Funnily enough, that article popped up when he repeatedly asked the artificial intelligence platform built into the Brave web browser to look for references on the topic鈥攁nd unlike some citations spewed by AI, this one was not hallucinated.
In it, J眉tte cites a Jesuit employed as a watchman during World War I who saw others administer saline injections as placebos. J眉tte鈥檚 source? Archives of the German Jesuit Province in Munich.
Given the aforementioned history of poor scholarship on the issue of placebo research, we had to track down this original source to confirm its validity. J眉tte replied that he had a copy of this century-old text possibly from his former Ph.D. student, and that McConnell could find it by writing to the Jesuit archives in Munich, which he did.
And sure enough, we received a scanned copy of this historic, typewritten text鈥攊n German. Mike Hall enlisted the help of a native German speaker to translate it, and it revealed a fascinating piece to this whole Henry Beecher/placebo research puzzle.
The tale was written by Fr. Josef Wegener鈥攁 title denoting either a priest or a Roman Catholic monk鈥攚ho relates his experience as night watchman every fifth night from March 1916 to March 1917. The ward he was assigned to was meant mainly for men who had been shot in the head. One of his tasks was to help bring the latest car-load of injured men to the ward and pull them out of their blood-soaked uniforms.
Wegener would give an evening prayer in the ward and turn off the lights. The soldiers who were better off could sleep, but those in significant pain would beg for morphine. A patient might threaten to give up on Catholicism if he did not receive this drug. This happened every night, soldiers begging for a pain reliever.
鈥淲e used extensive persuasion to avoid giving it to them,鈥� Wegener writes, presumably because morphine supplies were limited. 鈥淲hen the uproar wouldn鈥檛 stop,鈥� he continues, and here is the line we鈥檝e all been waiting for, 鈥渢here was no other way than to trick them with an injection of saline solution.鈥� (In the original German, 鈥�Wenn das Geschrei nicht aufh枚ren wollte, gab es oft kein anders Mittel, als sie durch eine Kochsalzeinspritzung zu t盲uschen鈥�.)
To be clear, this bit of arcane Jesuit documentation does not prove that the Beecher story is false. It simply demonstrates that the idea of deceptively giving pain-riddled patients a shot of saline instead of morphine can be dated back at least to the Great War. Given that the drug was first marketed to the general public in 1817 (and that the use of the opium poppy from which it is extracted has been documented as far back as the 3rdcentury BCE), we might yet find earlier instances of doctors playing this trick on their patients and hoping for the best.
But did it work?
What鈥檚 interesting in that Jesuit鈥檚 diary is that nowhere does he say that the saline helped in any way! Beecher is said to have noticed that the saline had acted as if it had contained morphine, hence his interest in placebos; but Wegener makes no such notes, which is strange given both situations involve deceitfully using saline in lieu of morphine to treat soldiers who had been brought back from the battlefield in pain. Was the placebo response not noticeable in World War I? Was it simply not documented?
Or is this whole Beecher myth concocted from collated bits and pieces into a single 鈥渁h-HA!鈥� moment primed for remembrance? The deceptive use of saline during the First World War mixed with Beecher鈥檚 later research into placebo effects mixed with that episode of M*A*S*H in which the characters run out of morphine. It鈥檚 possible we are looking at a Frankenstein鈥檚 creature of a placebo myth, which is still regularly cited in the medical literature as fact.
All I can say for now is that the investigation continues.
