Facts rarely get in the way of a good story. There is a foundational myth in placebo research that has been repeated over and over again, sometimes with inexplicable flourishes, often with the variations one expects from a telephone game. You have probably read it in a mainstream publication. It’s the story of a doctor, working in dark times, who cannot do his job properly and accidentally discovers the power of the placebo to relieve pain. It is such a good story.
And it might not even be true.
What follows is a story of my own. This one is true, and it involves bad scholarship, the basement of a library, and an episode of the television show M*A*S*H.
This is my story of the story of Dr. Henry Beecher who ran out of morphine while treating soldiers, and how it may never have happened.
Despair begets discovery
The placebo effects (plural, as there are many) generate a lot of misunderstanding. Popular culture likes to simply equate them with the power of the mind to heal the body. If you have a terrible headache and a doctor in a lab coat were to give you a sugar pill but tell you that it is a powerful analgesic, your headache would vanish, pop culture says, because your body healed itself, thinking it was getting genuine medication. And, don’t you know, four pills have a stronger placebo effect than two, and red sugar pills excite whereas blue sugar pills calm you down. So say the stories.
Mike Hall has spent the past few years tracking these myths down to their academic roots on the British podcast he co-hosts called Skeptics with a K. It turns out that many of these simplistic stories are distortions of actual research that either showed nothing of the sort or contained important flaws. The father of placebo research is often said to be Dr. Henry Beecher. Mike Hall recently took an interest in how Beecher discovered the placebo response in the first place.
The story which follows may not be true. Your brain has been warned.
Henry Beecher was a medical doctor who graduated from Harvard Medical School in the early 1930s. He became chief of anesthesia at Massachusetts General Hospital in 1936 and the world’s first endowed chair of anesthesia at Harvard University in 1941. This much is true.
During World War II, he was in charge of a military base hospital. The story goes that, one day, a badly wounded soldier needed surgery and Beecher had run out of morphine. Faced with this impossible situation, Beecher improvised and injected the soldier with a saline solution (salt and water to match the body’s own fluids). The soldier relaxed and Beecher carried on the operation without anesthesia. This was the moment Beecher realized the power of the mind over the body, and he would dedicate his career to studying the placebo response.
This origin myth has been twisted in the telling. On a website about brain facts, Beecher treats many soldiers in this way and 40% report an improvement in their pain. In an article published in Review of Ophthalmology, it is a nurse who chooses to inject the soldier with saline out of despair, and the wise Dr. Beecher takes notice. Where does this discovery take place? Often, it’s in Anzio, Italy, but in a junior high school student report, it’s in Northern Africa, and in one recollection, it’s on a Pacific island where Americans were fighting the Japanese, even though Beecher’s obituary in The New York Times only mentions North Africa and Italy as the places where he served during the Second World War. Oh, and in one book, it’s not saline that tricked the soldier’s brain but cigarettes!
You would think that a story that has been described as a “Pauline conversion,” referring to the spiritual rebirth of Paul the Apostle on the road to Damascus, would have been clearly documented by Dr. Beecher himself. He did, after all, publish many papers on the use of morphine against pain and on the effects of placebos on the human mind and body. But I scanned through every paper of his that mentions morphine and did not find a trace of this story.
Academics who write about this placebo miracle sometimes do not provide a reference. If they do, it will often be to one of two papers. The first is “The Powerful Placebo,” a deeply flawed summary by Beecher of the placebo literature in 1955. It makes no mention of this story. The other came out on the heels of the war. It is called “Pain in Men Wounded in Battle.” In it, Beecher argues that morphine is often administered almost willy-nilly, and that the majority of wounded soldiers have so little pain, they do not want morphine. He hypothesizes that, in everyday life, a wound upsets normalcy and causes us to focus on that pain. It feels really bad. On the battlefield, however, a wound might release a soldier from a dangerous environment. The soldier becomes euphoric at the thought of this deliverance. The pain becomes tolerable. Interestingly, Beecher mentions a 19-year-old soldier with extensive wounds. In the confusion, he was given a sedative instead of morphine, which got him to quiet down and fall asleep. “No morphine was needed.”
While this case report rhymes with the morphine-saline story, it is not the same.
This discovery of the placebo response on the battlefields of World War II, I started to think, had the markings of an urban legend. Could it be that Beecher’s report from the war of euphoric soldiers who did not need morphine have become mashed up, over the years, with another tale, becoming this hybrid medical legend with enough legs to grow in the telling?
On Twitter, a user named NeoRenfield made an interesting observation. This story of doctors who run out of morphine while treating soldiers at war and who give them a placebo, it had been told to a very large audience.
This is exactly what happens in the season six finale of the popular television show M*A*S*H.
Could it be that an episode of M*A*S*H collided, in the collective unconsciousness, with Dr. Beecher’s early writings, and that the fictional story of what happened to Hawkeye and his fellow surgeons was transposed from the Korean War to World War II?
There was only one way to find out.
I had to contact the man who wrote that episode.
“The best doctor is right up here”
Believe it or not, I had never seen M*A*S*H. I found myself really enjoying the whip-smart comedy of its season six finale, “Major Topper.” The dialogue crackles. The characters irk each other. There are bouts of lunacy. And sure enough, one of the three storylines involves the mobile army surgical hospital running out of morphine.
One of their wounded soldiers is burning up. He may have a raging infection… or it’s possible that last box of morphine the surgeons have is contaminated and the soldier is having a reaction to it. They throw the box out to be safe, knowing they won’t be getting a new shipment until the morning. It promises to be a long night, filled with soldiers in pain who can’t get relief.
Colonel Potter, who is instructing the surgeons, calls for secrecy as he tells them a story from his childhood. His aunt was visiting and came down with a terrible migraine. The doctor, who lived across the way, gave her sugar pills, unbeknownst to her. The migraine went away. Potter suggests they do the same with their wounded soldiers during the night. “If we sell it,” he claims, “really sell it, it just might work.”
They scrape powdered sugar off of doughnuts and stuff it into capsules. When they meet again, Colonel Potter reports that it worked. “Almost half,” he says, referring to the number of soldiers who were tricked by it. “Not too bad.” Later, he concludes, “The best doctor is right up here.” He taps his head.
Where did this story come from, I wondered. Had it been inspired by the tale of Beecher running out of morphine… or did it end up inspiring it? The man who wrote this episode of M*A*S*H is Allyn Freeman. The Internet Movie Database lists “Major Topper” as the only episode of the show for which he is credited. Besides that, he wrote five episodes of Hart to Hart. Freeman is now a writer and business consultant, and I managed to reach him through the college where he used to teach.
He wrote to me that the two other storylines in that episode—Corporal “Boots” Miller losing his sanity and Hawkeye’s foil bragging about this and that—came from him, but the plotline about the placebos was suggested to him. “It came from the late Gene Reynolds, the show’s producer, after he spoke with someone,” he wrote to me. “No name cited.”
If the story of Beecher running out of morphine did not exist prior to the episode airing, which was March 27, 1978, then there was a chance that this episode of M*A*S*H helped create it.
Thus began a mad, day-long scramble to find any trace of this myth prior to 1978. Mike Hall and I worked in tandem, exchanging leads. Search engines were used, virtual books were loaned out, obituaries were read. Indeed, Beecher’s obituary makes no mention of this Pauline conversion, nor does his entry in Encyclopedia Britannica. Factiva, an archive of over 32,000 news sources, was mum (although my academic account excludes 2,663 sources).
We did have a few leads, but they often proved to be closed circles of academics pointing the finger at each other when citing the story. It came from John, said Eric. John says he got it from Roberta. And Roberta references Eric.
One lead took me to the basement of the Redpath library at McGill. That Review of Ophthalmology article I mentioned earlier, it cited a 2004 book as its source: Mind over matter in modern medicine by D. Evans. That book itself cited as a reference to another book, The Antidepressant Era, by David Healy, a psychiatrist and author in the United Kingdom. Like a set of Russian dolls, the story told in that book apparently came from three references, two of which end up being for the same book. The first reference was to Dr. Beecher’s “The Powerful Placebo” paper, which does not contain the story. The other two references were to a book Mike and I could not find online.
Luckily for us, the Redpath library had a physical copy. It is called The Psychopharmacologists II and is the second volume of a series of interviews that David Healy conducted. One of these interviews is with Michael Shepherd, a professor of psychiatric epidemiology who trained in London, and it was conducted in June 1995, two months before his death.
There, in the basement of the library, I read about Shepherd’s recounting of the tale of Henry Beecher, “a powerfully built, solid character, very much in the mainstream of medicine,” who ran out of “morphia” during the war (an old British term for morphine). Accidentally, one of the nurses gave “an injection of still water and the patient came out of shock and lost his pain.” Beecher was amazed and he repeated the experiment, using distilled water until the supplies came in.
The problem with this recollection is that Shepherd did not seem to have any firsthand knowledge of Beecher. He came to know people who worked with Beecher, but there was no indication that he was there at Beecher’s military hospital. This was thus not a direct account. Moreover, he placed Beecher at a base hospital “in one of the Pacific islands,” but Beecher’s obituary states he served in North Africa and Italy during the war. And since the story was told in 1995, it is possible Shepherd was misremembering that episode of M*A*S*H.
The last lead came from a paper on Beecher and the placebo effect with two citations. The second citation itself cites the first, so it’s a case of a snake biting its own tail, but what is interesting is that one of them, this 1969 book chapter written by Martin Orne, mentions Beecher using saline solutions in battlefield situations and getting 90% of the effectiveness of morphine. This proves that the story did not originate with M*A*S*H.
Where it actually came from, I do not know. Author Shannon Harvey spent days trying to track this myth down, reading Beecher’s published papers and even contacting a librarian at Harvard who had access to Beecher’s personal archives. No luck.
What Colonel Potter said, about the best doctor being the mind, deserves a giant asterisk. In 1997, two researchers took a closer look at Beecher’s famous “Powerful Placebo” paper and concluded that it was riddled with holes. There was actually no evidence in the cited studies for a mind-over-body phenomenon. Instead, many of the non-specific placebo effects we know well today were simply ignored: spontaneous improvements, the fluctuation of symptoms, additional treatments, wanting to please the doctor, etc. They wrote that “the placebo topic seems to invite sloppy methodological thinking.”
Beecher’s road-to-Damascus moment, swapping morphine for saline and being amazed at the results, has become a sort of mind-over-matter placebo effect of its own. There is nothing tangible to this story, no active ingredient, yet its effect endures.
This whole investigation won’t change the record, I suspect. We often find ourselves impervious to facts in the face of a good story.
-The discovery of the placebo response is often attributed to Dr. Henry Beecher, who is said to have injected wounded soldiers with a saline solution during World War II because of a morphine shortage and to have discovered that it worked to reduce pain
-There is no evidence so far that this story is true