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August 15, 1977

The Return of the Medicine Show

JAMA. 1977;238(7):622. doi:10.1001/jama.1977.03280070062027

There was a period when traveling medicine shows provided promises for the ill and entertainment for everybody. They peddled elixirs and pills and proclaimed that they could cure everything from insomnia to impotence. The performance of the pitchman was just as important as the pills peddled. He first created a carnival atmosphere that counteracted the feelings of discouragement and depression that are associated with illness. He then generated hope by lavish promises backed up by anecdotal testimonials. Finally, he established conviction of worth by disclosing that the remedy was one of "nature's cures," a natural substance extracted from plants or animals. All this set the stage not only for the sale of a remedy, but also for ensuring its placebo effect.

Although the placebo effect is no better understood today than it was then, its existence cannot be doubted. Double-blind, controlled clinical trials have repeatedly demonstrated that a placebo will