Liisa Rankin author of “Mind over Medicine” just posted this on FB
In an interview about placebos on NPR, Ted Kaptchuk, director of Harvard’s Program in Placebo Studies and the Therapeutic Encounter (PiPS), said, “A sugar pill doesn’t do anything. What does something is the context of healing. It’s the ritual of healing. It’s being in a healing relationship…But the placebo pill is a wonderful tool, or a saline injection is a wonderful tool, to isolate what is usually in the background, take it away from the medications and procedures that medicine does, and actually study just the act of caring. That’s, I think, what we’re measuring when we study placebo effects.”
When Kaptchuk, who is trained as a Chinese medicine practitioner and acupuncturist, was asked how he, as a scientist, justified practicing acupuncture when most randomized, controlled clinical trials failed to demonstrate acupuncture’s effectiveness beyond placebo, he said, “Because I am a damn good healer. That is the difficult truth. If you needed help and you came to me, you would get better. Thousands of people have. Because, in the end, it isn’t really about the needles. It’s about the man.”
Kaptchuk’s sentiments are affirmed in the New England Journal of Medicine article he co-wrote, which studied asthmatics. Those who reported being short of breath were treated with an albuterol inhaler (standard treatment for asthma), a sham inhaler (placebo), fake acupuncture (also placebo), and no treatment. All of the treated patients felt equally better—approximately 50 percent improvement for those treated with albuterol, the sham inhaler, and the fake acupuncture, compared to a 21 percent improvement in those receiving no treatment.
However, unlike other studies, which demonstrated physiological responses that coincided with symptomatic relief, when researchers in this study measured lung function in the asthmatics, the physiological response did not equal the patient’s subjective experience. The lung function measured in those who received fake acupuncture, a sham inhaler, and no treatment all experienced improved lung function (7 percent), but not nearly as much as those getting albuterol (20 percent).
Why were these asthmatics feeling better, even when their bodies weren’t demonstrating physiological responses to explain the clinical improvement? Perhaps patients in the study were feeling better, not just because of the albuterol, fake acupuncture, or sham inhaler, but because somebody cared. What if the patients were treated not by the medicine itself, but by the medical care? Perhaps the treatment groups felt equally better because they received equal care, and perhaps that’s even more important than the drug or treatment they receive.