The Placebo Phenomenon: Acupuncturist and Harvard Professor Discovers How the Mind Can Heal the Body

Posted by on January 10, 2013 in Psychology-Psychiatry with 9 Comments
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An ingenious researcher finds the real ingredients of “fake” medicine.

 

Ted KaptchukCara Feinberg | Harvard Magazine

Two weeks into Ted Kaptchuk [10]’s first randomized clinical drug trial, nearly a third of his 270 subjects complained of awful side effects. All the patients had joined the study hoping to alleviate severe arm pain: carpal tunnel, tendinitis, chronic pain in the elbow, shoulder, wrist. In one part of the study, half the subjects received pain-reducing pills; the others were offered acupuncture treatments. And in both cases, people began to call in, saying they couldn’t get out of bed. The pills were making them sluggish, the needles caused swelling and redness; some patients’ pain ballooned to nightmarish levels. “The side effects were simply amazing,” Kaptchuk explains; curiously, they were exactly what patients had been warned their treatment might produce. But even more astounding, most of the other patients reported real relief, and those who received acupuncture felt even better than those on the anti-pain pill. These were exceptional findings: no one had ever proven that acupuncture worked better than painkillers. But Kaptchuk’s study didn’t prove it, either. The pills his team had given patients were actually made of cornstarch; the “acupuncture” needles were retractable shams that never pierced the skin. The study wasn’t aimed at comparing two treatments. It was designed to compare two fakes.

Although Kaptchuk, an associate professor of medicine, has spent his career studying these mysterious human reactions, he doesn’t argue that you can simply “think yourself better.” “Sham treatment won’t shrink tumors or cure viruses,” he says.


But researchers have found that placebo treatments—interventions with no active drug ingredients—can stimulate real physiological responses, from changes in heart rate and blood pressure to chemical activity in the brain, in cases involving pain, depression, anxiety, fatigue, and even some symptoms of Parkinson’s.

The challenge now, says Kaptchuk, is to uncover the mechanisms behind these physiological responses—what is happening in our bodies, in our brains, in the method of placebo delivery (pill or needle, for example), even in the room where placebo treatments are administered (are the physical surroundings calming? is the doctor caring or curt?). The placebo effect is actually many effects woven together—some stronger than others—and that’s what Kaptchuk hopes his “pill versus needle” study shows. The experiment, among the first to tease apart the components of placebo response, shows that the methods of placebo administration are as important as the administration itself, he explains. It’s valuable insight for any caregiver: patients’ perceptions matter, and the ways physicians frame perceptions can have significant effects on their patients’ health.

For the last 15 years, Kaptchuk and fellow researchers have been dissecting placebo interventions—treatments that, prior to the 1990s, had been studied largely as foils to “real” drugs. To prove amedicine is effective, pharmaceutical companies must show not only that their drug has the desired effects, but that the effects are significantly greater than those of a placebo control group. Both groups often show healing results, Kaptchuk explains, yet for years, “We were struggling to increase drug effects while no one was trying to increase the placebo effect.”

Last year, he and colleagues from several Harvard-affiliated hospitals created the Program in Placebo Studies and the Therapeutic Encounter (PiPS), headquartered at Beth Israel Deaconess Medical Center—the only multidisciplinary institute dedicated solely to placebo study. It’s a nod to changing attitudes in Western medicine, and a direct result of the small but growing group of researchers like Kaptchuk who study not if, but how,placebo effects work. Explanations for the phenomenon come from fields across the scientific map—clinical science, psychology, anthropology, biology, social economics, neuroscience. Disregarding the knowledge that placebo treatments can affect certain ailments, Kaptchuk says, “is like ignoring a huge chunk of healthcare.” As caregivers, “we should be using every tool in the box.”

Western medicine, however, has been slow to agree with him—partly because of his message, and in his case, often because of the messenger. An acupuncturist by training, he is an unlikely leader in the halls of academia. With a degree in Chinese medicine from an institute in Macao, Kaptchuk is one of the few faculty members at Harvard Medical School (HMS) with neither a Ph.D. nor M.D.—“a debit, not a credit at most medical schools,” says Finland professor of clinical pharmacology emeritus Peter Goldman, one of his early Harvard advisers. (Kaptchuk’s diploma is recognized as a doctorate in many states, but not in Massachusetts.) When Kaptchuk came to Harvard in 1995, “he knew about Chinese herbs and healing needles, and he’d written a very fine book on Chinese medicine [The Web That Has No Weaver (1983)],” says Goldman, “but he didn’t know the first thing about how to conduct clinical studies.”

Kaptchuk joined the faculty as an instructor in medicine and apprenticed himself to several seasoned clinicians and investigators. Within a few years, he was winning National Institutes of Health grants and publishing in medicine’s top journals. “What his colleagues saw was a fierce intellect and curiosity,” said Goldman. “He was asking questions no one was asking.”

Ironically, says Kaptchuk, it was his success as an acupuncturist that made him leave the profession for academia. “Patients who came to me got better,” he says, but sometimes their relief began even before he’d started his treatments. He didn’t doubt the value of acupuncture, but he suspected something else was at work. His hunch was that it was his engagement with patients—and perhaps even the act of caring itself.

For his ideas to gain traction with Western doctors, however, Kaptchuk knew he needed scientific proof. His chance would come in the early 2000s in a collaboration with gastroenterologists studying irritable bowel syndrome (IBS), a chronic gastrointestinal disorder accompanied by pain and constipation. The experiment split 262 adults with IBS into three groups: a no-treatment control group, told they were on a waiting list for treatment; a second group who received sham acupuncture without much interaction with the practitioner; and a third group who received sham acupuncture with great attention lavished upon them—at least 20 minutes of what Kaptchuk describes as “very schmaltzy” care (“I’m so glad to meet you”; “I know how difficult this is for you”; “This treatment has excellent results”). Practitioners were also required to touch the hands or shoulders of members of the third group and spend at least 20 seconds lost in thoughtful silence.

The results were not surprising: the patients who experienced the greatest relief were those who received the most care. But in an age of rushed doctor’s visits and packed waiting rooms, it was the first study to show a “dose-dependent response” for a placebo: the more care people got—even if it was fake—the better they tended to fare.

Kaptchuk’s innovative studies were among the first to separate components of the placebo effect, explains Applebaum professor of medicine Russell Phillips, director of the Center for Primary Care at HMS. For years, doctor-patient interactions were lumped into a generic “placebo response”: a sum of such variables as patients’ reporting bias (a conscious or unconscious desire to please the researchers); patients simply responding to doctors’ attention; the different methods of placebo delivery; and symptoms subsiding without treatment—the inevitable trajectory of most chronic ailments. “There was simply no way to quantify the ritual of medicine,” says Phillips of the doctor-patient interaction. And the ritual, he adds, is the one finding from placebo research that doctors can apply to their practice immediately.

 

 

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9 Reader Comments

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  1. strangecat@visi.com' StrangeCat says:

    Congrats to coming to a conclusion that has been known for 1000 of years!

    it’s the drug industries that push all there drugs that they poison everyone with , saying they heal this heal that. It’s big fat money grubbing joke of an industry and it’s dangerous.

    • Alcyone says:

      Agreed that the placebo effect has always existed and has been recognized by many over the centuries, but there is still value in seeing the effect scientifically validated and explored. The goal of the study was not to prove the existence of the placebo effect (which has been well established), but to better understand it so that we can more effectively utilize it in healing, with less reliance on pharmaceutical and invasive treatments. i find this goal to be an important and commendable one.

  2. strangecat@visi.com' StrangeCat says:

    yes it is. I find it scary how much power the FDA has!

    Do you see anyone in the main stream anything talking about the power of the mind for health and well being? no never. It hasn’t happened.

    People needs to realize that there mind is there body. Your state of mind controls your health, your well being. Even Milton wrote about the mind making heaven out of hell or hell out of heaven because of thinking.

    I don’t like what the establishment is doing when it comes to health and food.
    placebo is a big business with doctors too. There not innocent.

    I hope your study wakes up a few people.

    Think healthy be healthy. Study and question everything.

  3. harv.howard@sbcglobal.net' Harv says:

    …And so, the secret of the doctor and the shaman are revealed to some extent..again. Who’s to say that the mind, further coached into believing, can’t heal more serious issues? Actually, it happens all the time, but lacking acceptable credibility by the authorities, such instances get thrown our of formal studies and are simply considered inexplicable when happening in traditional medicine.

  4. dgturco@verizon.net' horus says:

    The only sham in this article is Harvard, as usual. Note to Harvard: acupuncture points energetically extend slightly up above the body and there is an acupuncture technique where the needles are held above the skin and never break it. Welcome to the 21st century, do your research before you mislead even more people.

  5. sebado_vezcha@yahoo.com' Francisco says:

    The ‘sham’ acupuncture treatment is not a sham if something pointy is touching the skin. The needle need no penetrate the skin to work, mere pressure will have effects on the boy. EMF technique uses this principle, applying pressure on the body’s meridian points, without piercing the skin to improve health. Manipulating pressure points for a few minutes is scientifically proven to produce anti-clumping effect on blood cells under microscope.

  6. abinico@gmail.com' abinico warez says:

    Unless an idea can create repeat customers and has huge profit potential, western medicine is just not interested.

  7. fokseebrey@gmail.com' Westchester NY infertility says:

    Hey Alcyone,
    Yes mind can heal the body when you feels depression.

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