Saturday, January 07, 2012

NPR Science Friday - One Scholar's Take On The Power of The Placebo

The other day I posted an article from Edge by Nicholas Humphrey that looked at the placebo effect as a jumping off point for a brain-based "health management system." So it was interesting, in light of that, to listen to this NPR Science Friday discussion about the placebo effect.
January 6, 2012
A placebo can take the form of a sugar pill or even a fake surgery. It's often used to test the effectiveness of a trial drug. Ted Kaptchuk, director of Harvard University's Program in Placebo Studies and the Therapeutic Encounter, discusses potential applications for the healing power of placebos.

IRA FLATOW, HOST: This is SCIENCE FRIDAY. I'm Ira Flatow. It's a story we've heard before: A doctor prescribes a fake pill to a patient after other medications have failed. The patient begins to feel better after taking what she thinks is a real drug, but is only a placebo.

The story is not fictitious. It's rooted in real data. One study estimates 50 percent of U.S. physicians who believe in the benefits of placebos and the placebo effect secretly give dummy pills to unsuspecting patients. The ethical, questionable practice led researchers at Harvard University to explore whether the power of placebos can be harnessed honestly, and what they found was the placebos work even when patients are in on the secret that it is a sham secret. They know that they're taking a placebo, and it still works.

Ted Kaptchuk is an associate professor of medicine at Harvard Med School, director of the Program in Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center in Boston. The program was created last summer and is wholly dedicated to the study of placebos. He joins us from Cambridge, Mass. Welcome to SCIENCE FRIDAY.

TED KAPTCHUK: Ira, thanks for inviting me.

FLATOW: How do you define a placebo?

KAPTCHUK: Well, a placebo is a sugar pill or inert substance that's used to hide the genuine treatment in a clinical trial. A placebo effect is the effect of a sugar pill. The problem with that common definition is that it's an oxymoron: An inert pill can't have an effect. So what our team says is that the placebo is also hiding a very important phenomena: the clinical encounter. We think the placebo effect is the - a surrogate marker, or a way of measuring the effect of just caring for a person, the act of caring for a person.

We think that it's - the placebo is about the words, the gestures, eye contact, warmth, empathy, compassion that a physician exchanges with a patient, a doctor-patient relationship. We think the placebo is about medical symbols, white coats, diplomas, prescription pads.

We think the placebo is about medical rituals, the ritual procedures in medicine: waiting, talking, disrobing, being examined and being treated by pills or surgery. Ultimately, we think the placebo is about the power of the imagination, trust and hope in the medical encounter.

FLATOW: Can you quantify any of this, then?

KAPTCHUK: Well, that's what my work is, and that's what our program at the Beth Israel Deaconess and Harvard Medical School is trying to do, is that this is usually considered the art of medicine. It's the in background. People are mostly concerned about drugs, procedures and surgery, and our job is to quantify what's been hidden in the background and move it to the foreground, to make the human aspects of health care more prominent and optimalize them once we understand what they can do and how they work.

FLATOW: Because we hear that the placebo effect works about 30 percent of the time, correct?

KAPTCHUK: No, that's more of a medical myth. Sometimes sugar pills will not shrink a tumor, will not lower cholesterols, don't lower hypertension. Placebo effects work in some conditions much better than others. Placebo treatments will work in things like pain, insomnia, depression, anxiety, functional bowel disorders, functional urinary disorders. So that 30 percent is really a myth that was created a long time ago.

FLATOW: And you've discovered - let me see if this is correct - that even when the patients know they're taking a placebo, it still works?

KAPTCHUK: Well, discovery is a big word. We - what we did was we randomized patients with irritable bowel syndrome, half of whom went - we gave them placebos. We told them it was placebos. The bottle said they were placebos. We told them that the study was about placebos. This is an inert pill they were taking. And half of them we randomized to no-treatment control wait-list to make sure that if they changed and got better, it wasn't the normal, natural waxing and waning of diseases or spontaneous remission.

And we found, after three weeks, that people who were taking placebos did much better than those in the comparison group. Our study was small. It needs to be replicated. It's more proof of principle. But it certainly changes the conventional wisdom, which was if you know you're taking a placebo, you're not going to get better.

And what we - I think many other teams have to replicate this and other diseases, and we hope that that will happen down the line.

FLATOW: But you're saying, if I heard you correctly, just to go back on your original statement, is that the placebo basically masks, or it's really the encounter with the doctor and all the trappings of the office and being taken care of that - the action that is actually helping the patient and making the patient feel better.

KAPTCHUK: I think that's what I meant to say. I'm glad you said it that way. Yeah, 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. And that's what we study.

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.

FLATOW: And how did you get involved in this, in Harvard opening up this center?

KAPTCHUK: I was originally hired at the Beth Israel Deaconess Medical Center and Harvard Medical School in 1990 to help do research in Asian medicine. And when I got there - my original training was in Asia - they talked about we have to find out whether this intervention, be it acupuncture, herbs or other kinds of alternative therapies, is more than placebo.

And I would ask: So what does it mean that it's more than placebo? And they say: Well, it's more than placebo. And I have a background in civil rights when I was a young person. And I said, boy, they're treating this placebo effect like it's really some kind of disgusting phenomena. And what is it exactly? So I would ask, and I realized there wasn't a lot known. And I thought this would be a better way of doing my career.

Luckily, at that time, the NIH created a National Center for Complimentary and Alternate Medicine, which has a deep interest in investigating the placebo effect. And I've been able to receive funding for many, many experiments, which hopefully have contributed to understanding this phenomenon better.
Read the whole transcript.
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