Placebo Effect

One good thing being here is that, any talk that you listen to, most probably is being given by the world leader of such topic. Recently, I listen to a short talk on Placebo effect by Dr Ted Kaptchuk. He participated in a lot of interesting and 'weird' trials and also an expert in understanding traditional chinese medicine, especially in acupuncture.

Placebo is usually defined as a tablet that has no effect, given in a trial that mimic the investigated drug, in order to make the patients feel that they are not being left out. Not using placebo in studies opens up to a lot of potential biases, which may render the result not applicable to the general masses.

His understanding of placebo is slightly different. He believes that so-called inert tablet DO have effect. He proved this by showing few publications that compared active treatment, sham treatment and no treatment. In one elegant study on asthmatic patients, patients who has exacerbation of asthma were treated either with b2 agonist (proper treatment) or 'faked' B2 agonist or 'faked' acupuncture procedure or no treatment (literally just observation). From objective improvement of FEV1 viewpoint, only those patients treated with B2 agonist improved. But from symptoms/subjective improvement, all patients improve except for those who did not receive any treatment at all. (Wechsler, NEJM 2011)

In another example, he mentioned that patients who were given morphine by nurses 'face-to-face' has much more improvement in pain symptoms compared to those who were given in 'secrecy'.

Recent study using functional MRI suggested that genuine acupuncture and sham acupuncture triggered different region in the brain, but subsequently leads to symptoms improvement.

He is also actively doing study using 'augmented placebo' to see if irritable bowel syndrome can be improved. He believes that the effect of placebo is real, and partly can be explained by that interaction that medical practitioner has with patients - something that he called 'augmented' placebo in his trials.

How is this going to help me? Previously, there was some ethical dilemma (for me) in terms of prescribing certain medications like vitamins to patients in certain situations that I know there may not be much of benefit, but unlikely to cause harm either. Now, with this possible placebo effect in mind, it can actually make some difference.