Have you ever considered the value of your doctor’s words and demeanor when it comes to healing disease? Have you ever entertained the possibility that they could even have as great an effect on pain-management as an actual drug? In light of new research, the way a doctor conducts himself in the presence of a patient might have a greater impact on health then anyone ever thought possible. The credit for this discovery goes out to a branch of science that was only recently legitimized: Placebo studies.
According to WebMD, a placebo is something that appears to be a medical treatment, but actually does not contain any active ingredient meant to affect health. The placebo effect, then, is the response a person can sometimes have to a placebo, e.g. symptom improvement, or even negative side effects.
Ted Kaptchuk, the current leading researcher in Placebo studies, has seen both kinds of effects. His first clinical drug trial involved comparing acupuncture and pain pills as treatments for tendinitis and elbow pain. Some patients called in reporting negative side effects from both treatments: debilitating lethargy from the pills and painful swelling and rashes from the needles. However, many patients also reported feeling a lot better after treatment, with patients who received acupuncture experiencing the greatest relief. The catch is that none of the patients actually took real pain-reducers or had real needles stuck in them. The pills were made of cornstarch and the needles had retractable tips that were unable to pierce skin (Knox).
This is only one of several studies done by Kaptchuk that shows patients having a real physical response in the absence of active medical ingredients. In another study, Kaptchuk gathered 66 volunteer migraine patients and tracked seven migraine attacks in each (495 attacks in total). He compared four different “treatments” in his patients: Maxalt (a common migraine medicine), labeled as such; a placebo, labeled as Maxalt; and a mystery pill, labeled as being either Maxalt or a placebo, and; simply taking no pills at all. Subjects were asked to rate their pain level after each attack and accompanying treatment (Feinberg).
Subjects who took no pills reported a 15% increase in migraine pain.
Subjects who took a placebo labeled as such reported experiencing 26% less pain.
Subjects who took a Maxalt pill labeled as such reported a 40% decrease in pain.
And finally, when subjects took the “mystery pill” that could have been either Maxalt or a placebo, they also reported a 40% decrease in pain (Feinberg).
Two important conclusions we can draw from this study is that 1) even when patients know they are taking a placebo, they still produce a physical response, and 2) that a placebo has the power to reduce a migraine patient’s pain as much as a scientifically proven drug!
Mind you, this is not to say that Maxalt is a completely impotent drug. While patients taking Maxalt and Placebos both reported a 40% decrease in pain in the short term, it turns out that 2.5 hours after taking the pills, the patients taking Maxalt were four times likelier to report being pain-free than those who had taken placebos (Feinberg).
Still, Kaptchuk’s groundbreaking work has allowed researches to conclude that a whopping half of a drug’s effect comes merely from our expectations of it! (Feinberg).
This is because, as it turns out, Placebos have the power to influence a patient’s brain using the exact same biochemical pathways as a drug. Studies have proven that placebos increase dopamine (the chemical associated with feelings of pleasure) in the brains of those suffering from both Parkinson’s and depression. In fact, besides Parkinson’s and depression, patients afflicted with sleep disorders, IBS, migraines and other pains, and menopause are all in the running to enjoy these same benefits from mere placebos ("What Is the Placebo Effect?").
But sham medicine in itself is not the only way a health care professional can manipulate a patient’s response.
Kaptchuk is actually an acupuncturist by training, and a very successful one. While he never questioned the beneficial effects of acupuncture, he couldn’t help but notice that many of his patients started showing improvement before being touched by a single needle. He began to hypothesize that the nature of his interactions with his patients, essentially the act of caring itself, was the explanation behind their sudden improvement (Knox).
He put his hypothesis to the test in the early 2000s. In collaboration with gastroenterologists studying Irritable Bowel Syndrome, Kaptchuk was able to measure the effect of a doctor’s words and behavior on 262 adults with IBS. The patients were split into three groups. Group 1 received no treatment, group 2 received sham acupuncture from a detached and somewhat absent practitioner, and group 3 received sham acupuncture from a practitioner who offered copious amounts of attention and sympathy to the patients. Care lasted at least twenty minutes and included a form of physical comfort, like hand-holding. Kaptchuk was not surprised to see that the patients who experienced the most care fared the best (Knox).
Yet another significant study done by Kaptchuk, researchers learned that the Placebo effect actually consists of many components, including the way in which the doctor delivers the placebo. This was also the first study to show a dose-dependent response for a placebo, the placebo being, in this case, the level of care and nurture given by the practitioner during treatment (Knox).
However, it should be pointed out that the patient’s own subjective measure of symptom improvement does not necessarily reflect a real change in health. In another of Kaptchuk’s experiments, patients suffering from Asthma were given placebo medication and then examined to see if their airways had in fact opened. Unfortunately, the placebo didn’t yield effective results. But, fascinatingly, the patients still reported symptom improvement. This serves as an important reminder that while mentality can indeed have a large affect on physical health, it is not necessarily always a reliable healing tool (Feinberg).
Given the evidence, in the end the patients who will fare the best will probably receive a harmonious balance of drug and non-drug treatment including, but not limited to, proper nurturing and words of hope from a doctor. If nothing else, Kaptchuk’s studies will hopefully encourage more and more doctors to treat their patients with care and respect. If a doctor’s attitude toward his patients can elevate the effects of sham medicine, then just imagine the potential benefits for a patient who receives a genuine treatment and exceptional care from his/her doctor!
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