The simple act of offering a therapy to a patient has tremendous psychological effects that can strongly blunt the perception of physiologic processes. This effect, also known as the “placebo effect” is hardly a new concept, but for the first time it is legitimized as an important aspect of care in the most prestigious American medical journal (The New England Journal of Medicine).
In a fascinating and (as always) thought-provoking Ted Kaptchuck (Harvard Medical School) study, 39 asthma patients were randomized to one of four groups and instructed to discontinue their asthma medications:
- albuterol inhaler (a common asthma medication) given at the time of the asthma symptoms
- placebo inhaler (inactive medication) given at the time of the asthma symptoms
- placebo acupuncture (fake needle that feels like it penetrates the skin but does not) given at the time of the asthma symptoms
- no treatment
In all 4 groups, the patients had their lung function tested every 20 minutes for two hours.
As expected, treatment with the albuterol inhaler improved lung function by 20%. The placebo inhaler and placebo acupuncture patients also had a modest improvement in their lung function (7%). Their was no improvement with the no treatment group.
When the patients were asked if they felt better after treatment, the same percentage of patients from the 3 intervention groups (albuterol inhaler, placebo inhaler and placebo acupuncture) stated that they felt better (approximately 50%). Only 21% of the patients in the no treatment group felt better.
A proven medical therapy (i.e. albuterol) is more effective than placebo when measuring the physiologic responses to the interventions, but there was no measurable difference in patient perception between active treatment (albuterol) and placebo…simply providing a therapy that was perceived to be effective had a strong therapeutic response that was the same among the intervention groups.
Point 1: As medical practitioners, we should never withhold safe and effective therapies from any patient who needs them.
Point 2: Placebo therapies do not have a defined physiologic effect, yet the simple act of providing care that is perceived as effective has legitimate and powerful ‘mind-body’ effects in relieving symptoms and disease…do no harm and relieve illness and/or suffering are the primary goals of the practice of medicine.
Conventional and non-conventional medical practitioners may not recognize that a significant component of their patients’ response to their interventions is from unintended, but active, placebo effects (i.e. prescribing sub-therapeutic doses of medications, practitioners’ appearance and manner is convincing to the patient, demonstrating attention and compassion to their patients, prescribing pharmacologically inactive supplements, etc.).
The beneficial effects of placebo on health and well-being of our patients provides further evidence of the power of the minds’ ability to heal the body and relieve its’ suffering.
As an integrative oncologist, I find placebo research very exciting as it will eventually lead to a better understanding of the complexities of mind-body physiology with the goal of helping our patients harness this innate self-healing power.