RESEARCH Can your doctor harness placebo power?

The results are real, but certain elements can increase the impact of treatment.
By WILLIAM HATHAWAY
HARTFORD COURANT
Not all placebos are created equal.
Harvard University researchers reported this month that people who received sham acupuncture treatments felt more relief from arm pain than those who took an inert sugar pill.
The different, but positive, responses to faux treatments illustrate that relief may lie in medical rituals as well as in the medicine, said Ted Kaptchuk, a placebo researcher who is associate director of Harvard's division for research and education in complementary and integrative medical therapies.
"It may be that it is the act of applying the needles that is important," Kaptchuk said.
Science has just begun to tease out what it is about placebos that seems to help ease patients' symptoms. Many scientists -- though not all -- accept that some patients can derive at least temporary therapeutic benefit from a placebo, as long as the patient believes he or she is receiving a real treatment.
However, the hypothesis has been difficult to test. Placebos are used in clinical trials to assess the benefits of new drugs and treatments. The placebo effect is so strong that in some trials, half the subjects who are given fake treatment or medicine show improvement. Although it is difficult to know how many of those subjects would have improved anyway, some imaging studies have shown that people who respond to placebos show physiological responses that mimic those receiving medical treatment.
Real results
The evidence for therapeutic effects of a placebo is strong enough that in 2002 the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, set aside up to $2.5 million in grants a year for the study of placebos.
However, no one has pinpointed what it is about false treatments that seems to aid improvement of symptoms.
Kaptchuk, an expert in Asian medicine, thought one way to resolve the mystery would be to pit one false treatment against another to see if one was more beneficial than the other.
In the new research, published in the British Medical Journal, Kaptchuk described what happened when he gave fake acupuncture and inert pills to 270 people suffering from chronic pain of the arm. For two weeks, half of the subjects were given inert pills and half were given sham acupuncture -- poked with needles that retracted rather than penetrating the skin. Both groups improved -- but initially there was no difference in the level of pain they reported.
However, after six additional weeks, patients who received sham acupuncture reported more pain relief than those who received fake pills. During that phase of the study, some subjects received real treatments.
But one finding may suggest that the improvement reported by those who received the phony acupuncture treatments was essentially a subjective matter of perception. Those people showed no measurable difference in grip strength when compared with those who took the sham pills.
More to come
The researchers will report results on those who received real acupuncture and pain pills in a later paper.
Kaptchuk said he began studying placebos because of his interest in health rituals in other societies -- "waving of feathers, chanting, that sort of thing." It could be that the more elaborate the ritual -- for instance, the application of needles over many areas of the body -- the more relief a subject will receive from a placebo treatment, he said.
Dr. Andrew Leuchter, who has also studied the effect of placebos, said ritual is one factor in their power, but another may derive from the human contact of a healer.
"The context in which (patients) are given a placebo may be important -- the talking to a health care provider, asking questions, being given answers, being given hope, expectations and encouragement," said Leuchter, who is vice chairman of the psychiatry department at University of California, Los Angeles.