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It's a Sham, Or Is It?

Posted Sep 14 2008 1:34pm

Placeboeffect For several decades, doctors have known that "sham" medical treatments, consisting of inactive ingredients like sugar, distilled water, or saline solution, can have a "placebo effect" can improve a patient's condition simply because the patient has an expectation that the treatment they are receiving will help them. According to an FDA article on placebos, "For a given medical condition, it's not unusual for one-third of patients to feel better in response to treatment with placebo."

A fascinating recent study conducted at Harvard Medical School sought to better understand the placebo effect by measuring it across three different treatment conditions. The aim was to see if they could tease out significant dose-response effects -- would increasing levels of placebo lead to increasing levels of wellbeing?

Associate Professor of MedicineTed Kaptchuk and his team randomly assigned 262 adults with irritable bowel syndrome to one of three treament conditions: waiting list ("observation"), placebo acupuncture alone (“limited”), or placebo acupuncture with a patient-practitioner relationship augmented by warmth, attention, and confidence (“augmented”). Participants remained in these treatments for three weeks, then half of them were randomly assigned to continue in these groups for another three weeks.

At 3 weeks and 6 weeks, the participants were assessed on an overall improvement scale, adequate relief of symptoms, symptom severity score, and quality of life. The percentage of patients reporting adequate relief of symptoms was 28% of the waiting list, 44% of the limited group, and 62% of the augmented group. The same trend was shown across all the outcome measures.

The researchers concluded that "Factors contributing to the placebo effect can be progressively combined in a manner resembling a graded dose escalation of component parts. Non-specific effects can produce statistically and clinically significant outcomes and the patient-practitioner relationship is the most robust component."

It seems that the main component of the placebo effect is the human interaction, not merely the expectation of getting better, but the "warmth, attention, and confidence" being offered by the medical professional. This is one of the components of alternative medicine that is attractive to many people -- receiving the practitioners time and attention, having someone listen to your issues, feeling that the practitioner genuinely cares about you. And, hopefully one that the medical and insurance communities will begin to re-integrate into standard patient care.

Reference: Kaptchuk T.J., Kelley J.M., Conboy L.A., et al. Components of the Placebo Effect: A Randomized Controlled Trial in Irritable Bowel Syndrome.British Medical Journal. Online publication, April 3, 2008.

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