Ethics in Medicine

What if Placebo Isn't a trick?

Kristen Sparrow • February 03, 2019

Interesting history of placebo and the current research.  Ted Kapchuk, famous for his work on acupuncture, feels that the placebo relies on the practitioner/patient relationship.  I don’t agree with that, but he’s the expert!  He’s uncomfortable with trying to pin down the placebo effect to the genome, or molecular/cellular response.  He seems to only be interested in keeping the doctor/patient relationship sacred, since, to him that’s the basis of results.  Since he was an acupuncturist, his opinions matter.  I disagree quite strongly and though I have respect form him, he’s not really doing science.  That’s his right, but I’m really not sure where his work can take us in the modern medicine world.
I have two major objections to his way of thinking.

  1. The bulk of acupuncture research that helps to guide and validate treatment is in animals, not subject to placebo.  There are some hand wavy arguments that you can get “placebo by proxy” but I don’t buy it.
  2. I’m interested in treatments that are reproducible.  That is everything to me.  Obviously not everyone will respond to each and every treatment, but using science and careful measurement of physiology and clinical effect is the most responsible way to practice. As I often say, medicine, and acupuncture are not gravity.  They are not always reproducible, but we can at least aim to get there. Only by doing that can I confidently continue to practice.

Some excerpts from the article…
An early hypnotist, a disciple of Mesmer, said the imagination, “directed to the relief of suffering humanity, would be a most valuable means in the hands of the medical profession” 
In 1955  a Harvard surgeon “Beecher had been looking at the subject systematically, and he determined that placebos could relieve anxiety and postoperative pain, change the blood chemistry of patients in a way similar to drugs and even cause side effects. In general, he told them, more than one-third of patients would get better when given a treatment that was, pharmacologically speaking, inert.
Later in the article, looking at the science behind placebo was particularly interesting to me, since I focus on stress and stress reduction.
“Hall points out that the catecholamines are associated with stress, as well as with reward and good feeling, which bolsters the possibility that the placebome plays an important role in illness and health, especially in the chronic, stress-related conditions that are most susceptible to placebo effects.”