BMJ  2008;336:1086-1087 (17 May), doi:10.1136/bmj.39577.459549.3A

Letters

Placebo effect

Helping patients feel better

The first 150 words of the full text of this article appear below.

On the basis of their study on the placebo response in irritable bowel syndrome, Kaptchuk et al. conclude that the patient-practitioner relationship is the most robust component of the placebo effect.¹ Despite some important limitations, including extremely brief follow-up and potential bias in patient recruitment, their findings fit with previous observations that the therapeutic relationship is correlated to beneficial outcomes.² However, the inclusion of another comparison group would have shed light on an important issue they do not discuss—how would patients respond to the augmented patient-practitioner relationship in the absence of sham acupuncture (or any other intervention)?

It is possible that the "doctor as drug" effect alone may be stronger than the study indicates.³ Doctors often feel under pressure to "do something," when much of the time our patients may benefit most when we are free to just "be someone"—the one who helps them feel better.

¹ Stirling Royal Infirmary, Stirling FK8 2AU

---

Competing interests: None declared.

1. Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ 2008;336:999-1003. (3 May.)[Abstract/Free Full Text]
2. Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. J Consult Clin Psychol 2000;68:438-50.[CrossRef][Web of Science][Medline]
3. Balint M. The doctor, his patient and the illness. 2nd ed. Oxford: Churchill Livingstone, 2000.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome

Ted J Kaptchuk, John M Kelley, Lisa A Conboy, Roger B Davis, Catherine E Kerr, Eric E Jacobson, Irving Kirsch, Rosa N Schyner, Bong Hyun Nam, Long T Nguyen, Min Park, Andrea L Rivers, Claire McManus, Efi Kokkotou, Douglas A Drossman, Peter Goldman, and Anthony J Lembo
BMJ 2008 336: 999-1003. [Abstract] [Full Text] [PDF]

Online poll

Find out more >>