Intended for healthcare professionals


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

BMJ 2008; 336 doi: (Published 01 May 2008) Cite this as: BMJ 2008;336:999

Helping patients feel better


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 significant 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 disuss - 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. Kaptchuk T.J., Kelley, J.M., Conboy, L.A., Davis, R.B., Kerr, C.E., Jacobson, E.E., et al. (2008) Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ, 336, 999-1003.

2. Martin, D.J., Garske, J.P., & Davis, M.K. (2000) Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438-450.

3. Balint, M. (2000) The Doctor, His Patient and The Illness. Churchill Livingstone, 2nd Edition.

Competing interests: None declared

Competing interests: No competing interests

06 May 2008
T Everett Julyan
SpR in Liaison Psychiatry
Stirling Royal Infirmary, Stirling FK8 2AU