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 .
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 .
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 . 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