Michael Specter profiles PiPS Director Ted Kaptchuk and his “quest to understand the placebo effect” in this excellent piece in this week’s New Yorker. Abstract below.

ABSTRACT:

ANNALS OF SCIENCE about the placebo effect.

For years, Ted Kaptchuk performed acupuncture at a tiny clinic in Cambridge, a few miles from his current office, at the Harvard Medical School. He opened for business in 1976, having just returned from Asia, where he had spent four years honing his craft. Not long after he arrived in Boston, he treated an Armenian woman for chronic bronchitis. A few weeks later, the woman returned with her husband and told Kaptchuk that he had “cured” her. “It had to be some kind of placebo,” Kaptchuk stated. “I’ve always believed there is an important component of medicine that involves suggestion, ritual, and belief.” This year, Harvard created an institute dedicated wholly to the study of placebos, the Program in Placebo Studies and the Therapeutic Encounter. It is based at the Beth Israel Deaconess Medical Center and Kaptchuk was named its director. He has already recruited leading researchers from around the world. The program was formed to explore an idea that even twenty years ago would have seemed preposterous: that placebos—given deliberately—might be deployed in clinical practice. As medicine. Kaptchuk has no shortage of critics. They acknowledge the power of the mind to influence health but question the vigor of studies suggesting that placebos could possibly prove as valuable as drugs. The research has been propelled in large measure by the emerging discipline of neuroimaging. In several recent studies, placebos have performed as well as drugs that Americans spend millions of dollars on every year. Kaptchuk acknowledges that placebos are not magic potions. Describes the history of placebo-controlled trials. Mentions Lieutenant Colonel Henry Beecher. A meaningful picture of the placebo response began to emerge only in the nineteen-seventies, with the discovery of endorphins. Mentions scientists Jon Levine, Newton Gordon, and Howard Fields. There will be no prescriptions for any placebo, unless clinical trials have demonstrated its effectiveness to the satisfaction of the Food and Drug Administration (F.D.A.). Mentions Robert Temple and Wayne Jonas. In 2001, Asbjøm Hróbjartsson, of Copenhagen’s Nordic Cochrane Center, along with his colleague Peter Gøtzsche, published a systematic review of a hundred and fourteen clinical trials that compared patients who received placebos with subjects who were told that they would receive no medicine at all. The Danish researchers repeated the study in 2004, and again last year, incorporating new data each time. “We found little evidence in general that placebos had powerful clinical effects,” Hróbjartsson wrote. Hróbjartsson and Kaptchuk were united on at least one front: they agree that the medical system needs to change. Kaptchuk wants to broaden the definition of healing, which is exactly what enrages so many scientists. It boils down to one question, Kaptchuk asserts: “Do you think this entire field is based on a foundation of magical thinking, or do you not?”

Read more here.