Asthma treatment beats placebo

Inhaling albuterol helps asthmatic lungs work better, but patients who get it don't feel much better than those treated with a placebo inhaler or phony acupuncture, according to a study in the England Journal of Medicine.

The results demonstrate the importance of, literally, caring for patients and not just providing drugs, said coauthor Dr Ted Kaptchuk of Harvard Medical School and an expert on the placebo effect.

"My honest opinion is that a lot of medicine is the doctor-patient relationship," he said. "A lot of doctors don't know that. They think it's their drugs. Our study demonstrates that the interaction between the two is actually a very strong component of healthcare."

Dr Kaptchuk said he expected to see different responses from the two different placebo treatments, but the patients, all with mild-to-moderate asthma, thought the placebos were just as effective as the real therapy.

Treating asthmatic patients

Those who got albuterol reported a 50% improvement in symptoms. The ones getting phony albuterol said they improved by 50% and those getting sham acupuncture had a subjective improvement rate of 46%.

The only thing that didn't work as well, according to the impressions of the patients, was no therapy, where the asthmatics were sent home after waiting for several hours. In those instances, patients reported 21% improvement.

Only when the researchers measured the patients' ability to force air from their lungs was the benefit of albuterol clear. The FEV1 volume improved by 20% with the drug, nearly three times more than the 7% increase in patients getting the fake acupuncture, ersatz albuterol or no treatment (P<0.001).

"Patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture," the researchers concluded.

They also said the findings show that a patient's self-report can be an unreliable indicator of actual improvement.

Dr Kaptchuk said the test may help resolve the longstanding question of whether placebo treatments, because they seem to show a benefit, actually affect the physical illness.

Fake acupuncture a convincing treatment

"We're saying it doesn't look like placebos change objective pathophysiology and if people want to make that claim, they'll have to show better evidence than we have," he said. "But changing subjective outcomes is very important for us.

There are lot of illnesses with no objective outcomes, like depression and chronic pain, and what we've demonstrated is that provision of care really does change people's experience."

In all, 46 asthmatics started the study and 39 completed it, randomly getting one of the three treatments (or no treatment) during their first four doctor visits, and other treatments in subsequent checkups.

Fake acupuncture turned out to be the most convincing treatment. It was done using needles that retract into the handle instead of going into the skin. In addition, the needles were "inserted" into the wrong acupuncture points, said Dr Kaptchuk, who is trained in the discipline.

Eighty five percent of the people who got it thought they were getting a real therapy, compared to 73% who received real albuterol and 66% who were getting placebo albuterol.

(Reuters Health, Gene Emery, July 2011)

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