Another Look at the Placebo Effect
Dec 12, 2011
For the last 50 years, the placebo effect has been a dirty word. Real interventions make a physiological change in the body. Placebos do nothing but convince the patient that something is different. Reality states otherwise. Ted Katpchuk, an acupuncturist and Chinese medicine doctor who focuses on the placebo effect in his research, wants to change all that.
In last week’s New Yorker, an article focuses on the placebo and the scholars who think about and examine the placebo.
What is a Placebo?
One of the difficult and fundamental questions is what is a placebo? We’ve come to believe a placebo is an inert intervention. A sugar pill.
In most clinical trials of medication, or even with some physical interventions, a group of people with a given condition are given active therapy or medication. The outcomes in this group are compared with a group of people who are given a placebo, but most often are not told which group they are in. Usually both groups improve, even people give the placebo. If the medication is successful, the people on active medication will improve more. The the placebo group improvement is called the placebo effect.
The placebo effect is thought to stem from a belief that a given intervention will help. People convince themselves that the medication is working, and miraculously it does. But the placebo does not change the body physiologically. Or so we thought.
Is the Placebo Inert?
One colossal challenge to the concept of a placebo, is that many studies have shown that a placebo is not inert. Meaning that your body has physiological reactions to taking a placebo. This could mean that belief in a specific drug or intervention actually stimulates your body to heal.
This is particularly true with chronic pain. Early placebo studies have shown that placebo intervention for pain relief actually influence the releases natural pain killers in your brain.
The All Encompassing Placebo
Many of the placebo researchers go further. A placebo is any aspect of a given intervention that may help you feel better, but without a specific physiological interaction with the body. This idea encompasses the whole experience of an individual. The environment of the office, the taste of the pill or tea, and how much the practitioner listens to you. The article even discusses how different colors and shapes of pills have various placebo effects.
A powerful concept in placebo research examines how a given intervention, be it medication, massage, or surgery, is more than simply the intervention itself. For example, my statistics professor at Mount Sinai would often discuss the fact that the clinical trial itself is a placebo. Patients in a clinical trial tend to do better on their medication than the general public. This could be because they feel special, receiving a new medication, being treated by expert doctors with a large staff at their disposal. Then, in the general public, the medications tend to work less well.
Doctor Patient relationship
Kaptchuk would like to explore how best to harness the power of placebos in the healing process. He has focused on the patient doctor interaction as placebo. He even ran a clinical trial of a placebo intervention on IBS where the patients were actually told they were taking a placebo, and that it had clinical efficacy in the past. And amazingly, it worked.
However, this dilemma brings a difficulty with the word placebo. Doctor patient relationship is a skill. A skill that many medical schools have begun to teach, as we loose this skill to technological advances.
Perhaps careful explanation, a caring tone, and an ear to listen can be called a placebo, as it is a non-specific intervention. It is not a chemical pill or an herbal remedy. However, it is also a skill, that can be developed and improved. Kaptchuk would certainly agree with teaching how to wield the healing power of the doctor patient relationship.
Yet, the placebo has a negative tone with the medical establishment, and also much of the population, because we are being fooled into getting better. Perhaps there needs to be a new name for a non-specific intervention.
Placebo: The Social Stigma
What is radical about the placebo idea is that nobody wants to believe that a placebo helps them. And its not just Western medical physicians. Acupuncturists, Chiropractors, and other modalities, as well as patients, fight against the idea that whatever intervention is helping, is a placebo. That means its all in your head.
Kaptchuk and others want to change this stigma. Even if the placebo is all in your head, so what. You feel better. You’re healthier and that’s what counts. But what’s interesting, in some cases, the placebo intervention can actually alter physiology of the body.
A Placebo or Common Sense
A comforting office environment has often be chalked up to placebo. But why would you not want to be comfortable in a doctor’s office with soothing colors and music? It is nerve wrecking enough to go to the doctor. And stress has a real effect on the body. It is just common sense to make the office nice.
I think there is a danger when discussing design of a pill and patient doctor interaction both as placebo because this could reduce the importance of the doctor patient relationship.
Acupuncture itself is an interesting question about the placebo effect. I have a hunch that Kaptchuk believes that acupuncture has a real physiological effect, as he has been involved in many studies comparing acupuncture physiology to placebo physiology, and there is often a difference. But it is not discussed in the article, because the point is that it helps people feel better.
Harnessing the Placebo
The field of studying the placebo itself is young. It questions central tenets to clinical research and shows that our bodies can physically heal ourselves of certain chronic conditions. We do not just react to medication, but also to caring, touch, and the environment.
Like much of good science, these studies bring up more questions than they answer. What is the most important aspect of placebo to focus on. Soft voice, listening to the patient, the examination. Or is it the office lighting, soft colors, and music. As the definition expands, the concept of the placebo can encompass almost anything.
Probably the best way to harness the power of many aspects of the placebo is by not calling it a placebo. Doctor patient relationship, a comforting healing environment, and physical touch are all words that don’t have the placebo stigma. These all help the patient get better, which is what is most important.
Lack of social acceptance in the public and medical community is a challenge that the research will not be able to overcome.
images: erix
What is Eczema?
Dec 6, 2011
Eczema is the most common inflammatory skin condition. Although commonly believed to be a disease, eczema is better understood as a group of skin conditions that have similar types of inflammation. Eczema rashes are often scaly, itchy, and red. They may have small fluid filled blisters, called vesicles.
Chronic types of eczema lead to long term discomfort and itching. Atopic eczema is the most common type of chronic eczema. Dyshdrotic eczema on the hands and feet, stasis eczema, and nummular eczema are other types of eczema.
What causes eczema?
The exact cause of eczema is not known. It is probably related to an overactive inflammatory response. Atopic eczema is probably inherited. It is commonly found in individuals with a family history of asthma and allergies.
The Acupuncture and Chinese Medicine Categories of Eczema
Chinese medicine takes a holistic approach to diagnosing eczema, considering physical, emotional, and environmental factors. The primary diagnosis is made by looking at the skin. This is combined with information from taking the pulse, observing the tongue and the skin, and asking in depth questions.
In Chinese medicine, too much heat is a common cause of eczema, which leads to the itch, redness, and irritation. Other imbalances called dampness can result in swelling and vesicles. Another possible imbalance is too little energy, or what we call “qi deficiency.” The acupuncture and herbs help to clear the heat from the body or to boost the body’s energy
If you have questions about acupuncture and Chinese herbs for eczema, please e-mail or call us 917-887-4946 to make an appointment.
Read More:
- Acupuncture for Atopic Eczema
- Acupuncture for Allergies
- Resetting the Immune System with Acupuncture
Traditional Chinese Medicine: A Literary Medicine
Nov 29, 2011
“And when you do find one, observe with care…they almost always have crystals in their hearts.”
From Love in the Time of Cholera by Gabriel Garcia Marquez
To understand Chinese medicine better, we also have to think about how acupuncture and Chinese medicine conceptualize and describe the body.
The Language of Acupuncture and Chinese medicine
Acupuncture and Traditional Chinese medicine is a comprehensive medical system with it own diagnosis and treatment. The terminology and language is also unique.
Sometimes, acupuncture language may sound a little magical. We may say that a headache is caused by liver qi stagnation in one person but in another person it may be from heat. Similarly, anxiety can come from heart blood vacuity but it also can be related to heat irritating the heart.
It is very important that the language and theory is consistent throughout the acupuncture diagnosis and treatment. In fact, if the wrong diagnosis is made, say heat instead of liver qi stagnation, the incorrect treatment will be used which can make the condition worse.
I like to think of these imbalances as metaphors describing the symptoms of your illness.
A Scholarly History
The causes and treatment of disease have been debated, discussed, and experimented with by clinicians and scholars throughout the more than 2500 years of Chinese medicine history.
They have evolved, as historian Paul Unschuld has written, into a system of medical correspondences. These debates still continue today about the best methods to approach and treat different diseases.
Health in Traditional Chinese Medicine
Acupuncture and Chinese medicine view health as a state of balance in the body, as well as balance within the enviornment.
Some of the most common imbalances pertain to the body’s energy, or qi. The qi can be too little, what we call qi vacuity, or it may not circulate as it should, called qi stagnation.
Other imbalances coorespond to the enviornment. Cold, heat, dryness, and wind can all cause diseases.
The Body Acupuncture
Acupuncture Channels
Acupuncture visualizes the body as a complex interconnected web. Meridians travelling throughout the body, connecting the surface to the interior, the upper body with the lower body.
The body’s energy circulates freely. If there is too little energy or if the energy gets stuck, imbalances occur. A build up of any imbalance, heat, cold, stagnation, or others leads to developing into an illness.
To correct the imbalance, we use acupuncture points and treatment methods specific to your imbalance.
For example, a headache from liver qi stagnation, we could use the acupuncture points LI 4, Liver 3, and Liver 14. But if it is from heat, we may choose Liver 2, Gallbladder 34, and San Jiao 5.
photo: geishaboy500
The Healing Process
Nov 11, 2011
I like to say that the acupuncture healing process is like hitting the reset switch. It works in the body to correct once healthy pathways that were knocked off kilter.
There is a process to getting to the root cause of the issue in order to reset the body. Like peeling off layers to get to to the core issue.
Many patients come to me with intense symptoms, often severe pain. The first goal is to reduce the pain to make them comfortable. Then we work on correcting the root issue causing the pain which can lead to long term relief.
In acupuncture and Chinese medicine we call this treating the root and the branch, that is treating the branch symptoms and the root cause. This is the key to the healing effect of Acupuncture and Traditional Chinese medicine.
Photo: Vertigogen
How Long are Acupuncture Needles Retained
Nov 3, 2011
Acupuncture and Moxa for Back Pain
Acupuncturists have a choice in terms of how long the needles are left in the acupuncture points. Different times have different clinical effects.
Most often, the acupuncture needles are retained in the acupuncture points for 20-30 minutes. Traditionally we say it takes 30 minutes for the qi, the body’s energy, to circulate in the channels.
But if it is an acute situation, such as a back spasm, it is generally better to leave the acupuncture needles in for about 20 minutes. This is because the muscles will relax quicker in an acute injury like a back spasm.
When the energy is weak, what we call qi deficiency, it is better to leave the needles in for a longer period of time, such as 35 or 40 minutes in some cases. This provides and opportunity for the body to work on improving the energy.
When using electro-acupuncture, as I often do for pain, 20 minutes has been shown to be the optimal amount of time. In this case, I retain the acupuncture needles for 30 or 35 minutes total. The first 20 are with electro-acupuncture. The second I remove the electro-acupuncture and twirl the needles. The combination of electro-acupuncture stimulation and manual stimulation I find is effective at pain reduction.
How Long is an Acupuncture Treatment?
Nov 3, 2011
One of the important logistical questions about acupuncture is how long is a treatment.
In my NYC acupuncture clinic, the first visit lasts about 75-90 minutes. The following acupuncture visits are about 45-60 minutes.
In the first visit, we have an examination, an acupuncture treatment, which is often followed by acupressure. Other therapies may be included such as cupping or gua sha.
The follow acupuncture sessions are very similar, but the examination is shorter. Periodically, I will conduct physical exams to see how the treatment is progressing.
Acupuncture for Chronic Pain
Oct 28, 2011
In this post, I will explain a number of the ways acupuncture works to reduce chronic pain.
Chronic pain is mysterious. It can come and go. It can get worse, or get better. Often without explanation.
Chronic pain is serious. It interferes with work, school, and relationships. Chronic pain is the most common issue that comes into my New York City acupuncture clinic.
Acupuncture has long been used for chronic pain and recently acupuncture for chronic pain is commonly recommended.
Acupuncture for Chronic Pain
Acupuncture is a complex therapy and works in a combination of ways to reduce pain and inflammation.
Acupuncture works to reduce pain and inflammation through regulating neural pain pathways, stimulating the release of natural pain relieves in the body, such as opioids, as well as regulating pain relieving opioid receptors.
Many studies have also shown acupuncture to have a anti-inflammatory effect, reducing the circulating inflammatory hormones in the blood, such as cortisol. Interestingly, many of the hormonal and neural effects last long after the acupuncture treatment has finished, suggesting that acupuncture has both immediate and long term regulatory effective in reducing pain.
What is the acupuncture needle doing?
We also can think about what the acupuncture needle itself is doing. When inserting a needle, the muscles near the acupuncture needle or along the acupuncture channel will often twitch. Many scientists have looked at this “twitch response” which can change the inflammatory mediators in the area of the acupuncture point. This could point to a mechanism related to local pain reduction.
Connective tissue stimulation is another possible mechanisms for pain relief that the acupuncture needle site.
Acupuncturists will twirl the needle many times during the treatment. Researchers have shown that this stimulates subcutaneous loose connective tissue. Helene Langevin, the remarkable researcher who discovered this, writes, “Fibroblasts (the cells) within the loose connective tissue respond to the mechanical stimulation with active cytoskeletal remodeling that may have important downstream effects within connective tissue.”
We do not know the specific clinical effects of the connective tissue responses. But Langevin believes these results may eventually lead to an explanation of the acupuncture channel circulation and connecting the body.
The next steps in acupuncture research will look to understand how these complex mechanisms work together for long lasting pain relief.
If you have questions about acupuncture for chronic pain, please e-mail or call us 917-887-4946 to make an appointment.
References
Napadow V, Ahn A, Longhurst J, et.al. The Status and Future of Acupuncture Mechanism Research. J Altern Complement Med. 2008 September; 14(7): 861–869.
photo: Wikipedia
How to Naturally Decaffeinate Green Tea
Oct 20, 2011
Green tea is well known for its health properties. Recently, it has become popular for its antioxidants, which have been purported to reduce heart disease and cancer rates. Traditional Chinese medicine practitioners sometimes will add green tea to an herbal formula, primarily for headaches.
In Chinese culture, green tea is the staple drink. Unlike in the West, in China people will refill their tea cup many times with water, using the same tea leaves.
Not only is refilling the cup efficient and cost effective, by doing this one is drinking more of the antioxidants from the tea.
The majority of the caffeine is extracted from tea within 30 seconds of brewing. So the refills have very little caffeine in them, but continue to extract other substances.
For most people, the small amount of caffeine in green tea is fine. For people with inflammation and anxiety even a little caffeine is too much.
How to Naturally Decaffeinate your Green Tea: Washing the Tea
It is easy to decaffeinate green tea yourself without loosing much of the taste or health benefits. Most of the caffeine is extracted within the first 30 seconds of brewing the tea.
To naturally remove the caffeine from the tea, quickly brew the tea and discard the water after 20-30 second. Refill the cup with hot water, and you have a naturally decaffeinated cup of tea. This process is called “washing the tea.”
When drinking more refine types of tea, the custom is to wash the tea. This is also part of the traditional Tea Ceremony.
There are other regional types of teas and styles of brewing. Some regions brew the tea at lower temperatures.
Green Tea in Chinese Medicine
There are many varieties of tea. Just as in New York, there are many varieties of apples. But they all come from the same plant, the difference is in the extent of their oxidizing, breeding, and region.
Green tea is cool in nature and as opposed to black tea which is warmer. Green tea helps to clear heat and drain dampness. As I mentioned before, it can also be used for headaches. Add ginger for headaches from damp weather.
My Recommendations
Because green tea is cooler, I prefer to drink more green tea in the summer and more black tea in the winter. For some people with weak digestion, green tea may upset your stomach. This is due to its cooling properties.
Oolong tea is somewhat neutral and is a good alternative for people who find green tea a little upsetting to the stomach.
I always recommend drinking organic tea. I generally purchase my tea at Mountain Rose Herbs. Or here in New York, Ten Ren is a very good tea shop in Chinatown.
photo: bkajino
What Acupuncturists observe in a tongue
Oct 13, 2011
Observing the tongue and taking the pulse are two of the most common diagnostic techniques in Chinese medicine.
Why look at the tongue?
Chinese medicine uses diagnostic approaches, like the tongue and the pulse, because they reflect the imbalances that are causing your health problem.
What are we looking for in the tongue?
When I am looking at the tongue, I am looking at the the color of the tongue, the size and shape of the tongue body, and the coating on top of the tongue.
If the tongue is very red, or very pale that can show there is heat, or qi deficiency. If the tongue body is purplish, it can show stagnation, a lack of circulation in the body’s channels. If the tongue coating is very thick and white, it can be dampness. But if the tongue coating is yellow and sticky, that can signal intense heat. If the tongue is very red and there is very little tongue coating, then the heat has damaged the fluids in the body.
The size of the tongue can differ as well. A common tongue sign is called toothmarked, where the sides of the tongue almost look like they have teeth marks in them. The tongue body can also be cracked, which can show too little yin.
Eczema: A clinical example of the holistic diagnosis
The information from the tongue is not taken in isolation, but rather combined with other techniques, such as the pulse, asking questions, and in the case of eczema, observing the skin.
When it comes to eczema, looking at the skin is very important. If the skin is very red, irritated, dry, and itchy, then it is probably caused by heat. We then look at the tongue. If the tongue is red with a sticky yellow coating, then it is certainly excess heat causing the eczema. The herbs and acupuncture are focused clearing heat.
But if the tongue is pale and large, with a thick white coat, then it may be heat mixed with qi deficiency, or lack of energy. The herbs and acupuncture would have to also address the underlying lack of energy.
Read more on Acupuncture for Eczema
- Chinese herbs for Winter Eczema: A Success Story
- TCM Treatment for Dyshidrotic Eczema
- Personalized Acupuncture and Herbs for Eczema
Photo: Mike Burns
Natural Remedies for the Common Cold
Oct 11, 2011
1. Ling Zhi (ganoderma or Reishi): This Chinese herb is a mushroom that has powerful immune boosting properties. We say it can boost the body’s qi, or energy. It can also be effective for fatigue and poor digestion.
This herb is best for preventing colds. Now, the change of seasons, is the perfect time to begin taking Ling Zhi. When the seasons change it is easy to get cold. Ling Zhi helps to prevent getting the cold be giving an immune boost. I take only a small dosage and still feel the improvement in my health.
It actually grows all over the United States. A few weeks ago, I went on an foraging tour with Wildman Steve Brill. We actually found Ling zhi on our trip in Westchester. If you are picking wild ling zhi, it is very important to go with a guide as many mushrooms can be dangerous.
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