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 important 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 discuss—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.