Leaders in Medical Innovation

Dr. Ted Kaptchuk, Director of the Harvard-wide Program in Placebo Studies

Osmosis Team
Aug 31, 2016

Ted J. Kaptchuk is Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School and Director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston, Massachusetts.  As a leading figure in placebo studies, a scholar of East Asian medicine, and an academic authority on medical pluralism, Professor Kaptchuk's career has spanned multiple disciplines, drawing upon concepts, research designs and analytical methods from the humanities and basic and clinical and social sciences. Professor Kaptchuk received a B.A. in East Asian Studies from Columbia University in 1968 and graduated with a degree in Chinese medicine from the Macao Institute of Chinese Medicine (Macao, China) in 1975.  He was appointed Assistant Professor of Medicine at Harvard Medical School in 1998, was promoted to Associate Professor in 2007, and to full Professor in 2013.  From 1998 to 2011, Professor Kaptchuk was Associate Director of the Osher Research Center at Harvard Medical School. He was a member of NCCAM's National Advisory Council from 1999 to 2010 and an expert panelist for the FDA from 2001 to 2005.  Ted Kaptchuk’s work was listed among “The Most Notable Medical Findings in 2015” by The New Yorker.  

How did you decide on a career in medicine and then in placebo studies?
It was the end of the 60’s and I wanted a career that wouldn’t be a compromise with the “system.”  I decided to study Chinese medicine for which there was almost no mainstream awareness.    I studied for five years and when I came back from China people had started to hear about acupuncture.   I taught herbal medicine and acupuncture.   I published successfully.  At some point, Harvard received a grant to study alternative medicine.   Very few people at Harvard  (or any other mainstream school) knew much about alternative medicine and I was invited to teach and help do research.   In research meetings, the main question centered on “is it more than placebo effects.”  It was like a ghost in the room.   Everyone was troubled by it, put it wasn’t clear what it was.   At best, placebo effects were the nuisances that were used as a comparator to determine whether something was “legitimate.”   After awhile, I decided that placebo effects were not being studied in any rational way.  The entire question of placebo was about moral judgments on methodology (is it more than a fake treatment) and few considered whether there was something in placebo effects to discover in its own right..   Eventually, I switch to placebo effects as a focus.  I wrote grants, performed experiments, published, wrote more grants and did more experiments and published more papers..  That became my career.

What does an “average” day look like for you?
Prayers in the mornings.  Make sure I have some time dealing with what is ultimately important.  Emails.  Try to read something important. Try to write something important.   Many meetings to plan grant submissions, implement project, analyze data and write manuscripts.  Lots of time is devoted to mentoring junior investigator one-on-one.  Some time is devoted to making collaborations.  Re-write papers for trainees.  Give advice.  Dinner.  Probably read some historical work to keep things in perspective.

What conclusions have you made from your research on the placebo effect?
Placebo effects are real and are more than spontaneous improvement and regression to the mean.   Placebo effects can be enhanced and diminished; they provide relief and symptoms reduction for many common symptoms, but rarely change, if ever, pathophysiology.  Placebo effects routinely enhance many important pharmaceuticals.   There is an underlying biology shaped by the release of various neurotransmitters, engagement of specific, quantifiable and relevant regions of the brain, and, its looks like there is genetic involvement. One important thing that should be said is that ”the placebo effect is an oxymoron.”  Inert substances have no effect.   Placebo effects are created by what surrounds pills or procedures (inert or active) – e.g., trust, support, hope, uncertainty, rituals, symbols and clinical engagement – and this in turn activates the underlying biology and moves people towards feeling better.  (For a brief introduction see New England Journal of Medicine 2015; 273:8-9.)

In your studies, was there a difference in how patients responded when they knew they were being given a placebo versus when they did not know?
We’re now performing a direct comparison to answer this question in a large NIH-fund randomized trial.  So I can’t answer this question directly.   Using indirect evidence, it seems that in some conditions, open-label honestly described placebo accompanied with a positive rationale, may have similar effects a or even larger effects that double-blind placebos.   That’s hard for the medical community to believe.   Our research suggests that we’re dealing with a complex process that involves non-conscious and embodied cognition. Obviously this is controversial and requires much more research.

Where do you see your research leading you in the future?
Hopefully we want to help develop ways that will allow placebo effects to be ethically harnessed. This could be about pills or about the patient-physician relationship.  The mechanisms of placebo effects needs to be better elucidated.  Lots remain to be done.   I think another generation will take this work in unexpected directions.

What advice do you have for students aiming to get involved in your field?
Study in laboratories and/or clinics that are interested in these questions.  If the clinic is interested spark some interest and try and get people to think about this.   There are always people who are waiting for such discussions.  All the NIH institutes have shown some interest in these questions…maybe not as a priority…but certainty as something that needs to be pursued.   There are some NIH T-32 fellowships that include “placebo studies” as part of their mandate.   Harvard has one.  Placebo effects are most of all medical interventions;  raise the questions.  There is funding available.

What are your thoughts on “alternative medicine” (its effectiveness compared to western medicine, etc.)? What kind of research did you do on this at Harvard?
I feel that I’m not current on the question of alternative medicine.  My focus has been intensely about placebo effects so I can’t be helpful here.

What issues do you think modern medicine faces today?
Certainly, one issue is how to keep advancing the science without losing the core commitment of medicine being “an embodied moral practice.”    How do we treat disease without losing the person?