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ANNALS OF SCIENCE THE POWER OF NOTHING Could studying the placebo effect change the way we think about medicine? BY MICHAEL SPECTER Re years, Ted Kaptchuk performed acupuncture at a tiny clinic in Cam- bridge, a few miles from his current office, at the Harvard Medical School. He opened for business in 1976, on a street so packed with alternative healers that it was commonly referred to as “quack row.” Kaptchuk had just returned from Asia, where, as an exiled alumnus of the turbulent sixties, he had spent four years honing his craft. “There were lots of alternatives on that street in those days, but no practitioners of Chinese medicine,” Kaptchuk, who is sixty-four and still lives in the neighborhood, told me recently as we sipped (Chinese) tea in the study of his house. “The area is a little too L. L. Bean for my taste now,” he said. “It was a different place then.” Not long after Kaptchuk arrived in Boston, he treated an Armenian woman for chronic bronchitis. A few weeks later, she showed up in his office with her hus- band, who had a Persian rug slung over his shoulder. He nodded to Kaptchuk and said, “This is for you.” Kaptchuk accepted the rug, which he still owns, but had no idea what he had done to earn it. “Oh, doctor, you have been so wonderful,” the woman told him. “You cured me. I was about to have an operation on my ovaries and the pain went away the day you saw me.” Kaptchuk never spoke to the woman again, but he has been unable to get her out of his mind. “There was no fucking way needles or herbs did anything for that Scientists are now seriously investigating—and debating—our response to sugar pills. 30 THE NEW YORKER, DECEMBER 12, 2011 woman's ovaries,” he told me, still looking mystified, thirty-five years later. “It had to be some kind of placebo, but I had never given the idea of a placebo effect much at- tention. I had great respect for shamans— and I still do. I have always believed there is an important component of medicine that involves suggestion, ritual, and be- lief—all ideas that make scientists scream. Still, I asked myself, Could I have cured her? How? I mean, what could possibly have been the mechanism?” At the time, few serious scientists would have entertained such questions, let alone allowed words like “ritual” and “belief” to seep into a conversation about medicine. Placebos had a bad name, which is not surprising, since they have been used primarily to deceive people. In clinical trials, if a drug and a sugar pill produce similar results, the drug has gen- erally been considered worthless. But the definition of medical treatment is chang- ing, and so are attitudes about placebos. This year, Harvard created an institute dedicated wholly to their study, the Pro- gram in Placebo Studies and the Thera- peutic 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, in disciplines as diverse as neuroanatomy and semiotics. The program was formed to explore an idea that even twenty years ago would have seemed preposterous: that place- bos—given deliberately—might be de- ployed in clinical practice. As medicine. Kaptchuk has no shortage of critics. They acknowledge the power of the mind to influence health but question the rigor of studies suggesting that pla- cebos could possibly prove as valuable as drugs. Indeed, the idea of dispensing sugar pills is jarring even to those who, like Kaptchuk, are enthusiastic about it. After all, placebos have almost always been defined as exactly what medicine is not. “I realized long ago that at least some people respond even to the sug- gestion of treatment,” Kaptchuk said. “We know that. We have for centuries. But unless we figured out how that pro- cess worked, and unless we did it with data that other researchers would con- sider valid, nobody would pay attention to a word we said.” The research has been propelled in & large measure by the emerging discipline % S WENNGREN HOUSE_OVERSIGHT_029925