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livered to the government by members of the Black Panther Party,” he told me. Even that didn’t work. The Chinese de- nied the request, and Kaptchuk spent much of the next decade studying in Macau. Today, it is hard to imagine Ted Kaptchuk as a radical, let alone a fugitive. He is an observant Jew who wears a yar- mulke on top of a shaggy bowl haircut that looks as if he'd copied the Beatles, circa 1964, then let it grow. As a devotee of Eastern thought, he bars shoes from his house and speaks in a hushed, mea- sured voice. David Carradine would have played him beautifully. Kaptchuk is the first prominent pro- fessor at Harvard Medical School since Erik Erikson with neither a medical de- gree nor a doctorate, and it would be easy to dismiss him as a signature representa- tive of the unsubstantiated-alternative- health-care movement. But he has pub- lished scores of books, articles in highly regarded peer-reviewed journals, letters, and review notes—on subjects ranging from placebo research to exorcism, from cancer treatment to shaman rituals among Navajo Indians. He has just finished a study designed to answer a central ques- tion in placebo research: Do the genes of people who respond to placebos differ in significant ways from those of people who don't? (The data, compelling but so far preliminary, suggest that the answer is yes.) “Ted Kaptchuk is the most knowl- edgeable person in the world on all mat- ters placebo,” Franklin Miller told me. Miller is a senior faculty member in the Department of Bioethics at the National Institutes of Health. “He has done the research, the scholarship, and the most interesting and clinically relevant stud- ies.” One day, I asked Kaptchuk how a man who practiced acupuncture and dis- pensed herbs, rather than earning a Ph.D. in biology or statistics, had learned to design complicated trials. He told me that he spent years seeking the advice of the most highly respected and rigorous medical statisticians. “I basically appren- ticed myself,” he said, “and they were happy to help a quack who wanted to deal with data.” Kaptchuk is proud of being what he calls “a card-carrying member of the Harvard establishment.” It is a dis- tinction that did not come easily, even 36 THE NEW YORKER, DECEMBER 12, 2011 though he has received millions of dol- lars in funding for his projects from the National Institutes of Health. “The goal is to understand placebos so that they may be used intelligently,” he said one day. “But this is the area where I veer from some of my colleagues. Because what do I really want? Anything that gets people away from the conveyor belts that move from the pharmaceutical houses to doctors and on to patients is worth considering. Anything. We need to stop pretending it’s all about molecu- lar biology. Serious illnesses are affected by aesthetics, by art, and by the moral questions that are negotiated between practitioners and patients. Chiropractors never say that your pain is all in your head. But orthopedists do it all the time. What a fucking way to try and help somebody heal. Do you know how evil that is?” That kind of deeply held conviction touches on the fundamental questions that challenge American medicine. Kaptchuk wants to broaden the defi- nition of healing, which is exactly what enrages many scientists. In one recent study of a major asthma drug, he and his colleagues reported that, although place- bos had no impact on the chemical markers that indicate whether a patient is responding to therapy, patients none- theless reported feeling better. Kaptchuk concluded that objective data should not be the only criterion for doctors to con- sider. “Even though objective physiolog- ical measures are important,” he wrote in the study, published earlier this year in The New England Journal of Medicine, “other outcomes such as emergency room visits and quality-of-life metrics may be more clinically relevant to pa- tients and physicians.” “My jaw dropped when I read this,” David Gorski, a professor of medicine at Wayne State University School of Med- icine, wrote on the science blog Re- spectful Insolence. “ ‘Other outcomes’ besides objective measures of disease se- verity may be ‘more clinically relevant?” That kind of assertion clashes with the basic truths of the scientific method. Kaptchuk counters that we are losing sight of our goal—which is to make people feel better. “This study demon- strated that, without a change in objec- tive data, you still get incredible subjec- tive improvement,” he said. “So is a doctor really supposed to say, Gee, the patient is feeling good but I better ig- nore that and go by the numbers?” It was late in the afternoon, and we were sitting in Kaptchuk’s garden in Cambridge. He looked at me and threw his hands into the air. “Is my approach just hocus-pocus?” he said softly. “Isn’t that what you are really asking? You want to know the relationship between ratio- nality and feeling and between science, critical thinking, and the art of medicine. And that boils down to one question: Do you think this entire field is based on a foundation of magical thinking, or do you not?” hree years ago, a week before Thanksgiving, while I was sitting in my office, my chest began to throb. It was a diffuse pain, but pain nonetheless. I am a middle-aged man with the usual amount of stress (too much) and I han- dle it in the usual way (denial). My cho- lesterol and blood pressure are normal, and I exercise regularly and try to eat sen- sibly. Still, I have read many obituaries of “healthy” men my age who ignored chest pain. So, somewhat sheepishly, I called my doctor and explained the situation, and he told me to come right over. He conducted a thorough examina- tion, and then we talked. He told me I was fine, that Thanksgiving is often a tense time, and that I should relax. My pain suddenly disappeared. I have writ- ten frequently of my belief that magic is for fairy tales and science is for hu- mans. But something about that process soothed me. Of course, it was a relief to know that I wasn’t sick. But could words really banish a pain I had struggled with for hours? After I got home, I realized that I had been given a placebo. Not purposefully, perhaps, but it had the same effect. My doctor told me that I was fine, and that made my pain go away. It also eased my anxiety at least as effectively as if I had swallowed a pill. My doctor takes an ex- tremely science-based approach to his work. That’s what makes him so good at his job. But that afternoon we engaged in exactly the type of ritual that, according to Kaptchuk, will have to play a critical role in the future of American health care. And, at least in this instance, it would have been hard to argue that it didn’t work. ¢ HOUSE_OVERSIGHT_029931