Asthma Study Shows Placebo Can Help Symptoms
Researchers Find That Fake Treatment Doesn't Help Lungs, yet Asthma Patients Feel Much Better
Disease vs. Illness
What's going on? Kaptchuk says there are two aspects to being unwell: disease and illness.
"Disease is what doctors search for -- the underlying physical thing they can detect with labs and imaging and can express in hard numbers," he says. "Illness is what a patient experiences. A lot of times these two things are not congruent. ...There is a difference between what doctors find and what patients experience."
What the asthma study demonstrates is that making patients better requires treating illness as well as treating disease.
"Our goal as asthma doctors is really to try to take care of the underlying problem, which is why we give the medicines we do," Wechsler tells WebMD. "But with this study we saw that part of taking care of the discomfort patient experience is being there for them. There is definitely some mind-body interaction in asthma that relates to the shortness of breath that patients feel."
Franklin G. Miller, PhD, a placebo-effect expert at the National Institutes of Health, says that the study adds to previous research showing that objective medical outcomes (in this case, lung function) are not the same as patients' subjective medical outcomes (feeling less shortness of breath).
"In the ideology of medicine, objective outcomes are seen as real and subjective outcomes are seen as not real or clinically meaningful -- and that is a mistake," Miller, who was not involved in the study, tells WebMD. "A very basic goal of medicine is relief of suffering. And suffering is subjective. I am the only one who can say I am in pain or distress. So to wash that away as merely subjective is counter to one of the real goals of medicine."
On the other hand, Miller notes, drug treatment really did make patients' lungs work better. Without drug treatment, many if not all of these patients would have had a preventable asthma attack -- no matter how much better fake treatment made them feel.
The balance, Wechsler says, is to give asthma patients both medical treatment and medical care.
"I counsel other asthma doctors to interact as much as they can with their patients," he says. "We tend to interact only during doctor visits, but certainly patients experience symptoms between visits. Perhaps some interactions by phone and by email can allay some of these symptoms."