July 15, 2011 / 12:34 IST
Inhaling albuterol helps asthmatic lungs work better, but patients who get it don't feel much better than those treated with a placebo inhaler or phony acupuncture, according to a US study.
The results, which appeared in the New England Journal of Medicine, demonstrate the importance of, literally, caring for patients and not just providing drugs, said co-author Ted Kaptchuk of Harvard Medical School.
The findings also demonstrate the impact of the so-called "placebo effect," or the phenomenon seen in clinical trials when people given inactive, fake "treatments," such as a sugar pill or saline, show improvements.
"My honest opinion is that a lot of medicine is the doctor-patient relationship," Kaptchuk told Reuters Health.
"A lot of doctors don't know that, they think it's their drugs. Our study demonstrates that the interaction between the two is actually a very strong component of healthcare."
All of the 39 patients, each of whom had mild-to-moderate asthma, thought the placebos were just as effective as the real therapy.
Those who got albuterol reported a 50% improvement in symptoms. The ones who got phony albuterol said they improved by 50% as well, while those getting sham acupuncture had a subjective improvement rate of 46 percent.
The only thing that didn't work as well, according to the patients' impressions, was no therapy at all, with the asthmatics sent home after waiting for several hours. In those cases, patients reported 21% improvement.
Only when the researchers measured the patients' ability to force air from their lungs was the benefit of albuterol clear. The so-called FEV1 volume improved by 20% with the drug, nearly three times more than the 7 percent increase in patients getting the fake acupuncture, ersatz albuterol or no treatment.
Fake acupuncture turned out to be the most convincing treatment and was done doing needles that retract into the handle instead of going into the skin. In addition, the needles were "inserted" into the wrong acupuncture points, said Kaptchuk, who is trained in the discipline.
85% of the people who got it thought they were getting a real therapy, compared to 73% who received real albuterol and 66% who were getting placebo albuterol.
"Patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture," the researchers wrote.
They also said the findings show that a patient's self-report can be an unreliable indicator of actual improvement.
Kaptchuk said the test may help resolve the longstanding question of whether placebo treatments, because they seem to show a benefit, actually affect the physical illness.
"But changing subjective outcomes is very important for us," he said.
"There are lots of illnesses with no objective outcomes, like depression and chronic pain, and what we've demonstrated is that provision of care really does change people's experience."
