Josephine P. Briggs, M.D.
Maybe it's all placebo?
A recent study in the New England Journal of Medicine (NEJM) showed a positive outcome for tai chi in the management of the troubling symptoms of fibromyalgia—a condition with which many patients struggle and for which conventional medicine has little to offer. That is why this study is so provocative—can a CAM modality really affect this condition?
Tai chi is one CAM practice that clearly illustrates the challenge of conducting clinical research in CAM. As an accompanying editorial in NEJM notes, it is a complex intervention involving multiple components: exercise, breathing, meditation, relaxation, and a practitioner. How do you control for all of these variables when designing a study? Some CAM proponents will say that it is the combination that makes the intervention work; many conventional researchers will say you must isolate the components to identify the active "ingredient." Critics will say it all just the placebo effect—you expect the intervention to work, and so it does.
This is a clear example of the challenges facing NCCAM and the researchers we fund—to develop methodologies to study complex CAM interventions upholding the rigorous standards of research and at the same time respecting the traditions and practices inherent in CAM. NCCAM recently held a workshop on research controls and methods to begin the dialogue that will lead to better studies in this area. Understanding the complexities of doing CAM research and developing the tools with which to study CAM more effectively is also a theme for our next strategic plan.
In the meantime, we are also interested in understanding and exploring the many components of the placebo effect: what role does expectation play? How important is the patient-provider interaction in health? What is the mind-body connection and how can it be harnessed to promote health and well being?
As a physician and a researcher, I find these issues intriguing and am excited for us to further explore these important research questions.