Q&A | Dr. Josephine Briggs

Alternative therapies and placebos

“The automatic use of psychoactive drugs for symptom management creates problems,” says Dr. Josephine Briggs. “We have an opioid abuse epidemic.”
“The automatic use of psychoactive drugs for symptom management creates problems,” says Dr. Josephine Briggs. “We have an opioid abuse epidemic.”Handout

Dr. Josephine Briggs directs the National Center for Complementary and Alternative Medicine, a part of the National Institutes of Health, which researches mind-body therapies and non-multivitamin dietary supplements. A kidney doctor and graduate of Harvard College and Medical School, Briggs became interested in alternative medicine after running a conference on the placebo effect. She came to Boston last month to speak at another placebo conference.

Q. Why does the government need to fund research into alternative and complementary medicines?

A. This kind of research doesn’t attract private sector support. The supplement industry doesn’t have to establish efficacy to market its products.


Q. Most of the time your agency’s findings have debunked a popular therapy.

A. There are a few exceptions, but echinacea doesn’t prevent colds, St. John’s wort in our studies did not affect major depression, Saw Palmetto didn’t do much. These are very careful, very rigorous trials. Small studies suggest promise and then large studies often fail to demonstrate it. That’s true in mainstream medicine also.

Q. What therapies do you think are most important for your agency to study now?

A. Our portfolio is increasingly focused on symptom management, particularly pain management. Our [mainstream] strategies for helping people with pain are not very good and we need non-pharmacological alternatives.

Q. So the alternative therapies people use to treat chronic pain are likely effective?

A. If the patient tells you it helped, it helped. I’ve come to feel that mind-body practices, whether it’s massage therapy, chiropractic for a bad back, or meditative relaxation techniques should be part of chronic pain management.

Q. How many people use complementary or alternative approaches and who are they?

A. We get to about 40 percent of the American public. Everybody who has disease is using it more than the general public. People faced with health problems look for answers. One of the places they look for answers is the Internet, another [place] is what their grandmother said, another is what their health care provider says.


Q. You got interested in alternative medicine after organizing a conference on the placebo effect.

A. The placebo effect is very strong for symptoms. It sometimes gets oversold for changing the course of chronic disease — it by and large doesn’t. This word “placebo effect” is really a short-hand for all the contextual factors that influence the patient and their interaction with the health care provider and the system. Context really changes symptoms.

Q. What about acupuncture, one of the few complementary treatments that is backed by lots of scientific research?

A. Acupuncture may be a particularly effective placebo because it includes a ritual and a somewhat aversive stimulus and it activates belief. I sometimes think that traditional Chinese medicine learned over centuries how to optimize the placebo effect.

Q. So, should doctors use the placebo effect to treat their patients?

A. As a patient, I wouldn’t want to go to someone who gave me a placebo.

Q. Do we all take too many medications in general?

A. We are too dependent on pills. In nursing homes, [residents on average take] something like 10 separate biologically active compounds per day. The potential for drug interactions is a mathematical problem that’s just mind-boggling. I think that as health care providers, it’s easy to understand why the pharmaceutical solution is the first one looked for, but it’s clearly resulting in overuse of pharmaceutical agents for symptom management.


Q. What kinds of medications should we be taking?

A. I’m a kidney doc. I really believe in treating blood pressure rigorously. I’m not anti-pharmaceutical for things that matter.

Q. And which ones do we overuse?

A. The automatic use of psychoactive drugs for symptom management creates problems. We have an opioid abuse epidemic.

Q. What role do patients play in that overprescribing? We all expect to come home with something when we go to the doctor.

A. Expectations play a huge role. I do think that patient empowerment and the development of more engaged and informed consumers is really important.

Q. Some people say that the government, as the ultimate insider, will never support alternative therapies.

A. We start with a skeptical approach, but we think there are promising things hidden in this wide array of health practices.

Q. What about meditation?

A. I find myself very intrigued by the ways in which meditative exercises and mindfulness can both contribute to well-being and health.

Q. Do you use any complementary and alternative approaches yourself?

A. I do some yoga. No vitamins. I try very hard to eat a fruit- and vegetable-rich diet. I’m not really a vegetarian. I love bacon. Lamb chops too, that’s another weakness.

Interview was edited and condensed. Karen Weintraub can be reached at Karen@KarenWeintraub.com or follow her on Twitter @kweintraub.