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Ted Kaptchuk Interview

First published in NZRA Journal of TCM, Winter 2006

Ted Kaptchuk graduated with a doctorate in Oriental Medicine from the Macau Institute of Chinese Medicine in 1975 and is an acknowledged scholar in the field of Chinese medicine. Author of the book, The Web that has no Weaver: Understanding Chinese Medicine, he is considered an expert in many other forms of alternative medicine. A prolific writer, he has written over 70 articles and reviews, co-authored 4 books and presented a number of scientific and technical papers. His most recent research is focused on the implications of placebo effects in randomized controlled trials at Harvard Medical Schoolsí Osher Institute.

How did you end up at Harvard Medical School?

I was interested in science for a long time. In college, I studied religion and philosophy. Then I studied Chinese medicine in China and I came back and was a practitioner of Chinese medicine. When people became interested in alternative medicines, they asked me to help out at Harvard Medical School. I realized that in order to survive there I had to become a scientist. So I became a scientist.

What research are you doing now?

I study acupuncture. I study alternative medicine. I study placebo effects. I'm mostly interested in the philosophy of medicine, the history of medicine and the history of science. I research to what extent the placebo effect is real: Is it an artifact of the way we do clinical trials? What's its duration? Itsí magnitude? Is it plastic? Can one vary it? In what illnesses does it apply?

Some of my research looks into what itsí mechanism is. Do we see what physiological pathways it takes? How does ritual get translated into physiology? Does acupuncture or herbal medicine have more efficacy than a placebo?

I'm not a proponent of alternative medicine. Iím the same way anyone else is at Harvard Medical School - probably even more critical of those phenomena. I consider myself a scholar and a scientist. But I am unusual in that I am a TCM practitioner and I have no problem being a TCM practitioner. I don't know if it's me, my charisma, the placebo effect, or the needles or the herbs I give, but I don't have any problem with that.

Then my philosophic questions are: What are the scientific, moral and ethical implications of the placebo effect? Maybe this placebo effect is really what we should be doing here! In the Middle Ages, the pope said you couldn't visit Jewish doctors. That was an ethical judgment. Is that the same thing we say now, you can't get a placebo because it's a forbidden form of treatment? That it's not the outcome that matters, it's how it got done? That's an ethical judgment, too.

There are great theoretical differences between conventional medicine and Chinese medicine, what about the similarities?

They both try to take care of people; they both try to help people. They both use rational ideas - they don't use altered states of consciousness. They try to assess the situation using cognitive processes and they try to interpret what the situation is caused by. Then, they use material intervention - acupuncture or surgery or drugs. They both believe that the doctor/patient relationship is very important.

There are some inherent requirements of Chinese medicine that make for a better doctor/patient relationship. You never want to treat just the finger or just the toe. You have to treat the person wherever the complaint resides. At that level, there is automatically a more integrated doctor/patient relationship. You're required to know about the person. It's not a conscious emphasis on the doctor/patient relationship, but it's part of the system thatís a more holistic approach.

In conventional medicine, one measures and isolates something, gives it a precise numerical equivalent and quantifies it. East Asian medicine looks to the quality of the patient. Conventional medicine tries to quantify and privileges causality based on the smallest piece that they can reduce the question to. If they can find the germ, or the gene, or the metabolic chemistry, that's what they look for.

The direction of Chinese medicine is the exact opposite. The emphasis is the context of the complaint. It's more macroscopic. What kind of patient is this? How does this person behave in his or her everyday life? In their work life? What are their feelings and their sensibilities and their beliefs? If a patient has an eye problem, you ask about their knees. If they have a knee problem, you ask about their digestion. You can't interpret the knee unless you know how the person gets angry or doesn't get angry. Or how the patient likes certain types of food, but not others.

To put it a different way, modern medicine is quantitative and Traditional Chinese Medicine is qualitative.

Hippocratic medicine was very similar to Chinese medicine, with the four humors and the four elements, and you balance them. Hippocrates didn't treat people; he treated the Ďweather conditioní the person was in. If the person was bilious, that means that they were like a hot summer day and they were agitated and that's the issue that you had to treat no matter where the complaint was. If someone was phlegmatic, they were cold and lazy and didn't move around a lot and no matter what the complaint was - knees, eyes or digestion - you treated that quality. That's the same for Chinese medicine.

What is the relationship between conventional medicine and alternative medicines like TCM in the United States today?

Until 10, 15 years ago, there was a tug-of-war. That's a polite way of describing an all out attempt at destroying each other. What's happened is realignment or a type of armistice. I think people of both camps have realized that it's not to the patients' benefit that the providers of the same patient are ignorant of one another and even doing counterproductive things. So in the end patients demanded a cease-fire.

People have always been mistrustful of their doctors because no one medicine satisfies all the complaints that people have. For a short period, people thought modern medicine was wonderful and invincible, because the penicillin, antibiotics, some surgeries and cortisone drugs that came out after World War II really were wonder drugs. But, by and large, medicine - any medicine - can't alleviate all human suffering. But there will always be doctors around. Occasionally, they'll be liked, and occasionally, people will mistrust them. That's part of the human condition.

Human beings are the only animals that take pills. Humans are the only beings that see the possibility of things being very different. That applies to medicine and healthcare.

The first doctors were religious figures. The secularization and rationalization of healing and the removal of altered states of consciousness as a central feature of healing is parallel to the rationalization of human self-understanding. Hippocratic medicine exactly parallels the rise of Greek philosophy and Chinese medicine exactly parallels the rise of Chinese philosophy.

Why does conventional medical science get such good press coverage?

There is a way that science purports to be objective and independent of preconception. The press is always confused because the scientists have this myth. And in fact, scientists contradict each other all the time. I think the problem is not the press, but that science has given itself its own religiosity of being objective.

But there is a very big gray zone on the edge of science, and the public demands clear answers on important questions. In fact, studies sometimes only cloud the gray zone. And sometimes what science thinks is an absolute clear zone becomes cloudy with more experimentation.

There's an element of mythos in science, and the press and the public are colluding with scientists in order to promote their priestly function in the secular world. I don't have any problem with that. I think people have the right to religion, but they should be clearer about the fact that there's a lot of subjectivity in science - from the questions asked, to the interpretations of results.

What is it about the placebo effect that makes it so hard to study scientifically?

The idea of ritual is what science detests. The scientific revolution is about getting rid of culturally embedded behaviors, uncovering natural universals. A drug is a natural universal. Penicillin works in Africa or Asia. A ritual depends on belief, religion and imagination. Ritual is specific to culture. Placebo effect is presumably about the appearance of things, the belief in things and the ritual of things. There is something inherently unscientific about it.

It may be that ordinary people have demanded the investigation of alternative medicine. It may be that alternative medicines have demanded the placebo investigation. But I think that the National Institutes of Health (NIH) has really accelerated the placebo stuff. The NIH conference on the placebo effect in 2000 was very important in initiating the debate. NIH is a governmental bureaucratic institution, but it also tries to be innovative and look into important questions.

Do you think of your research work as radical?

I think my work is radical in terms of science. But I try to abide by scientific rules. I try to be imaginative and innovative, potentially critical. I operate on the margins and don't march with thousands of other scientists. But Iíve worked at the NIH and I still fundraise for Harvard Medical School. That's pretty straight. I havenít cut my hair though.

There is some speculation that the popularity of alternative medicines signals the entering of a non-scientific age. What do you think?

I'm a scientist, but I can live with superstition. Scientific perspective is so rational that it forgets that the passion and foibles of human beings are part of the dialogue and discourse of all ages. I don't mean to say science is bad, but there's a hubris there that science has all the answers and you've just got to get rid of all the superstitious stuff and then we'd have a great world. I think we have to get rid of the arrogance and racism and intolerance and xenophobia, and that would be more important than getting the public to be purely rational.

Sciencesí demand for privilege has to be negotiated, not automatic. There are a lot of reasons to be disappointed with science. In the same way, there are a lot of reasons to be pleased with it. Getting rid of the arrogance will make people more appreciative of science, more than suppressing other tendencies with strict rationalism.

But I think the NIH has every right and absolute responsibility to be absolutely scientific in everything it does because that's itsí job. But I can tolerate Haitian hoodoo medicine, and Hmong refugees have a right to Hmong medicine. I believe that Christians, Jews and Muslims have the right to pray to the creator of the universe and I don't object if my wife believes in astrology. I think patients have a right to that; I don't care whether it's scientific or not.

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