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August 1, 2012

Complementary Health Practices—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (offit2email.chop.edu).

JAMA. 2012;308(5):452-453. doi:10.1001/jama.2012.8169

In Reply: Drs Briggs and Killen from NCCAM point out that I neglected to mention that 30% of NCCAM's research is now directed at determining whether alternative therapies can relieve chronic pain based on “expectancy, context, and placebo effects.” I agree, as I stated in my Viewpoint, that it would be valuable for NCCAM to understand the physiology of placebo responses. Indeed, acupuncturists, chiropractors, and yoga instructors owe it to the medical community to determine why their methods occasionally work. For example, studies have shown that placebo analgesics can promote endorphin release.1 But if alternative medicine is considered placebo medicine, it would be nice to learn to do it without the needles, pills, electrical devices, and appeals to magical thinking. I disagree, however, with the statement by Briggs and Killen that these studies are “scientifically plausible” in that acupuncture can relieve pain independent of whether needles are inserted under the skin2 and, chiropractors' protests aside, diseases are not based on spinal misalignments.

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