Last week I was invited to attend a debate between two local medical doctors regarding whether applying what is considered the gold standard of research (the randomized control trial) is a fair assessment of whether complementary modalities like acupuncture actually "work."One doctor argued that the randomized control trial works well for testing the efficacy of pharmaceuticals but not that of complementary modalities, while the other doctor more or less concluded that such studies are fair assessments of complementary therapies and that any benefits from complementary therapies are likely derived from the placebo effect.Before going any further, let's define placebo effect. The placebo effect refers to a positive outcome from a treatment that is the result of the patient's expectations that the treatment will produce that successful outcome. As a Doctor of Acupuncture and Oriental Medicine, I have witnessed time and time again that acupuncture works beyond the placebo effect, which the second doctor stated is from the provider spending time with the patient and the patient would likely get better anyway. For the purposes of this article, I am not going to argue that position as I am more interested in exploring the role the placebo effect may or may not have in acupuncture based on my clinical experience. The majority of my patients experience at least a partial, if not a full recovery of their presenting chief complaints with acupuncture treatment. For acute symptoms (symptoms that have only been present for a short while), acupuncture helps quickly and pain is often diminished immediately upon the insertion of needles. For chronic conditions, acupuncture tends to help one layer at a time, until the root of the problem has been addressed sufficiently. While I admit that my patients receive individualized care and that I listen to each patient with a caring and empathetic ear, here are personal clinical experiences that make me question the power of the placebo effect during acupuncture treatment. • Occasionally, I will have a patient show up in my office who was nearly dragged in by a loved one to see me. These patients often make it quite clear to me that they don't "believe" in acupuncture during their initial intake. This was the case of an older gentleman who presented with severe and chronic lower back pain. The first treatment resulted in a significant decrease in his pain, and he has been coming in for acupuncture periodically for the last seven years for various other complaints such as knee pain and depression. He also now makes sure his dog receives acupuncture from a local veterinarian who is specially trained in acupuncture for animals. With this patient, it is hard to believe the placebo effect had an impact on his initial treatment results because he did not "believe" the acupuncture would help him feel better. • I have had several experiences with patients who come in expecting acupuncture to help for their chief complaint, but find it also helped a symptom not admitted to me during the intake. For example, numerous patients have come in for one reason or another and while the treatment helped the chief complaint, they will also report things like their sinusitis or insomnia improved after treatment even though they had not mentioned it to me because they did not "think" acupuncture could address such complaints. These seemingly miraculous improvements in other symptoms often do not come as a surprise to me because of the Chinese perspective that different body symptoms are often related. • I have had several experiences where patients come in with chief complaints that I think the acupuncture will help, and it doesn't. About a year ago I had a patient return to me for acute back pain after I had helped her through chemotherapy treatment several years prior. She expected the acupuncture would alleviate her back pain, as did I. However, after three treatments, her back pain was only minimally improved. This is a case where both the patient and I expected the acupuncture to help, but it did not. Based on the above examples of clinical experiences that challenge the perspective that acupuncture only helps due to the placebo effect, I cannot surmise to what degree the placebo effect optimizes treatment results. I can conclude, however, that our minds are very powerful and I do "believe" that our thoughts greatly affect our health. What do you think? For further conversation regarding this topic, visit Healing Horizons' Facebook page and we will be happy to entertain questions and comments. April L. Schulte-Barclay is a doctor of acupuncture and Oriental medicine and is a licensed acupuncturist. She is licensed by the Colorado Board of Medical Examiners and is certified by the National Certification Commission of Acupuncture and Oriental Medicine. She is founder and clinic director of Healing Horizons Integrated Health Solutions, located at 2139 N. 12th St. #7. For more information, call 970-256-8449.