The search for an antidote to the ills of our ailing healthcare system inevitably bumps up against the pervasive mindset that more is better. Each year we develop and prescribe more drugs, more tests, more technology. Yet, despite these investments, more treatment doesn’t always result in better outcomes. Procedures can be invasive or have unintended consequences, medications can have side effects, and tests can be unnecessary. But what is the alternative? As we look to improve quality and reduce cost, less can actually be more.
Results of recent research indicate that there is much to tap into beyond reliance on drugs and other interventions when helping patients heal. For example:
The doctor’s connection with a patient can improve clinical outcomes
In a treatment experiment where the only variable was the quality of the clinician’s engagement with the patient, those in the “higher engagement” group reported much greater relief. 1
Seeing a treatment administered increases effectiveness
Morphine injected directly by syringe has greater pain-killing effects than when added, out of view, to a patient’s IV.
Sugar pills can work as well as “real” medicine 2
In a study concerning migraine, patients reported as much relief after taking a dummy pill labeled as a proven medication as patients who took the proven medication that was labeled as a dummy pill. 3
These occurrences tend to be aggregated under the rubric of the “placebo effect.” Once pigeonholed as a nuisance factor in clinical drug trials, the placebo effect is now the subject of a promising list of studies and experiments in the fields of neurophysiology, psychology, neuroscience, molecular biology, and genetics.
Placebo research underscores what we have always known but perhaps have lost sight of; that an engaged patient-clinician relationship and the treatment context can have dramatic positive effects. Studies have demonstrated that the clinical encounter alone – without the provision of any “real” medicine – can alleviate pain, improve sleep, relieve depression, and ameliorate the symptoms of a wide variety of conditions.
Not only has the placebo effect been shown to improve health outcomes, studies also reveal it can a) be intentionally evoked, b) enhance the effects of drugs, and c) be effectively administered without deception. A dramatic demonstration of the latter point occurred in a study involving patients with chronic irritable bowel syndrome.4 They were instructed to take two placebo pills (labeled as such) twice each day. Many improved dramatically and more than one described the symptomatic relief as “a miracle”. We can only conjecture what the overall cost savings would be if we were to make greater use of such approaches to healing.
More research is needed to help doctors make the best possible use of the placebo effect. The Robert Wood Johnson Foundation has invested in a series of public seminars at Harvard University to explore the potential of the placebo effect to improve care. The initiative is engaging an international line-up of scientists, researchers, academics, clinicians, and policy-makers in this exploration. The seminars have fostered meaning dialogue between senior faculty from fields as diverse as anthropology, religious studies, and history of medicine with audiences from across the spectrums of academia, health care, and medical education. One might conclude from their popularity and attendance that placebos represent an idea whose time has come.
The human body has a remarkable network of neurochemicals that automatically respond to internal and external cues. We have been drawing on this arsenal to promote healing for thousands of years. It’s time we embrace these less invasive methods for what they are: simple and effective tools to employ in our approach to illness. It’s time we realize that when it comes to health interventions, less is often more.
By Deborah Grose, Program Administrator at The Program in Placebo Studies and the Therapeutic Encounter, Beth Israel Deaconess Medical Center Harvard Medical School