Quantifying the Art of Medicine

Screen Shot 2015-07-01 at 6.06.36 PM

Historically, placebos have been defined as a sugar pill or inert substance used as a control variable in experimental studies. Placebo effects were considered a nuisance. Researchers and clinicians have paid little attention to the fact that placebos seem to produce their own health impacts.

But in a July 2 New England Journal of Medicine Perspectives piece , Ted Kaptchuk of Harvard Medical School and Franklin G. Miller from the Department of Bioethics at the National Institutes of Health, show us that there’s more to placebos than we originally thought.

For example, in a study of patients with irritable bowel syndrome, patients experienced adequate symptom relief when given a placebo, compared to those who didn’t receive a placebo. That’s a common enough finding. But what’s most interesting is that relief was even greater when the placebo was coupled with more engaged positive interactions with a provider, such as attentive listening and thoughtful conversation. In another study, when given morphine directly by a doctor or nurse through a syringe, patients experienced more pain relief than when it was administered through an IV. Seeing it administered increased the effectiveness of the medication.

This evidence leads the authors to argue that placebo effects are not the products of dummy treatments but actually the effects of immersion in a health care environment with all its cues and signals.

During every medical visit, we experience the rituals of care: We take in sensory information—our eyes see the doctor’s white coat and the diploma on the wall, our ears hear the tone of the nurse’s voice and words laden with meaning, we feel the touch of the provider’s hand on our arm. We take in all sorts of stimuli that tell us:  I can expect to be healed in this environment, I can trust this person, or, this drug is going to work. And the brain responds in ways that help us heal.

Kaptchuk calls this the placebo effect.

Imagine if we could harness these “placebo” effects. Understanding and applying rituals of care that are proven to be effective could help advance healing and reduce the need for costly or potentially harmful interventions, putting us on a path to a Culture of Health where everyone has the opportunity to attain the best health possible.

To be sure, placebo effects aren’t a cure-all. But they are real and quantifiable—science has already proven how the engagement between a patient and provider can enhance the effectiveness of certain medical treatments and alleviate unnecessary suffering, one of the key tenets of medicine.

As Ted recently told me, if every provider out there took just 15-30 seconds of a visit to get to know the name of someone in the person’s family, it could make a key difference.

So why don’t more health care providers apply them in practice?

Last year, as part of a series of five public forums to explore the potential of the placebo effect sponsored by the Robert Wood Johnson Foundation, Kaptchuk’s team brought together a small working group to debate its merits.

During the course of the small-group discussion, it was plain to the participants—from health policy types to clinicians, ethicists, patient advocates, and experts in informed decision making—the enormous, untapped potential of placebo effects. It’s clear we need broader awareness about the placebo effect and greater investment in clinical studies to spur the development of much-needed clinical guidelines if we are to harness the healing power of placebo effects.

It’s time we started taking the placebo effect seriously.

Brian C. Quinn is the Assistant Vice President for Research-Evaluation-Learning at the Robert Wood Johnson Foundation. 

Categories: Uncategorized

2 replies »

  1. Our brains make dozens of hormones called neurotransmitters and endorphins and releasing factors, etc. Some of these, we think, have effects outside the central nervous system and promote healing and affect immunity, whatever. So placebos may not be magic at all. Just biology and physics.

    And, if they are just the “power of suggestion” they become art, do they not? And we can’t charge for, or regulate, or guideline art, can we?

    You can see that I have taken both sides of the question. :-).

  2. “So why don’t more health care providers apply them in practice?”

    No billing code.