Can digital medicine have a placebo effect?

Is the placebo effect something that demands the presence of a living human – or can we program it into a cell phone app? What happens to healthcare if we can?

I must admit I have always been fascinated by the concept of placebos. You give a research subject with a documented medical condition a sugar pill – and they get better. They heal themselves despite the fact they have not swallowed anything known to have an effect on their disease. Placebos are fascinating, yet the placebo effect is what is truly inspiring.

What is it about the encounter with the researcher that triggers the patient’s natural healing mechanisms? What did the doctor do or say? What did the patient hear and feel? How can we learn to use this ability to inspire the patient to heal themselves consciously?

I have always wanted this superpower — to be a board certified placebologist.

There is an entire matrix of raging debates on what causes the placebo effect. The Wikipedia page for “placebo effect” is the largest I have ever seen.  I am just a simple country doctor and here are my old school beliefs on its origin.

When a sick, hurting or scared person seeks out the advice of a healthcare provider and is given advice and treatment that they understand and the assurance of follow up if things go awry, it triggers a cascade of physiologic effects that modern science is incapable of measuring at this time. The result is healing.

The healing can occur without outside assistance — as the placebo effect in drug studies shows — or it can augment whatever medication or procedure you might also prescribe.  I believe it is the human qualities of attention and caring that trigger the placebo effect. These exist parallel to the provider’s ability to diagnose and select an appropriate medical treatment.

You can arrive at the correct diagnosis and treatment and not trigger a placebo effect. You can fail to make eye contact, write out a prescription, hand it to the patient and walk out the door.  Right answer — no placebo effect.  Your skills as a placebologist rely on the ability to create the expectation of healing in the patient. This is most definitely part of the art of medicine.

If you have different thoughts on the placebo effect and how to practice the art of placebology, please leave a comment. The bigger question for me is this.

Can the computer scientists write a program that exerts a placebo effect?

My hope and belief is that the answer is no. I admit that I am an old school doctor. I believe that being an empathetic, caring, competent human being in the physical presence of my patients makes a huge difference. This is why the epidemic of compassion fatigue and burnout in medicine is so damaging to our profession.

With the tidal wave of clinical data that will soon come from the universal adoption of electronic medical records, it is highly likely that our clinical decision making skills will be replicated by computers very soon.

If they figure out a way for the programs to feel like they actually care about you and solve the riddle of capturing the art of placebology in binary code, we will be all out of a job.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • Leonard Kish

    I’ll weigh in that the answer is probably yes. We’ve “codified caring” into thousands of other systems. I think of the scene in Clooney’s “Up in the Air” where he talks about his love of simulated hospitality.

    Go to the grocery store, a chain restaurant, a chain hotel, an airport counter, call customer service or interact with thousands of other company interfaces, and you get a script. When you see them and you are aware of them, they’re easy to despise. It’s population-based caring, and if you’re part of a rewards program, as in the movie, it becomes personalized, but still scripted. It’s certainly a love/hate kind of thing. We appreciate simulated hospitality over no hospitality, but it’s incredibly frustrating when you find yourself in some kind of corporate decision tree where there’s no way to get to the answer you need. “If only I could talk with a real, live person.”

    My sense is that the edge of what can be “simulated caring” will continue to be pushed. Today, it’s better than no caring and no access, that’s why we go to Google or Wikipedia, to get whatever access we can. We will always need to be attentive to where simulated caring can work and where it can’t. When we can get beyond population-based caring and into personalized care, I suspect it will all be easier to stomach. Mostly, patients want answers, and in their care (to quote from another part of “Up in the Air”) they want to know “what to do next. ”

  • Julie Barnes Weaver

    As a Healing Touch Certified Practitioner, I’ve seen hundreds of cases of what many doctors would call the “Placebo Effect” of my Energy Medicine work… and I say: Yes! Right! It IS the Placebo Effect – that demonstrates (ok, anecdotally) the real power of the Mind-Body connection. I agree wholeheartedly with you, Dr. Drummond, when you say: “it is the human qualities of attention and caring that trigger the placebo effect”, because it’s the result of the attention and caring I give to my clients and patients that help their own bodies give them a greater sense of well-being. I have both private clients and I work with patients during their chemo treatments in Minnesota Oncology Hematology PA clinics in Minneapolis/Saint Paul MN. So glad you wrote this column.

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