Is the placebo effect something that demands the presence of a living human – or can we program it into cell phone medical apps?
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 placebo effect and 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 – an expert in the art of wielding the placebo effect.
There is an entire matrix of raging debates on what causes the placebo effect. The Wikipedia page for the Placebo Effect is the largest I have ever seen.
I am just a simple country doctor and here are my old school beliefs on the necessary ingredients to produce the placebo effect.
When a sick, hurting or scared person seeks out the advice of a healthcare provider
– who is emotionally present, empathetic, confident and optimistic
– and they are 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 the apparently spontaneous healing we call the placebo effect.
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 for medical apps that exerts the 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 and installed into any number of medical apps very soon.
If they figure out a way for these medical apps to feel like they actually care about you and solve the riddle of capturing the placebo effect in binary code … we are all out of a job.
My nightmare …
… is the thought of cell phone medical apps that take your history in an algorithm that simply asks you yes or no questions. Once it arrives at the correct diagnosis, a holographic projection of the doctor of your choice (you can pick an older white male avatar, young female asian, even the movie star of your choice) pops up to “treat” you with all the skill and caring of Marcus Welby MD.
Here’s the real nightmare … it works.
You feel cared for and you respond as if you had actually seen a real human caregiver.
When the computer programmers are able to capture the art of the placebo effect and translate into any number of medical apps – that is a future I must say I am not looking forward to. I am not a luddite. I won’t throw a spanner in the works. AND that is a new era when I think something has been lost.
PLEASE LEAVE A COMMENT with your thoughts on the placebo effect, medical apps and the future of medicine.
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