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 health care 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 health care 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 healing.
The healing can occur without outside assistance -- as the placebo effect in drug studies indicates -- 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 are all out of a job.
Dike Drummond, M.D. is a family physician, entrepreneur and executive coach. He provides stress management, burnout prevention and leadership development services to physicians and other healthcare professionals through his website, The Happy MD.
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