• by Wendy Lurrie , Columnist, November 10, 2016

Dr. Human: How I Learned To Stop Worrying And Love The Placebo Effect

Everyone who works in healthcare (and many who don’t) knows the placebo effect. When given a sugar pill, many patients experience a benefit that cannot be attributed to the treatment, since the treatment itself has no healing properties.

It’s been long studied and documented. The power of the placebo is often explained by the power of expectation – that the therapy will work, or confidence that the therapy will work for me.

It’s a form of self-efficacy, the well-known construct pioneered by psychologist Albert Bandura that an individual’s belief in their own ability to perform a specific task or in a particular situation can determine their likelihood to succeed.

I was reminded of the power of the placebo effect by a recent piece on NPR, “Skeptics Question the Value of Hydration for the Healthy.” The story delves into intravenous infusions of water – sometimes with vitamins, sometimes without – to treat everything from chronic fatigue to migraine to fibromyalgia.

Patients who received the placebo IV (just water) were, unsurprisingly, as likely to report that they felt better than those with the vitamin and mineral-enriched water. These patients happily underwent a particularly invasive form of placebo therapy, and because they expected a happy result, they achieved one. Expectation high, expectation met. But is that all there is to it?

As I wondered, and researched, I came across something else about the placebo effect. The underlying hypothesis of placebos has always been that patients don’t know what they’re getting – they could be getting an effective therapy, not just a sugar pill (or an IV bag full of water). What would happen if they knew that what they were getting had no intrinsic benefit? Could it still work, and if it did, why would it work?

NPR to the rescue. Ten days later, I found a report titled “Is a Placebo a Sham If You Know It’s a Placebo?” The article referenced a study from the journal Pain. The study it referenced was conducted in Portugal, and participants were told about the placebos, that they were inactive, contained no medication, but that their bodies could react to them.

Spoiler alert: the “knowing placebo” group did extremely well. And they knew throughout that the placebos were placebos

Let’s go over that again. This group knew that the placebos were placebos. They knew what they were receiving had no intrinsic therapeutic benefit, that it had all of the efficacy of a sugar pill. And they experienced a benefit nonetheless. What gives? If this study is right, it’s not expectations that make placebos work, or at least it’s not expectations alone. Or confidence. Or self-efficacy. It’s something more.

Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center, has a theory. “It’s absolutely not the pill,” he says. It’s what surrounds the pill.”

What surrounds the pill?

One theory is that it’s a trusting relationship between a healthcare provider and a patient. It’s the human connection. Underneath everything else – the data, the technology, the clanking bureaucracy and the systems within systems – are what matters most in healthcare.

It’s the thing that is the simplest and most profound – the link between provider and patient, based on trust. It’s what patients yearn for, and why healthcare professionals chose their fields. But, of course, it’s harder than it looks.

In an era of six-minute doctor’s appointments, real and looming physician shortages, a roiling healthcare ecosystem and the distractions of technology, it’s easy to lose sight of the basics. A bond between a person in need and a caregiver is simple, profound, and ancient. But what if it’s more than that? What if the theory behind the known placebo idea is true – that patients with strong bonds to providers don’t just feel better, but actually get better?

We all know how hard it is to make significant and sustainable changes to our healthcare system on a broad scale (exhibit A: the Affordable Care Act). But in the work we do as marketing communications pros in the healthcare space, there’s a lot we can do.

We can, and should, ensure that all the work we do helps to build trust between provider and patient. We can establish criteria and measure our work against them to make certain that our work builds the confidence on both sides of the relationship

Are we helping to minimize jargon, understand family dynamics and social networks, better educate, and distribute decision-making? Are we creating support programs that truly supportive? Do we have a clear understanding of the rational and emotional drivers for both provider and patient?

Have we used our many tools to understand the barriers to trust so we can overcome them? How will we know when we have?

Marketing and communications can’t fix the healthcare system. But we don’t have to. What we can do is make real and meaningful contributions to the part of the system that matters the most – the relationship between provider and patient.

Because the placebo effect is real, and the higher our expectations and the more deeply we trust, the greater the benefit.