Future Now
The IFTF Blog
Your Personal Placebo Profile
During their work on the Future of Persuasion, my colleagues in the Technology Horizons program developed the idea of a personal persuasion profile - that, in effect, each of us will be profiled based on the kinds of pitches, targeting and information we're most likely to respond to, that, over time, will follow us around in our virtual lives. It seems to me that in health, we may be on the verge of a similar concept in health: A personal placebo profile that identifies the kinds of non-biological medical practices that influence us, which can follow us around from medical encounter to medical encounter.
My argument here is based on a key shift we've begun seeing in recent years: That medical researchers have begun pushing the view that rather than dismissing placebo effects as statistical noise, we should instead figure out how to use the placebo effect as part of a broader set of health interventions, that, while not nearly as effective as traditional biomedical treatments, can still help us get better.
In the New Yorker a couple of months ago, for example, writer Michael Scherer profiled the head of a new Harvard Program dedicated to studying placebo effects. In the piece, Sherer makes a useful distinction between illness and disease:
Disease is a biological condition that we have historically treated with drugs, surgery, and other technological solutions. Illness, on the other hand, defines the context of a medical encounter, including the relationship between doctor and patients… Placebo research demonstrates that it is essential to consider both the science and art of medicine--to think about diseases as illnesses, and not rely solely on short-term, high-tech solutions.
This is similar to something I wrote about last year, with regards to efforts to leverage placebo effects--that health care is intensely meaningful, but that for the most part, medical care has focused on optimizing the biological side of care and minimizing the importance of meaning.
It stands to reason that this meaning-making is personal, of course. At least one (not very good) study, for example, claims to have found links between genetic mutations and placebo responses. A very good 2009 article from Wired notes that placebo responses to different pill colors, shapes and so on vary by culture--and that pharmaceutical companies have already begun looking for ways to harness these effects when deciding how to design their medications.
Now, of course, there are a lot of reasons to be skeptical of placebo effects--particularly since it's the sort of space invites all sorts of quackish nonsense. But what this research into placebos is showing is that how doctors treat people matters:
In a study last year, Harvard Medical School researcher Ted Kaptchuk devised a clever strategy for testing his volunteers' response to varying levels of therapeutic ritual. The study focused on irritable bowel syndrome, a painful disorder that costs more than $40 billion a year worldwide to treat. First the volunteers were placed randomly in one of three groups. One group was simply put on a waiting list; researchers know that some patients get better just because they sign up for a trial. Another group received placebo treatment from a clinician who declined to engage in small talk. Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition.
Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.
In other words, making the clinical encounter a positive one, at least in this study, did as much to improve IBS as leading drugs--and notably, of course, these aren't mutually exclusive strategies.
So what would a personal placebo profile be? A ton of money is going into personalizing medicine to our underlying biological states. And while I don't think placebo effects will ever be nearly as important, a useful area of innovation will involve understanding the qualitative factors--like how each of us likes to interact with caregivers--that can improve health outcomes.