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Could an app replicate the placebo effect?

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New research shows deception isn't needed to induce healing effects with fake meds

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medical cupcakes
medical cupcakes

Daniel Jacobs believes in the placebo effect, the well-documented but not well-understood phenomenon in which sick patients sometimes feel the same healing effects from swallowing a sugar pill that they would from taking a real one. He believes in it so strongly that he doesn’t believe people even need to take a pill in order to produce a positive placebo effect; an app with a picture of a pill will do.

That’s the basis of his startup, Placebo Effect, which is raising $50,000 through the crowdfunding site Indiegogo to build his prototype into an iPhone app that he says can harness the placebo effect in order to help people make positive changes in their lives, such as feeling happier or quitting smoking.

New research shows deception may not be necessary for the placebo effect

The app offers a variety of "placebos," including images of a pill, a magic wand, a communion wafer, and other options. "Placebo pills are actually chosen often. About 12 percent of people in our testing choose pills," he said. "The reason for that probably is that in our society, we feel that pills work really well."

He’s done limited testing with good results, he said, and plans to do more. So far, 39 people self-reported an average of 31 percent increase in the effect they were trying to create in their lives, for example joy, energy, physical healing, or love, after one use. Seven users reported no change, and one person reported a negative change and did not complete the trial.

Jacobs’ idea may sound a bit bogus, especially since it is widely believed that the placebo effect only works if the patient believes he or she is taking a real treatment. This perceived need for deception is part of the reason doctors don’t prescribe placebos, despite the fact that they can occasionally work as well as FDA-approved treatments for some conditions.

However, new research suggests deception may not be necessary to induce a placebo effect. In 2010, researchers from Harvard Medical School and other institutions did a study on patients diagnosed with Irritable Bowel Syndrome (IBS). One group received no treatment, while the other patients were told they’d be taking inactive drugs and told that placebos can have healing effects. To drive the point home, the fake drugs were placed in bottles labeled "placebo pills."

The patients who knew they were taking placebo pills reported twice as much relief as the control group. The placebo had healing effects comparable to some of the best real IBS drugs. "Our results challenge ‘the conventional wisdom’ that placebo effects require ‘intentional ignorance,’" the researchers wrote.

Placebos are used to test treatments, but in the future they could be the treatment

If placebos could be effectively prescribed without the need to lie to patients, it would be revolutionary. Placebos are cheaper and safer than many treatments. Studies have shown placebos to be 75 percent as effective as antidepressants. Fake surgeries have been shown to be just as effective as real surgeries in treating Parkinson’s. Today placebos are used to test treatments, but in the future they could be the treatment. Some doctors are already prescribing placebos this way. "We should be using every tool in the box," Ted Kaptchuk, a Harvard professor, leading placebo effect researcher, and alternative medicine expert, told Harvard Magazine.

Kaptchuk worked on the IBS study that showed a placebo effect even when patients knew they were taking a placebo. He now runs the Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center, a group dedicated to placebo research. The placebo effect varies from person to person, and some may be genetically predisposed to it. The type of placebo and the condition also matter: pills work better for insomnia, studies have found, while injections work better for pain.

It's also important not to cause the nocebo effect, in which patients suffer the same harmful side effects associated with a real medication, for example, even when taking the fake version. It works like the placebo effect but induces negative reactions instead of positive ones. "Placebo" translates to "I will please" in Latin. "Nocebo" translates to "I will harm."

Kaptchuk and his colleagues have plenty of critics within the FDA, the pharmaceutical industry, and academia. A group of Danish researchers conducted a meta-analysis in 2001 and again in 2004, concluding that there is "little evidence in general that placebos had powerful clinical effects."

It’s also unclear how much of the measured effects are due to the placebo effect, and how much might be due to other factors. It’s been suggested that patients experiencing improvement could be have a reporting bias, for example, that skews in favor of the result they believe will please their doctors.

"This is extremely effective."

As to whether the placebo effect can be simulated by an app, more research is needed there too. (Due to the lack of empirical evidence, Kaptchuk declined to comment, via his program manager, on whether an app could induce the placebo effect.)

"What we’re not saying here is, ‘stop taking your antidepressants and to then do this instead,’" Jacobs said. "What we are saying is that the literature shows, and our own internal studies, and later on, clinical trials that we will surely do, that this is extremely effective. It would be wonderful if you could complement this with whatever else you’re doing in life."