Placebo effect may be harnessed to produce better care outcomes

Contributing Writer
AMA Wire
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A physician who shows personal interest in patients while exuding competence and optimism about their course of treatment may do more than put patients at ease during medical encounters. A growing body of research is showing how a patient’s mindset about the care she is receiving—and about the physician or other health professional providing it—can have a measurable impact that goes beyond subjective perceptions of quality to actually affect objective health outcomes.

So concludes Alia Crum, PhD, assistant professor of psychology at Stanford University and principal investigator at the university’s Mind & Body Lab. Crum talked about her studies into the psychosocial factors that affect patients’ outcomes at the AMA’s recent Inspirations in Medicine event, held in Chicago in partnership with TEDMED.

Crum’s research focuses on the placebo effect. During her talk—entitled “What if our mindset determines our health outcomes?”—she argued that physicians could provide specific benefits to patients, in addition to any diagnosis, treatment or advice they offer.

The benefits—an air of competence and a sense of warmth—have demonstrable, positive effects on patients in relation to many of their biological systems and the pace with which they heal. The biochemical changes they experience and the speed with which they recover can result directly from the verbal and non-verbal cues they picked up from their physicians, she said.

“The words we choose to use and the connections we choose to create [with our patients] can leave them with the belief that this treatment will work because the patient is in good hands,” she said during her talk. “Placebo effects are not magical. They can be quantified and … they are our allies in healing.”

During her talk, as well as in an interview with AMA Wire® and articles published in BMJJAMA  and Health Psychology, Crum expanded on how perceived competence by patients and physicians’ warmth and positive messaging, working in concert with each other, produce optimal outcomes.

Crum referred specifically to her longitudinal study of 164 subjects who participated in an experiment in which an allergic reaction was induced by a histamine skin-prick test. All participants developed a wheal, but the size of the red bump was considerably smaller in those who believed their physician was highly competent and compassionate and who received assurances from the physician that the cream given to them to lessen the wheal—which had no medicinal properties—would mitigate the problem.

At the other end of the spectrum—patients with the largest wheals—were those who received the same treatment from physicians they deemed competent but who offered little in the way of warmth and hopeful messages about positive outcomes.

“This study suggests that, if physicians have a reason to hold positive expectations about a particular treatment … [they] may amplify the power of positive expectations by demonstrating warmth (likeability) and competence (credibility) in their interactions with their patients,” she and her Stanford colleagues wrote in a March 2017 Health Psychology article.

Crum said that physicians’ tone of voice, gestures, eye contact and small talk could make an appreciable difference in patients’ recovery times.

But while headaches, colds, rashes and low-grade fevers are conditions from which almost all of your patients are guaranteed to recover, what of patients with graver conditions, such as coronary artery disease, emphysema and cancer? Competence and compassion should be offered to all patients, but how do you convey messages of hope to patients with chronic or life-limiting illnesses? And will doing so make a difference in their lives?

“Compared to the amount of time we spend on developing new drugs and treatment, we have spent next to no time answering those questions,” Crum told the AMA Wire®. “We are still in the infancy of understanding” the roles that patients’ mindsets play as they cope with major conditions.

Such studies are in the offing, Crum said.

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