Institutional Placebo Effect: Tapping Into the Mind-Body Connection for Better Outcomes

I often fantasize about the ideal long-term care facility: a facility without regulations or resulting need to document everything. In this dream — we will call it Nirvana nurses, certified nursing assistants, dieticians, therapists, and social workers spend very little time on computer more interacting with residents. Freed from burden of documentation, nurses assistants can do what they best: provide compassionate care. Of course, because is such wonderful place work, always fully staffed. The staff support each other, resident conflicts are resolved forgiveness accountability. Everyone at an active part community, no matter how small, leads greater sense purpose interconnected family. longer work in care, reimagine make reality. While lack documentation stay fantasy, physicians, physician nurse practitioners working help influence culture ways that result meaningful experience for better outcomes patients. We by teaching power their over residents’ through ability mind-body connection generate form treatment almost adverse effects. “institutional placebo effect.” effect positive produced intervention due patient’s belief its effectiveness as opposed itself. lies recipient’s expectations beliefs. home (the institution) have profound beliefs, whether aware not. By understanding ethical uses residents, providers dramatically reduce reliance medications improve reported symptoms limited risk Imagine you just taken all residents rural home. Now imagine most them taking opioids chronic pain half either antidepressant antipsychotic medication. learned if report pain, anxiety, nausea, poor sleep, cough, be given medication; majority least 10 medications. average age 85, one-third still “full code.” recently faced Despite my good intentions, situation was fraught effects polypharmacy unhealthy dependence medication cope It also posed interesting challenge: could concepts our quality life? answer pleasantly surprising. On one hand, considered futile intervention, intended deceive patient. use has several obvious problems, being illegal unethical patients staff. Opting instead been proven effective deprives patient benefit provide; also, unlike real treatment, transient effect. other large growing body evidence indicated associated symptom relief many cases regardless condition. produce substantial symptomatic across wide range medical conditions. discovered sharing way teach outcomes. Compelling presented early 1950s. A study angina pectoris used mammary artery ligation cause natural bypass collateral arteries occur, which found 80% 90% success rate alleviating chest (N Engl J Med 1959;261:1017–1020). However, when some participants died years later causes, were arteries, despite having total symptoms. So researchers surgeons decided perform another whereby would put people under anesthesia, saw open breastplate, but not touch any internal structures; then sewed back up told had occurred. results exact same: rate. couple lawyers pointed out problems study, days using medicine essentially over. 2002 approach arthroscopic surgery improving osteoarthritis knee 2002;347:81–88). well-designed get lavage, débridement, incisions only group). who assessed next two blinded group in. improved advantage point during after surgery. Interestingly, placebos bigger pills than smaller ones, pill, elicit physiological response, like flushing niacin, those Going beyond pills, procedures injections saline powerful surgical. seems ritualistic intense placebo, Research offers insight into reap benefits ethically. National Cancer Institute reports cancer trials prove much 20% (J Natl Inst 2003;95:19-29) whereas leading clinical agents 30%. Based these results, means physical drugs might marginal percentage points mystery self-healing. Providers embrace talk homes find therapeutic tool, consistent scientific connection. Faced dependent virtually everything, began all-staff meeting presentation topic handed articles discussed studies demonstrated 2011;365:119–126). My focus staff’s interactions relationships even other. suspect experience; however, degree altering meaning illness direction well understood significantly underestimated. Through discussion science offering examples language symptoms, change powerless empowered feel less Shortly introducing concept home, reductions. One main concerns reductions example, met resistance. collective took toward dose reduction break success. ask pain. For say, “I know your fentanyl patch decreased, done lower doses. Are feeling yet, too soon tell?” This sets expectation decreasing outcome while opportunity endorse nonpharmacological interventions ice heat, added topical lidocaine as-needed hydrocodone. mention thought be, take extra massaging area where applied. attention, touch, voicing endorsement potential response. response approach, together overwhelmingly positive. With exceptions, embraced changes asking faster tapers broader wasn’t smooth sailing, inevitably failed, successful, attribute willingness idea meaning. don’t surprised staff, quickly appeared entire embracing paradigm shift. Instead resistance, voiced approval Our step add massage therapist acupuncturist offer services both weekly basis, once COVID-19 restrictions allow it. true illegal. discussing emphasize There placebo-like vitamin D St. John’s Wort depression; there fine line between exaggerating conducting intentional deception. prefer experience. Do really listen them? Is environment trust? knock door before entering room, sit down stand, level keep eye contact, reflective listening sure understand, truly moment rushing things same decisions. These “emotional intelligence” skills extend provider and, turn, institutional effect, enough encourage adoption techniques responses practice. post-acute environment, abundance high prevalence disease, importance reinforcing tap costs results. may Nirvana, feels right direction. Mr. Neill assistant PALTC years.