Traditionally, the placebo effect has been a "nuisance variable" to compare against the real effect of whatever drug is being tested in a research trial. Placebo has been about sham treatments and deceiving patients, not something to be studied in its own right.
But that's changing. Because of initiatives like the Program in Placebo Studies & Therapeutic Encounter at Harvard, placebo research now has a scientific basis, and the wider research community is beginning to take it more seriously. There are now dozens of teams exploring the context and ritual of medicine, and the role patients play in affecting or internalizing treatment.
It's an open question how exactly this research might be applied, if at all. It could help improve the effectiveness of treatments, or lead to more focus on care and context in delivering drugs. Or, it could even lead to situations where "active drugs" aren't used at all: Doctors could prescribe placebos knowing they're just saline jabs or sugar pills.
If the placebo works as well as the active drug, we could perhaps take them the way we take pills today, perhaps even knowing they were fake. Several studies have shown placebos working even when patients knew what was happening.
Daniel Jacobs, an entrepreneur from San Francisco, is one of the first people to apply the new science. Last year, he developed an app intended to induce joy and serenity. Now, he's back, raising money on Indiegogo to fund a research project looking at potential placebos for happiness.
"The placebo effect is really the result of various inputs in supporting people to feel better," Jacobs says. "We now know that some of those inputs include positive belief and daily rituals. We're using everything we know about the science to support people in things that are meaningful for them."
The original app involved users answering questions about their goals, then taking virtual walks, where they could take a "pill" or wave a wand. The research will compare the effectiveness of Jacobs's app against others, including one from CNN Hero Robyn Benincasa. Jacobs says he's helping along 10 projects at the moment.
In a sense, the actual content of the placebo "prescription" (as Jacobs calls it) isn't that important. It just needs to be something people are willing to engage with and do regularly. What really matters is the mechanism—that people believe they are taking something beneficial.
Jacobs's first app has sold more than 6,000 copies on a pay-what-you-can basis (on average, people pay $5.50). If they want it for free, they need to promise to use the placebo six days out of seven. "The reason for that is, if we don't use payment for leverage, then they have to have a recurring dosage," Jacobs says. "We find that's extremely effective. More than half of people who've paid nothing come at least once a day."
Eventually, Jacobs could build a marketplace of placebo prescriptions. But he thinks more research is needed before he gets to that stage. "Our long-term goal is to see what happens when you take placebo out of the lab and you use it in people's lives. Second, we want to support as many people as possible," he says.