Placebo Ponderings

The following post is based on a speech which for an international training conference.

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The Placebo Effect is one of the few scientific concepts that almost everybody knows. Undoubtedly this is because it speaks to our imagination: could the power of our mind be the most potent medicine imaginable?
Examples of the Placebo Effect abound, and almost everyone can name a few. Placebo painkillers (that’s to say: pills that had no therapeutic value whatsoever) can be shown to have half the pain-killing effect of morphine, and placebo steroids can have a significant impact on the muscle gainz of gym-goers.

Also within the self-development sector (as well as far weirder places), placebos are a common topic. They are usually spoken of with a degree of reference; after all, they play neatly into the narrative that results are inevitable if only believes hard enough. Listeners are generally admonished to try to create their own placebos, and allow their own positive thinking to yield significant results.

Given the productivity and self-improvement focus of this blog, you might then assume that this post is then a praise song for the placebo effect. Nope. Rather the opposite.

I find the placebo effect to be a rather negative force in the world in general, and in the process of finding truth in specific.

The main pitch in favour of the placebo effect will always be that “Whether it works better than something else or not, you’re still achieving an effect”. Bodybuilders taking placebos really do lift more weight. Children taking placebo pills really do get better from their colds.
Fair enough: I’m not discounting the real effects that come from placebo (beliefs). And I’m open to the argument that placebos have a place in areas like medicine and psychology.

However, placebos are built upon false beliefs; and beliefs tend not to exist in a vacuum. False beliefs in particular may lead to advantages in some areas, but can undermine you elsewhere.
And the main problem with placebos is that for them to work, you have to believe that they work. And this makes you forget that… well, they don’t actually work. This has several applications:

  1. Accepting a placebo means you lose the motivation to search for alternative solutions which may yield superior effects. You already think you found the magic pill; why search anything else?
  2. Placebo beliefs are generally tethered to other beliefs. If you’re being sold placebos, you’re likely (there are exceptions) dealing with people who are okay with selling you misinformation or a faulty worldview in general.
  3. While believing in nonsense seems relatively harmless when everything is going well (and truth “matters less”), graver situations may come and then you’d better not waste time letting go of your cherished placebo.

Examples like homeopathy and faith healing clearly bring all these disadvantages into view. There is almost no question that homeopathy is an elaborate and long-lasting kind of fraud… to say nothing of the faith healing performed in various denominational churches. However, it remains very popular in the sphere of alternative medicine and catches many patients disillusioned with modern medicine.
Using a placebo may provide temporary belief for a condition, but look at the long-term cost: the patient might stop using actual treatment that has a chance of actually curing him (point 1), often gives the patient a very slanted and misinformed view of medicine and how the world operates (point 2) and one might very well die if one keeps believing in the treatment as the condition gets worse (point 3).

On balance, this is not a great deal.
And I see no place where to stand and say that some placebos are okay (even when things look relatively harmless) without being on the slippery slope towards accepting false beliefs when we think they’ll help us.

https://www.explainxkcd.com/wiki/images/2/24/blind_trials.png

However, being aware of the placebo effect is an extremely important factor in creating processes and practices that actually work.

Let’s apply this to an example from my own life: being a soft skills trainer in an NGO. The purpose of our training was to meaningfully develop the soft and hard skills of our members, so they could fulfill their responsibilities better. As the style of training was quite different from traditional engineering lectures, participants were often ecstatic at the end of a 4-hour session, claiming many learning points and a lot of fun.

In my view, a pervasive problem in this community was its focus on these ‘ostensible results’ of the training. However much of which was undoubtedly placebo, caused by the experience of being exposed to a novel and entertaining way of education.
A few observations on this:

  • It’s rather easy to impress people with less knowledge than you, and achieve ostensible results. Snake oil salesmen do it, charismatic faith healers do it, consultants do it, and so on. But this tends to be short-lived and a distraction from finding better methods.
  • Reporting impact is not the same thing as achieving impact. Just think of most non-fiction books you read in the past: you may have felt that it was great when you finished it, but how much has it really impacted you? In the same way, participant’s momentary self-reporting is not a good metric.
  • Invariably, trainers would get psyched from the (again, ostensible) performance differences in participants at the end of the 4-hour session, versus at the beginning start. But this is a flawed comparison that ignores the placebo effect.
    The real question is: how much have they learned compared to other methods of spending these 4 hours? Could they have learned more reading a book for 3 hours and then discussing? Could they have learned more just talking to each other for 4 hours? This should help you figure out whether the teaching methods actually had an impact, or whether it was just a natural consequence of letting people talking in a room for 4 hours.

In essence, each trainer should have frequently asked themselves: ‘Am I a placebo? Am I simply achieving the lowly placebo fruit rather than creating unique value?’.
Thinking about these issues didn’t need to be depressing: it would have helped us get clearer on our impact/effort, and then start maximising it.

As a conclusion: here’s the way I think we should deal with the placebo effect:

  • In world of ideas: do not be satisfied with the advantages that come from the placebo belief in misguided ideas. As long as people distract themselves with placebos, they cannot find a true solution.
  • When impacting the world, let’s be skeptical with ourselves and our methods, and be ready to discount the ostensible results that also other methods could provide.
  • In our own life: seek to prove that we’re creating unique value rather than the placebo value that any pill could create.

I do believe there is some value to the power of belief even when it cannot be 100% rationally justified. But that will be a story for another day!

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