Placebo is the name of a band. I’m not interested in the band, in this post. This is about the nature of the placebo (and related) effects. I’m not giving a definition on this occasion. Readers can jump on the net and find whatever definitions they like.
I’m sharing some experience and knowledge of the placebo effects. Some will have references on the net, and some will not. My mission is not primarily to ‘explain’ the placebo effect, though I may touch on some possible mechanisms.
The placebo effect is where a thing has the effect of improving something but it has no real efficacy. This can occur in human beings, organisations or systems. I have not asserted that it is a false effect. The positive effect is highly rewarding and creates an almost unshakeable belief that the ‘intervening thing’ is of value. Many will have missed the word ‘efficacy‘ or assumed what it meant.
– a doctor says that s/he think you have condition X, prescribes a pill which he is fairly confident will improve the symptoms of the condition. You take this and after a few days you feel better. This means that the pill is working. That’s pretty simple. Ahhhh.. but after a further few weeks symptoms are not eradicated and actually grow worse. So now you think, maybe it wasn’t working that well. It’s easy in the initial part of treatment for belief to be rewarded by improvement. Doubt sets in when symptoms return.
– a company is having some problem with marketing a particular product. After a consultation exercise, they decide to implement some plan. Things improve over the next few months. They breath a sigh of relief – and conclude that their strategy was effective. They roll out the plan wider to the organisation, then in the next year it all goes pear shaped.
What’s happening there? In both there was expectation that the intervention would improve things. Following the intervention they concluded that the ‘treatment’ was effective. B followed A which led to causal thinking, instead of a deeper understanding of confounding variables. Some of those variables were missed and came back to bite.
In social life – people often report to each other that A, B, or C thing helped them with this or that problem. Numerous such reports are convincing – due to the herd effect. As I said elsewhere the herd effect is a powerful influencer from our psycho-evolutionary inheritance. So, individuals become convinced based on herd reports, then try A (for example) and get ‘symptom relief’. Expectation of relief (a psychological thing) could have driven the reduction in symptoms, while dangerous underlying pathology (for some) remained roaring below the surface (a sort of poultice effect). Powerful beliefs develop as a result of these social myths about ‘what’s good for what’. Any fool can jump on the internet and find a range of remedies for any ailment known to man (or woman) – from vaginal eggs to urine! Even prayer and exorcism can have placebo effects.
Relief from physical or financial pain, is a powerful reward mechanism. It leads people to conclude that there is efficacy. In medical conditions the symptom, not unusually represents a deeper problem. I’m not talking about the common average headache here. The unusual recurring headache could be due to any one of dozens of serious conditions.
Similarly in business operations, a failure in one area may be connected to several other deeper complex problems. In other words the one has to be cautious not to rely on the ‘poultice’ effect.
People are naturally attracted to simplicity – everybody likes the simple and neat solution. This is why ‘pain relief’ is often taken as efficacy.
I’m using ‘pain relief’ to cover a range of issues in medical complaints (of symptoms) and other scenarios. When you get that pain relief, you’re convinced that whatever it is that brought it will continue to work and work in the future. That’s fine for mild symptoms without underlying complexity or complications. But the average Joe or Jane won’t know what’s mild and uncomplicated until too late.
The first danger is of everybody turning into a hypochondriac – and rushing to GP’s surgeries demanding ‘X-rays’ and other tests. The next danger is being the exact opposite i.e. doing nothing.
The social value of some remedy – in the realm of myth – becomes pretty powerful. Hence, we see roaring debates between pure scientists and ‘the herd’ about the efficacy of homeopathy, chiropractic and alternative medicine. The way this works is that ‘some’ people will say that A, B, or C works for ‘some people’ some of the time. But even this does not mean efficacy. Again the word ‘works‘ is important to focus on, because what people really mean by that is symptom relief. They are certainly not talking about a ‘treatment’ or ‘intervention’ that targets the core of some pathological process.
But it gets more complicated because some of the alternative treatments become wrapped in a ‘quasi-science’ which is appealing and ‘makes sense’ – but still lacking in hard evidence of mechanism of aetiology or actual change in underlying pathology post-intervention. I will avoid going into each of those ‘alternative treatments’ which occupy my mind because I know it’s a total waste of my time engaging in myth busting.
This post is not about ‘advice’, so I’m not here to tell people what to do.
- The human mind can believe whatever it wants.
- Unconscious determinants of belief are numerous and can be powerful and risky.
- Seemingly conscious determinants of belief based for example on herd effects are equally risky.
- Symptom does not mean illness.
- Symptom relief does not mean effective treatment of an unseen underlying pathology.
- Quasi-science is attractive and dangerous.
- The placebo effect is powerful and dangerous.
Disclaimer & Guidance