What’s the relative effectiveness of treatment regimens that are never delivered. Get that? It’s how effective is something when it’s faked.
The study was originally published in the British Medical Journal, of two different groups of chronic arm pain sufferers. The first was given a fake pill that resembled one of the normal medicines for repetitive strain injuries. Almost a third of them developed the real pills’ side-effects. The whole group averaged a drop of 1.5 points on the standard 10-point pain scale after a few months.
Placebos (fake pills) produce real results.
We knew this already. Luckily they didn’t stop there.
The other group was given fake acupuncture. You may be wondering how this can be faked as it involves actually sticking you with needles. They used special trick needles that don’t actually puncture the patient. (You have to wonder where they got these and who would have developed them.) Almost a quarter of them developed red skin and pain at the faked puncture points, and after the same time reported an average of 2.6 points lower on the 10-point pain scale.
“In other words,” Andrew Leuchter, a professor at the David Geffen School of Medicine at UCLA and a noted placebo expert, seems to agree. He told the The (Hartford) Courant that he believed that the “human touch” came into play in Kaptchuk’s results:
“The context in which [patients] are given a placebo may be important — the talking to a health care provider, asking questions, being given answers, being given hope, expectations and encouragement,” said Leuchter….
What’s interesting is that this works even when you tell people they are receiving a placebo, according to research Kaptchuk led which was published in PLOS ONE in 2010. People can experience real reduction in symptoms when they know it’s all fake. According to the Harvard Magazine article, these folks got “twice as much symptom relief as the no-treatment group. That’s a difference so significant, says Kaptchuk, it’s comparable to the improvement seen in trials for the best real [Irritable Bowel Syndrome] drugs.”
Of course, as Leuchter pointed out to The Courant, placebos aren’t anything new because
in the 1950s doctors regularly kept jars full of sugar pills.
“They gave [them] impressive Latin-sounding names and told patients to take [them] twice a day and call them back in a week. And, of course, they got better.”
Your presentation of your expertise matters. Placebos don’t do anything on their own. They don’t have power other than what we give them. (Otherwise Tic-Tacs would be a healing drug.) It was the rituals, the special uniforms, the magical sterile spaces, the heavy special activities.
Erving Goffman made this point fifty years ago.
We co-create social realities. Most of the areas that we think are important aren’t anything on their own. We give them meaning by agreement. We negotiate reality as defined by our language together. Words don’t mean anything except what two humans agree that they do.
It’s one of the problems with sacred spaces — Westerners have created non-space, following in the austere sacredness of the Reformation. The creation of the sacred space in doctors’ offices (as described above) lets us be healed. We believe in the myth of medicine and need the symbols of that mythical power to help us heal ourselves.
(Yes, medicine in and of itself can do things. Antibiotics really were miraculous. Just remember that more years were added to American lives by proper sewage control and water treatment than by antibiotics.)
The accoutrements of business leadership often do matter, but mostly because the effectiveness of the organization is due to our belief. Heck, most of what we believe works in business we believe by faith, not evidence. The actual work of business is so complex, with so many variables that most of what we do we simply do because we have blind faith. It’s one of the reasons why getting business people to behave differently, even when there is strong evidence that doing so is in their best interest, is so difficult.
Business-men and -women work through superstitions, faith, signs and wonders. Almost nothing in business is done rationally. It’s really amazing once you start analyzing it.
Then again, almost no decision gets made rationally. We decide through emotions.
Read More Here
- Signaling, Legitimacy and Reputation: Another Problem High-Potentials Must Overcome
- Get Your Staging Right to Get Your Expertise Heeded
- Get a Creative Class Job Through Manipulating Your Image, Part 2
- Price the Placebo Appropriately
Read More Elsewhere
- For more on Ted Kaptchuk
- “The Placebo Phenomenon: An ingenious researcher finds the real ingredients of ‘fake’ medicine” (Harvard Magazine 2013).
- Research showing placebos work even when you tell people they are receiving a placebo:
- Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, et al. (2010) “Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome“. PLoS ONE 5(12): e15591. doi:10.1371/journal.pone.0015591
- The New Yorker take on the placebo challenge:
- Specter, Michael (2011). “The Power of Nothing” [PDF]
- Leuchter’s research on placebos and their effects on the brain
- Placebo Research at the UCLA Neuropsychiatric Institute
Image credit: ADLER typewriter Model n°7 (Frankfurt / Germany). Unknown model date (probably ~1930/40). © Dake. (CC BY-SA 2.5)
Not sure I understand what signaling is?
OK, I’ve totally rewritten this post to make more sense and added some signalling links. Signaling (if you prefer one “L”) is something from biology. An animal signals its fitness as a mate through extravagant appearance or actions that are extremely costly. There’s no good reason to have bright colored plumage except to attract attention, and attention usually leads to being eaten. So a male with bright plumage is advertising, or signaling, that he has so much going for him that he can blow a lot of energy on creating the plumage and handle the massive added risk of looking like a neon sign that says “EAT HERE”. You can signal other things, too, like subordination or being poisonous.
I probably over interpret this in light of Erving Goffman’s Presentation of Self In Every Day Life and other works.
Got it :-). So, what you’re saying is that the people in charge don’t really know what they’re doing we believe they know what they’re doing essentially on blind faith. So if you can get someone to view you as knowing your stuff, it’s as good as knowing it…right?
No it’s more than that. The placebo results from fake pills and acupuncture mean that how you do things may matter as much as what you do. The way that you present your expertise, and what your clients or customers expect someone like you to look like can affect the end results.
Goffman wrote extensively about this. The doctor comes in wearing the pure white robes of his priesthood. You wait upon him, along with everyone else. His presences is presaged by acolytes who prepare you to come into the priest’s presence.
The more specialized his or her medicine, the more these rituals are observed.
I’ve talked about how 2HiPo’s need to follow the pointers from Stuff White People Like because no one knows how to judge Creative Class applicants. So they make the call based upon signals, and these can include clothing.
But so is the entire way that you bring your results to the client. The client has no way of judging you or your expertise. They rely on these signals and markers. The more you put some dramatics around it the more they will respond.
(Did you know that you can still do seances using the fake techniques from the 19th c and people today will still totally buy it? It’s not that we’re stupid but that we’re human and the trappings matter.)