The Placebo Effect: Mind over Biochemistry

The problem gets your attention. Pharmaceutical researchers are facing a new and puzzling phenomenon: as medicines become more effective, so do the placebos that they use in clinical trials.

Wired magazine has published an excellent report on this. Link here. I am indebted to Neo-neocon for having brought it to our attention.

How is it possible to have more effective placebos? They are still the same sugar pills, innocuous substances that patients are induced into believing are the real thing. Yet, researchers at Merck had to stop tests on a new anti-depressant because, however much it was an improvement over current treatments, the placebos were just as effective.

In itself the placebo effect is not especially mysterious. If you believe that a treatment will cure you, your mind will trigger certain biochemical processes that will either aid or abet the therapeutic properties of the medicine. But the mind will trigger a similar reaction even when the medicine is a fake, a placebo.

Placebos only work if you believe in a lie, if you allow yourself to be tricked. When the subject is disabused of his credulity, the placebo will not be effective.

But then, you might imagine an experiment where a subject was taking a biochemically active substance but was allowed to discover-- by accident-- that he was really taking a placebo.

For some medicines disillusionment would make no difference, but for some it would.

Now, what produces the state of belief that will allow the placebo to work? What makes you take the word of a physician or a clinician for the absolute truth?

Perhaps the reason lies in the fact that you have a vested interest in believing it. You gain no real benefit for believing that the physician is lying to you.

In his Wired article Steve Silberman outlines several factors that enhance the placebo effect.

First, physician empathy counts. If your physician believes in the clinical effectiveness of the treatment he is prescribing, if he cares about whether or not you will get better, and if you trust him... then you will feel a therapeutic benefit, even if you are swallowing a placebo.

Perhaps your reaction is purely self-interested. You would rather feel better than lose faith in your physician.

Second, clinical trials are social rituals. We are more likely to believe in something if that belief makes us members in good standing of a social group.

Active participation in a group means performing rituals. Surely this isan effective therapeutic agent for people who are depressed, thus, suffering from isolation.

Third, and perhaps paradoxically, placebos work better because the latest treatments work so well. All the hype and hoopla, all the media stories and advertising campaigns... the more the culture touts the great cures for depression the more likely they are to work.

If they also work for you, you feel like you are part of the culture. And this will make you feel better, even before your body has built up therapeutically beneficial levels of the chemical.

The corollary here is that if you do not live in a culture where people believe in the miracles of modern biochemistry, and where this belief enhances your social status, the placebos will not work as well, if at all.

As I was reading Silberman's article I had a strange thought. The placebo effect involves mistaken beliefs coupled with participation in a social ritual that affirms your membership in a group. But doesn't this sound a little like religious practice?

Perhaps this is the reason why recent research has shown that people who believe in religion are likely to be healthier than those who do not. Link here.

Obviously, clinical trials are not quite the same as religious rituals. The placebo effect is based on an outright lie, a statement contrary to fact. Belief in the Supreme Being is not a statement contrary to fact since it can neither be proven nor disproved by observing physical objects.

Like the human mind and like ideas, the Supreme Being is a metaphysical entity. Strictly speaking you cannot see, hear, taste, touch, or smell God. Nor will there ever by a microscope or a telescope sufficiently powerful for you to do so.

Of course, many of us believe that physical events, even the physical world itself, was produced or ordered by the mind of God. Otherwise, how would it be intelligible to a human mind.

And this is not inconsistent with Darwin or Newton or Galileo or Newton or Kepler. As Jacques Lacane once argued, we know that the planets were orbiting the sun according to Kepler's formula well before Kepler wrote it down. But if planetary orbits were following this law or this idea before any human mind thought it, was there another mind, the mind of a Supreme Being, that had been thinking it.

In other terms, if we assume that it was actively functioning before Kepler wrote it down, where exactly was it?

At the least this line of reasoning is worthy of respect. Even without referring to miracle cures.

If you do not believe that a metaphysical entity like the mind can trigger a physiological process of cure then you cannot believe in the placebo effect. Whatever you think about God, the placebo effect is demonstrably real.

Small Steps on the Path to Change

Some excellent advice from Robert Maurer, via Gretchen Rubin. Link here.

The question is simple: how do you motivate people to change and how do you get them to take the steps needed to effect that change?

Maurer, via Rubin, suggests that small steps, even steps that are small to the point of feeling inconsequential, are better than attempts at quick, radical change.

In his example, if you tell someone that she needs to do more exercise, you should not tell her to go out and find a trainer and start exercising thirty minutes a day.

This might be the goal, but if she tries to do it all at once it will disrupt her daily routines and feel like a trauma. Thus, she will recoil at such a drastic reorganization of her time.

Maurer's solution: ask her to march in place for one minute every day in front of the television. It is a easy to do, it does not interfere with any routines, and it is easily accomplished.

By following this piece of advice the woman took a small but consequential step toward better health.

How can we change bad habits or develop good ones? Rubin recommends that when you identify a goal or a challenge you push yourself to find the smallest step that will move you toward that goal.

It does not matter whether you achieve it today or next month or six years from now. If you have not taken steps in the right direction you will never get there.

Don't Sell Yourself. Buy Them. Part 4

Here's one of my favorite piece of job-hunting advice, expressed well by Alexandra Levit in the Wall Street Journal:

"...nothing takes the place of expressing excitement about every firm you approach, and this enthusiasm should be expressed to everyone from the relative who is a company alum to the receptionist who greets you in the lobby."

For the rest of Levit's article, link here.

For my previous musings, see here, and here.

"The Summer of Our Discontent"

I am not so sure that I agree with Joe Queenan's take about the summer of our discontent, but his overview of America in the summer of 2009 makes for wonderful reading. Link here.

It is not easy to argue, as Queenan does, that nothing happened, especially when we have all been living under the impression that things were happening. I for one think the the events surrounding the town hall meetings-- raw democracy, we can call it-- were a momentous event.

The spectacle of our elected representatives having to answer to the voters who elected them is not nothing.

As I say, I do not consider that to be inconsequential. With that small caveat, I heartily recommend Queenan's great article.

"The Happiest Place on Earth"

I just had one of those cognitive dissonance moments. I was reading a writer I admire, namely Peter Bregman, discuss how to escape perfectionism. A good topic for a column, I thought to myself.

Given that, as the old saying goes, the perfect is the enemy of the good, and given that I am in favor of the good, I was looking forward to reading the piece. Link here.

Truth be told I was gobsmacked, as they say in England, to read that a happiness expert had just discovered that Iceland was "the happiest place on earth."

How did Icelanders earn this dubious distinction? Bregman tells us that they do not stigmatize failure. They are not afraid to fail, and thus they rush right in where more judicious hands would fear to tread. As Bregman puts it: "they pursue what they enjoy." This being the case, he continues: "Iceland has more artists per capita than any other nation."

Bregman quotes one Eric Weiner, author of a book on happiness: "There's no one on the island telling them they're not good enough, so they just go ahead and sing and paint and write."

Bregman summarizes the lesson he draws from the happiest place on earth: "So if you think you're good at something, whether or not you are, you'll do it."

Reading this I felt like I had entered a dopey version of Paradise. Discomfort would not begin to describe it. I was shocked and shaken that so intelligent a writer could completely ignore the fact that a year or so ago Iceland was just about completely destroyed by precisely those qualities that make it so appealing to happiness researchers.

As I read Bregman's article, I was recalling Michael Lewis's description of the catastrophe that is Iceland. Lewis described Iceland, its financial recklessness, its culture, and its people in a great article that was published a mere six months ago in Vanity Fair. Link here.

I recommend that everyone re-read Lewis's article carefully. Nothing about the people of Iceland contradicts the description given by Bregman and Weiner.

What Lewis saw, with exceptional perspicacity, is that these creative free spirits, possessed of an overweening self-esteem, feeling that they must be good at international finance, jumped right in to that world, thoughtlessly and mindlessly, and destroyed a nation in the process.

Since I have written more than a reasonable number of posts arguing that the nostrums offered by the therapy culture created a mindset that contributed to the financial collapse, I am both interested and chagrined to see how it all played out in the laboratory that is Iceland.

Beauty Will Ruin a Man's Mind

So it seems. Having warned everyone of the dangers of adhering to a theory on the mere grounds that it is beautiful, I have just discovered the most recent research on the effect beauty has on the male mind.

To many people it may not be news, but apparently a man who engages a conversation with a beautiful woman will lose mental capacity.

Link here.

How to Be a Great Trader?

Trading coach Brett Steenbarger offers a great list of the five characteristics he finds in people who are great at trading. His list also applies to other areas of life where character counts.

Link here.