There are certain philosophical questions that may never be answered, at least not to the satisfaction of a pragmatic engineer like me. If a tree falls in the forest and no one is there to hear it, does it make a sound? Why is there something rather than nothing? What is the sound of one hand clapping? And of course, the ever popular – What is the meaning of life?
Although any one of these could keep a person’s brain tied up in knots for a very long time, I’d like to add one more to the list - Is a placebo still a placebo when you know it’s a placebo and it still works?
When the word placebo enters the conversation, most of us think of a drug trial. Some of the folks in the trial will get the actual drug being tested, and others will receive the placebo - a presumably worthless decoy. If an inactive, nondescript pill can’t outperform a soon-to-be outrageously expensive miracle drug, there’s a problem in Big Pharma Land.
These trials don’t always work out as expected. This was noticed by Ted Kaptchuk, director of the Program for Placebo Studies at Beth Israel Deaconess Medical Center. The fact that a program for placebo studies even exists provides a bit of a clue as to what’s to come. Dr. Kaptchuk and his team found that placebos are often effective in relieving some subjective symptoms like anxiety, fatigue, nausea and even pain.
In theory, your doctor could give you a bottle of M&M’s, tell you they are the newest wonder drug, and watch you recover. Assuming that the pills aren’t labeled “M&M’s”, there are at least two problems with this. First, it is just a bit unethical for a doctor to deceive a patient this way and, furthermore, the generic is available at the local market in a small brown bag for less than a buck.
But what if the doctor told you he was giving you a placebo, handed it to you in a traditional, child-proof prescription bottle, and gave you detailed instructions on how to take it? Perhaps this sets up a mental story-line that leads to success. Surprisingly, so-called “open-label” placebos have been found to work for many patients. This holds great promise, at least until the drug companies raise the price of M&M’s to $100/bag.
Medicine isn’t the only area where placebos have made their mark. Olympics, Super Bowls, World Cups – all those highly intense, super-lucrative athletic endeavors - have sought that millisecond edge ever since the Greeks were running around naked in Athens. While PED science and drug testing technology are sparring in the octagon of fair play, seemingly benign strategies (cupping, kinesio taping, breathing nasal strips, IV hydration, cryotherapy and icing, vitamins and supplements…) continue to show up in athletic contests of all kinds. None has ever been scientifically shown to work.
Why then are placebos even a thing in athletics? Experts, looking beyond chemistry and physiology, have found that trust in the person supplying the solution is a big factor in its efficacy, and they may actually work by reducing anxiety, perceived effort, or the mental experience of pain. Those that are visible (e.g. cupping or kinesio taping) may actually intimidate competitors who suddenly feel they are at a disadvantage.
Placebo science is just getting started, and it has already shown great promise in treating pain, nausea, anxiety and fatigue. If psychosomatic illnesses have real symptoms, why shouldn’t psychosomatic cures work as well?
In my days as a college professor, I once faced a lecture hall of about 150 students preparing to take their final exam. All the test papers were handed out face down and the usual silent, anxious moment followed. In my straight-faced lecture-voice, I told them of scientific studies proving that students who smile immediately before beginning an exam generally score higher. I’m sure most of them recognized this as a placebo of sorts, but they smiled anyway - just in case.
Author Profile - Paul W. Smith, a Founder and Director of Engineering with INVENtPM LLC, has more than 35 years of experience in research and advanced product development.
Prior to founding INVENtPM, Dr. Smith spent 10 years with Seagate Technology in Longmont, Colorado. At Seagate, he was primarily responsible for evaluating new data storage technologies under development throughout the company, and utilizing six-sigma processes to stage them for implementation in early engineering models. He is a former Adjunct Professor of Mechanical Engineering at the Colorado School of Mines, and currently manages the website “Technology for the Journey”.
Paul holds a doctorate in Applied Mechanics from the California Institute of Technology, as well as Bachelor’s and Master’s Degrees in Mechanical Engineering from the University of California, Santa Barbara.