The rise of placebos

I’m a fan of appropriate placebos. They often have few side effects, they’re inexpensive and they work when used in the right situations. You can check out my rant on them here, it’s been read millions of times to date.

A placebo isn’t just a medical intervention. It’s any tool we use to feel better in a complicated world. They don’t just make us feel better, sometimes they actually change our physiology and can make us better. A wine label is a placebo for some (expensive wine tastes better, until the labels are obscured) and even search engine satisfaction largely comes from the story we tell ourselves about what we’re using to do the search.

Many forms of marketing are actually efforts to build placebo effects.

But how do we pick them? Why is chicken soup good for a cold but not tomato soup or turkey soup?

And why are we seeing (often to our detriment) a rise in nostrums, conspiracies and stories around things that used to be driven by facts and replicable studies?

For a placebo to be effective, our brain needs room to maneuver. That probably involves:

• Complicated problems

• Taking place over time

• That have emotional implications

When those conditions exist, our minds look for an explanation, firm footing and a chance to make things better.

But that’s always been true. The other factor is that we need to hear about a placebo from someone who had it work. The power of suggestion requires that a suggestion be made.

If an influential person was dieting on chicken soup when their cold naturally got better, it’s not difficult to ascribe the improvement to the soup. Because the placebo was around when the disease ran its course, we associate the soup with the improvement. We can then tell others (increasing our confidence, status and affiliation) in an effort to generously improve the health of our friends. Some of them will also be eating soup when their cold improves, further cementing the advantage that chicken soup has in the race to be the placebo of choice for colds.

We had plenty of placebos of every kind a thousand years ago. We had no idea why the sun rose, why the snow fell and why someone got sick. Placebos were essential for our emotional well-being. But the rise of the scientific method moved many of these stories to the side, because we understood things more clearly, and things that were complicated became less so.

In the last ten years or so, we’re seeing a shift happen.

And, as always, the internet is the agent of change here. The internet has given people a chance to share their fears and confusion and frustration about the world, particularly complicated things that happen over time. The world is not getting more complicated, but our fears and confusions are getting more widely shared, which makes it feel more complicated. Few people rant about gravity, but it’s easy to see mystery or even conspiracy in events and trends that are less simple.

If someone suggests a placebo as a cure, a palliative or a cultural touchstone, it might be used by others. And some that use it will find that it was present as things got better, and so it gains in currency. Not because it worked in the way that vitamin C works to cure scurvy, but worked in the sense that it was co-existent with something else happening.

Placebos that give us solace and patience with no side effects are magical. Alas, when we apply them to areas where we’d be better off doing something that has a more direct impact, we’re making a mistake that costs us and those around us as well.