by Brian Kim, MD, MS
“Preservation of sound judgment both in the laboratory and in the clinic requires the use of the “double blind” technique, where neither the subject nor the observer is aware of what agent was used or indeed when it was used. This latter requirement is made possible by the insertion of a placebo…into the plan of study.”
The world took notice in 1955 when Henry Beecher published his influential paper “The Powerful Placebo,” in which he reported that, on average, 35% of patients respond favorably to nothing more than a placebo, or “sugar pill.” For decades thereafter, it was widely assumed (erroneously) that a similar proportion of people, whatever the circumstance, could expect to have their fortunes changed with the help of a placebo.
This “placebo effect,” or at least what we had come to understand of it, was challenged in 2001, when another groundbreaking report argued that giving someone a placebo pill was no better than giving someone nothing at all!
Now, as we have delved deeper into the paradox, scrutinizing the very concept of placebo itself, a more nuanced view of the placebo effect has emerged. For those faithful to the scientific process (as we are here), essentially everything except for the active treatment itself could be considered part of the placebo effect. We’re talking about the rituals of treatment:
1. the doctor-patient relationship
2. the possibility of spontaneous recovery
3. the expectations of the patient
4. the power of positive thinking
Think back to the last time you had a refreshing cup of coffee to brighten up a bleak, up-before-dawn, is-it-really-only-Wednesday kind of morning. Do you think it was the caffeine in the coffee that snapped you out of your work day blues? That’s certainly a possibility, a likely one at that. Caffeine has a known stimulant effect. Put two and two together and you have what looks like an obvious cause-and-effect situation.
Seems simple enough. But let’s consider the ritual of your morning cup of Joe. What else could have brightened up your morning? Maybe the cute barista who flashed a flirty smile while she handed you your grande drip (with your name spelled totally correct, for once). Or, perhaps, as the morning wore on you had a spontaneous energy burst from a late cortisol kick. Subconsciously, the exercise of “getting coffee” may simply be associated with the idea of “waking up” because, hey, that’s what Folgers has been telling you all these years! The only way to confirm that it was actually the caffeine that energized you would be to repeat your same bleak morning with a cup of decaf, unbeknownst to you and the barista! This may be tricky to arrange…
Odds are, you did not just dream up a double-blinded placebo-controlled version of your coffee consuming self…but do you see where we’re going with this? Our experiences, and particularly those related to pleasure or pain, are inextricably tied to our expectations and perceptions; whether or not, at this moment, that glass looks half empty or half full. We see fascinating examples of this in the realm of athletic performance, where the power of positive thinking appears to be in full effect.
Middle distance runners tend to believe that consuming sodium bicarbonate, or baking soda, prior to a race will lead to faster times (as far as we know, this is not true). We’re not entirely sure where this came from but we’re glad someone looked into it. In a trial of 16 runners, each ran four 1000 meter time trials under four separate conditions, in no particular order.
1. In the first situation, they were told they would get baking soda, and got it (prior to running)
2. In the second, they were told they would get baking soda, but actually got a placebo
3. In the third, they were told they would get a placebo, and got it
4. And in the fourth, they were told they would get a placebo, but actually got baking soda
Deceptive? Yes. But totally worth the results. As expected, those who thought they took baking soda, and actually did, ran the fastest. The next fastest times came from the runners who thought they had taken baking soda, but had actually taken placebo Interestingly, the slowest times came from runners who believed they had received placebo, regardless of whether it was actually placebo or baking soda.
There is clearly an argument to be made about the power of suggestion. The idea that your belief in something, whether it’s a product or your own willpower, can actually contribute to your likelihood of achieving success. But what is this belief based on? If you’re trying something for the first time, let’s say a new pair of running shoes, your belief in the efficacy of that product is likely inferred from portrayals in advertising, social media, or word-of-mouth from a friend or acquaintance. But if BQing, or accomplishing any other goal, is the name of the game, both your expectations and motivations are likely derive from your recent history of failure or success. What have you done for me lately?
To build the confidence (and, perhaps, audacity) required to get yourself to 26.2, it helps to set a foundation of winning (and not in the Charlie Sheen way) that you can look back on when the going gets tough. By setting a few small, reachable goals every day, you can start improving the expectations that your mind jumps to when it encounters a new, bigger challenge. The way I see it, the placebo effect is the mind helping the body fight.
I am emboldened when I remember that I trained intensely for twelve weeks during my most difficult year of med school to run my goal of 1:36 in the half marathon. I am encouraged by the fact I came home today after a grueling, frustrating day of work and still managed to lace up and run a set of hill repeats. I consider it a small victory every time I floss. And, lastly, I’m pretty stoked to be done with this article. Time to call it a day.
Make success a habit. No goal is too small.
Dr. Kim’s Week 1 Training Program
Saturday: 4.0 miles, tempo run, 7’57 pace
Distance: 10.5 miles
Calories burned: 1277
Mileage to date: 10.5 miles
Questions? E-mail the author: firstname.lastname@example.org
Hrobjartsson A, Gotzsche PC. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N. Engl. J. Med. 2001; 344:1594Y602.
Beecher, H.K. The powerful placebo. J. Am. Med. Assoc. 159: 1602Y1606, 1955.
Eichner, R. Placebos, expectations, and the power of words. Curr Sports Med Rep. 2011 Nov-Dec;10(6):312-3
Beedie, C.J., D.A. Coleman, and A.J. Foad. Positive and negative placebo effects resulting from the deceptive administration of an ergogenic aid. Int. J. Sport Nutr. Exerc. Metab. 17:259Y269, 2007.