Tag Archives: placebo

You’re Not In Control

dual_elevator_door_buttons

Press a button, then something happens. Eat too much chocolate, then you feel great (and then put on weight). Step in to the middle of a busy road, then you get hit by an oncoming car. Walk in the rain, then you get wet. Watch your favorite comedy show, then you laugh.

Every moment of our lives is filled with actions and consequences, causes and effects. Usually we have a good sense of what is likely to happen when we take a specific action. This sense of predictability smooths our lives and makes us feel in control.

But sometimes all is not what is seems. Take the buttons on some of the most actively used objects in our daily lives. Press the “close door” button on the elevator [or “lift” for my British readers], then the door closes, right? Press the “pedestrian crossing” button at the crosswalk [or “zebra crossing”], then the safe to cross signal blinks to life, right? Adjust the office thermostat, then you feel more comfortable, right?

Well, if you think that by pressing a button you are commanding the elevator door to close, or the crosswalk signal to flash, or the thermostat to change the office temperature, you’re probably wrong. You may feel in control, but actually you’re not. In many cases the button may serve no functional purpose; the systems just work automatically. But the button still offers a psychological purpose — a placebo-like effect. We are so conditioned to the notion that pressing a button yields an action, that we still feel in control even when the button does nothing beyond making an audible click.

From the NYT:

Pressing the door-close button on an elevator might make you feel better, but it will do nothing to hasten your trip.

Karen W. Penafiel, executive director of National Elevator Industry Inc., a trade group, said the close-door feature faded into obsolescence a few years after the enactment of the Americans With Disabilities Act in 1990.

The legislation required that elevator doors remain open long enough for anyone who uses crutches, a cane or wheelchair to get on board, Ms. Penafiel said in an interview on Tuesday. “The riding public would not be able to make those doors close any faster,” she said.

The buttons can be operated by firefighters and maintenance workers who have the proper keys or codes.

No figures were available for the number of elevators still in operation with functioning door-close buttons. Given that the estimated useful life of an elevator is 25 years, it is likely that most elevators in service today have been modernized or refurbished, rendering the door-close buttons a thing of the past for riders, Ms. Penafiel said.

Read the entire story here.

Image: Elevator control panel, cropped to show only dual “door open” and “door close” buttons. Courtesy: Nils R. Barth. Wikipedia. Creative Commons CC0 1.0 Universal Public Domain Dedication.

The Killer Joke and the Killer Idea

Some jokes can make you laugh until you cry. Some jokes can kill. And, research shows that thoughts alone can have equally devastating consequences as well.

From BBC:

Beware the scaremongers. Like a witch doctor’s spell, their words might be spreading modern plagues.

We have long known that expectations of a malady can be as dangerous as a virus. In the same way that voodoo shamans could harm their victims through the power of suggestion, priming someone to think they are ill can often produce the actual symptoms of a disease. Vomiting, dizziness, headaches, and even death, could be triggered through belief alone. It’s called the “nocebo effect”.

But it is now becoming clear just how easily those dangerous beliefs can spread through gossip and hearsay – with potent effect. It may be the reason why certain houses seem cursed with illness, and why people living near wind turbines report puzzling outbreaks of dizziness, insomnia and vomiting. If you have ever felt “fluey” after a vaccination, believed your cell phone was giving you a headache, or suffered an inexplicable food allergy, you may have also fallen victim to a nocebo jinx. “The nocebo effect shows the brain’s power,” says Dimos Mitsikostas, from Athens Naval Hospital in Greece. “And we cannot fully explain it.”

A killer joke

Doctors have long known that beliefs can be deadly – as demonstrated by a rather nasty student prank that went horribly wrong. The 18th Century Viennese medic, Erich Menninger von Lerchenthal, describes how students at his medical school picked on a much-disliked assistant. Planning to teach him a lesson, they sprung upon him before announcing that he was about to be decapitated. Blindfolding him, they bowed his head onto the chopping block, before dropping a wet cloth on his neck. Convinced it was the kiss of a steel blade, the poor man “died on the spot”.

While anecdotes like this abound, modern researchers had mostly focused on the mind’s ability to heal, not harm – the “placebo effect”, from the Latin for “I will please”. Every clinical trial now randomly assigns patients to either a real drug, or a placebo in the form of an inert pill. The patient doesn’t know which they are taking, and even those taking the inert drug tend to show some improvement – thanks to their faith in the treatment.

Yet alongside the benefits, people taking placebos often report puzzling side effects – nausea, headaches, or pain – that are unlikely to come from an inert tablet. The problem is that people in a clinical trial are given exactly the same health warnings whether they are taking the real drug or the placebo – and somehow, the expectation of the symptoms can produce physical manifestations in some placebo takers. “It’s a consistent phenomenon, but medicine has never really dealt with it,” says Ted Kaptchuk at Harvard Medical School.

Over the last 10 years, doctors have shown that this nocebo effect – Latin for “I will harm” – is very common. Reviewing the literature, Mitsikostas has so far documented strong nocebo effects in many treatments for headache, multiple sclerosis, and depression. In trials for Parkinson’s disease, as many as 65% report adverse events as a result of their placebo. “And around one out of 10 treated will drop out of a trial because of nocebo, which is pretty high,” he says.

Although many of the side-effects are somewhat subjective – like nausea or pain – nocebo responses do occasionally show up as rashes and skin complaints, and they are sometimes detectable on physiological tests too. “It’s unbelievable – they are taking sugar pills and when you measure liver enzymes, they are elevated,” says Mitsikostas.

And for those who think these side effects are somehow “deliberately” willed or imagined, measures of nerve activity following nocebo treatment have shown that the spinal cord begins responding to heightened painbefore conscious deliberation would even be possible.

Consider the near fatal case of “Mr A”, reported by doctor Roy Reeves in 2007. Mr A was suffering from depression when he consumed a whole bottle of pills. Regretting his decision, Mr A rushed to ER, and promptly collapsed at reception. It looked serious; his blood pressure had plummeted, and he was hyperventilating; he was immediately given intravenous fluids. Yet blood tests could find no trace of the drug in his system. Four hours later, another doctor arrived to inform Reeves that the man had been in the placebo arm of a drugs trial; he had “overdosed” on sugar tablets. Upon hearing the news, the relieved Mr A soon recovered.

We can never know whether the nocebo effect would have actually killed Mr A, though Fabrizio Benedetti at the University of Turin Medical School thinks it is certainly possible. He has scanned subjects’ brains as they undergo nocebo suggestions, which seems to set off a chain of activation in the hypothalamus, and the pituitary and adrenal glands – areas that deal with extreme threats to our body. If your fear and belief were strong enough, the resulting cocktail of hormones could be deadly, he says.

Read the entire story here.