Nobody understands exactly how to harness the placebo effect, but once again scientists have demonstrated its almost unbelievable power.
The latest example comes in the areas of endurance and obesity. Scientists genotyped people for their genetic exercise capacity and physiological satiety, a fancy description for desire to eat.
If you’re into science, you can’t help but be intrigued by the placebo effect.
In this case, scientists deliberately misled volunteers in their study, telling some genetically equipped for endurance that they had a gene called CREB 1 that predisposes people to tire easily and telling others who had that gene that they were genetically programmed for high-endurance.
“Merely receiving genetic risk information changed individuals’ cardiorespiratory physiology, perceived exertion and running endurance during exercise.”
When the scientists ran the same experiment with a second gene – FTO – they got similar results. FTO influences the desire to eat.
People told they had a version of the gene that left them still hungry after meals weren’t influenced by the size of the meal they ate. People told they had a version of the gene that reduced hunger – even those who had the gene that was supposed to leave them hungry – felt well fed after eating only a small meal.
The feeling of being well fed wasn’t just in their head either. Their thoughts had influenced their bodies to the extent they their blood contained higher levels of a hormone associated with the feeling of fullness.
As the researchers summarized, the simple idea that the FTO gene was supposed to do something “changed satiety physiology and perceived fullness after food consumption in a self-fulfilling manner.”
What you believe
The control the mind exerts over the body is one of those great unknowns in human health, sport and more. And yet it is has been documented time and time again.
“How placebos work is still not quite understood, but it involves a complex neurobiological reaction that includes everything from increases in feel-good neurotransmitters, like endorphins and dopamine, to greater activity in certain brain regions linked to moods, emotional reactions, and self-awareness,” according to the Harvard Medical School.
“Placebos won’t lower your cholesterol or shrink a tumor,” Harvard adds. “Instead, they work on symptoms modulated by the brain, like the perception of pain.”
Faith healers would argue that. Studies on faith healing, mainly directed at prayer, have been all over the place on the issue of efficacy.
Ian Ayers sums that all up pretty well at Freakonomics. Suffice to say, the studies are bogged down in religion in which the true believers, by definition, believe, and the non-believers disbelieve.
Prayer may work; it may not. The subject is inherently hard to study. Even among the true believers, most put at least some faith in modern medicine, and are thus likely to seek standard medical treatment.
And studies on those diagnosed with terminal illnesses are difficult because they’re terminal. They’re destined to die within a prescribed timeframe, and most of them will.
What it means if they out live that timeframe is hard to say. Scientist Stephen Jay Gould was in 1982 famously diagnosed with mesothelioma, a rare cancer caused by exposure to asbestos, and given eight months to live.
He died 20 years later from metastic adenocarcinoma, a lung cancer unrelated to mesothelioma. Along the way he wrote a now semi-famous article titled “The Median Isn’t the Message,” which essentially argued that just because things are predicted to happen doesn’t mean they will happen.
“All evolutionary biologists know that variation itself is nature’s only irreducible essence,” he wrote. “Variation is the hard reality, not a set of imperfect measures for a central tendency. Means and medians are the abstractions. Therefore, I looked at the mesothelioma statistics quite differently – and not only because I am an optimist who tends to see the doughnut instead of the hole, but primarily because I know that variation itself is the reality. I had to place myself amidst the variation.”
He looked at the data on mesothelioma deaths and realized that though most people died soon after diagnosis there was “a long tail (however small) that extended for several years above the eight-month median. I saw no reason why I shouldn’t be in that small tail, and I breathed a very long sigh of relief.”
Whether his belief that he was going to be part of that long tail saved him from an early death can be debated at length.
But there is no debate about the placebo effect. It has been shown to work over and over again. Pharmacological studies now correct for it. Why?
Because the simple fact that a doctor gives you a pill and tells you it will help is likely to make you feel better.
The definitive study goes back to neuroscientist Jon Levine in the 1980s who “conducted what is now considered one of the quintessential analyses,” as Benika Pinch writes at Harvard’s Science in the News. “In this study, postoperative patients received either a secret dose of 6-8 mg of morphine, or an overt dose of a substance described as a powerful painkiller (but was actually saline solution!). The results were remarkable: patients in both groups reported the same degree of pain relief.”
The problem with the placebo effect is that it isn’t foolproof and worse yet, you have to believe. If you don’t believe, you’re basically screwed.
The placebo effect has long intrigued me because I have had experience with it. For most of a decade, I suffered from back pain that ranged from nagging to acute.
Like Gould, I immersed myself in the literature. What it said was that most back issues are muscle related, but there are certain skeletal problems that can only be fixed with surgery.
I didn’t want surgery. I regularly in those days talked with Dave Harkness, the Anchorage area wildlife biologist for the Alaska Department of Fish and Game. He’d had several surgeries to fix his back. They’d left him with nothing but more pain.
He had good days, and he had bad days, as did I. But his pain made anything I was dealing with seem minor. It was such that he eventually committed suicide.
I went to doctors, physical therapists and chiropractors looking for solutions, but the treatments provided very little relief. Probably, in part, because, deep down, I just didn’t believe they would.
It was sort of like knowing the morphine was actually saline solution. Eventually, to make a long story short, I went to see a neurosurgeon who ordered an MRI. I remember seeing the problem the day I walked out of the imaging center and held that MRI to the light. The neurosurgeon looked at the MRI and said he could fix it.
I put the surgery off until the day a short run ended with my back seizing so bad I couldn’t stand. After crawling from the bedroom to the bathroom and finding it almost impossible to pull myself up to where I could pee, I called the neuro and said, “we need to do this, and we need to do it now.”
I was in surgery within a couple of days. A week later I was hiking pain-free for the first time in years. A week after that I was running. And what followed was my real experience with the placebo effect, which makes the recent study on endurance so personally interesting.
Believing you can
While in the hospital, I decided I was going to run a marathon in under three hours by the time I turned 40. I’d long been a runner, but not a very competitive one.
I’m not exactly designed to be a runner: big muscles, big bones.
Back in my diving days, friends used to laugh at my negative buoyancy. Even when overweight, even with lungs full of air, I sank. Wetsuits, which provide bouyancy, were a revelation. Suddenly I had some idea of what swimming more on top of the water instead of down in the water was like for other people.
But despite the bone and muscle liabilities, I had a pretty big motor, and I knew what the marathon predictors said. If you could run a 10 kilometer race in 37 or 38 minutes, you should be able to run a marathon in under three hours.
Having run near 40 minutes in a 10K already by then, I didn’t figure it would take long to take a few minutes off, and it didn’t. I was soon regularly running sub-40 10Ks.
That sub-three hour marathon proved trickier. For one thing, I had to get my body weight down to what was for me an almost skeletal 170 pounds, which was significantly harder than increasing my training mileage to 100 miles per week and beyond.
Despite the weight loss and the training, the first few marathons were abject failures. They generally went well until halfway or so, and then the wheels fell off.
Fatigue set in and I slowed down. It wasn’t until I trained my mind to believe I could maintain pace even when fatigued that everything changed. My overall fitness never improved all that much in this period, but my thinking certainly did.
I’d take my lunch hour to go to the club and run 10-minute intervals at 6-minute-per-mile place on a treadmill with only a couple of minutes of recovery between. Afterward, I’d be barely able to walk the couple blocks back to the office, but those long intervals were convincing me that I could maintain a high rate of turnover even in the face of fatigue.
To run a sub-3 marathon, you only need to run an average 6:50 pace. Convincing myself that I could run even faster than that when tired made me believe 6:50 would be easy.
It was, and it wasn’t.
The first sub-3 hour marathon I ran was in Vancouver, and it started badly. I didn’t feel good. I spent time looking for a port-a-pottie in which to make an emergency pit stop in the first third of the race. I thought about quitting at halfway.
By then, I was significantly behind pace and feeling pretty disappointed, and then things just started to click. I won’t say the running was easy, but I was clicking off 6:30 miles and didn’t feel at all uncomfortable. I began passing runner after runner, and by the time I hit the 10K-to-the-finish mark, I was only about 42 minutes away from going sub-3.
In my head, the only thought was “42 minutes for a 10K? I can run a 42 minute 10K without even trying.”
Crossing the finish line in 2:58 was almost anti-climatic because I’d known – known – for more than six miles that this was going to be something better than three hours. The end was in some ways even a little disappointing. I could have gone faster.
But the result was also a big eye-opener: What you know you can do in training is what you can do in a race.
The performance was part physiological, but a whole lot more psychological. Psychologically, I was in a whole different place than I’d ever been before.
When I started the Vancouver Marathon, I knew I could run sub-3 hours though I’d never come all that close before. But still I KNEW. The training had fully convinced me. I was a believer, and the believe delivered results.