I received a lot of questions from people who watched the BBC Horizon documentary about placebos and back pain. Some even asked: ‘Where can I get those placebos I saw on TV?’ The placebos we used in the documentary aren’t available commercially. But the placebo effect is caused by more than the placebo pill. The placebo pill doesn’t cause anything by itself. If it was just the pill, I could easily tell people to go online and buy placebos (for example here).
The placebo effect is complex, and is caused by different things. We can also harness the placebo effect for our own benefit. For the next 7 days I’m going to talk about one aspect of the placebo effect per day. One of the things people mean when they say ‘placebo effect’ is ‘Hawthorne effect’, and I’ll start with that here. I’ll share the remaining 6 on Medium.com and social media.
1st of 7 things you need to know about placebo effects: Hawthorne effects
In a series of experiments between 1924 and 1933, scientists fiddled with the lighting in parts of the Hawthorne works belonging to the Western Electric Company factory near Chicago. When they turned the lights up in one part of the factory, they found that productivity went up. Then they tried turning the lights down: productivity went up again. Since productivity increased whether the lights were turned up or turned down, they reasoned that the factory worker performance went up because workers knew they were being watched. They called the effect of being observed the ‘Hawthorne effect’.
Scientists are finding that Hawthorne Effects could occur in medicine too. For example, one study looked at rates of hand washing in hospital staff. When staff knew they were being observed, they were more likely to wash their hands than when they didn’t know they were being observed. Researchers in Denmark looked at what happened to 3000 people in trials who weren’t taking an intervention or a placebo (for example they were on waiting lists). These patients were simply being observed. In spite of not taking anything, their symptoms improved by 24%. Most of us can relate to this. If we knew we were being carefully observed as part of a trial, we might do things that are good for our health, like exercise more, eat healthier, drink less alcohol, or expect to recover. All of these could have health benefits.
In any study like the BBC back pain documentary, participants knew they were being watched. This could have caused them to be more optimistic about trying to do things like move more, or expect to recover. Being optimistic and moving more (as I’ll describe in later posts) can reduce back pain.
Some evidence shows that we can use (something like) the Hawthorne effect to improve our own health. For example, some trials show that people who weigh themselves regularly lose weight. Weighing yourself regularly is called ‘self-monitoring’ and basically means observing (a measurement of) yourself. I also find Hawthorne-like effects helpful for reaching my fitness goals. At the moment I’m trying to improve my running endurance. I share how far and fast I run via social media with the group I sometimes run with. Sharing my scores with a group means I’m observing the records of my training, and it also makes me ‘accountable’ to the group. This motivates me to train a bit more and a bit harder. Clinical trials show that ‘accountability’ improves physical fitness.
Hawthorne effects don’t occur in everyone, and they are different in different people. The best way to find out how powerful they are for you is to try. Monitor something you’d like to improve (like your weight or fitness level) and make yourself accountable to others. Then, observe any improvements.
#pain #placebo #DoctorYou #exercise
@DrMichaelMosley @OxEmCare