Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago

The placebo effect is a well-known, well-evidenced factor that is very relevant when it comes to the testing and implementation of medical treatments:

NIH | National Center for Biotechnology Information | Placebo Effect

Some things that make placebo effect stronger include:

• Larger pills instead of small ones: because there’s got to be more going on in there, right?
• Thematically-colored pills: e.g. red for stimulant effects, blue for relaxing effects
• Things that seem expensive: e.g. a well-made large heavy machine, over a cheap-looking flimsy plastic device. Similarly, medication from a small glass jar with a childproof lock, rather than popped out from a cheap blister-pack.
• Things that seem rational: if there’s an explanation for how it works that you understand and find rational, or at least you believe you understand and find rational ← this works in advertising, too; if there’s a “because”, it lands better almost regardless of what follows the word “because”
• Things delivered confidently by a professional: this is similar to the “argument from authority” fallacy (whereby a proposed authority will be more likely trusted, even if this is not their area of expertise at all, e.g. celebrity endorsements), but in the case of placebo trials, this often looks like a well-dressed middle-aged or older man with an expensive haircut calling for a young confident-looking aide in a lab coat to administer the medicine, and is received better than a slightly frazzled academic saying “and, uh, this one’s yours” while handing you a pill.
• Things with ritual attached: this can be related to the above (the more pomp and circumstance is given to the administration of the treatment, the better), but it can also be as simple as an instruction on an at-home-trial medication saying “take 20 minutes before bed”. Because, if it weren’t important, they wouldn’t bother to specify that, right? So it must be important!

And now for a quick personality test

Did you see the above as a list of dastardly tricks to watch out for, or did you see the above as a list of things that can make your actual medication more effective?

It’s arguably both, of course, but the latter more optimistic view is a lot more useful than the former more pessimistic one.

Since placebo effect works at least somewhat even when you know about it, there is nothing to stop you from leveraging it for your own benefit when taking medication or doing health-related things.

Next time you take your meds or supplements or similar, pause for a moment for each one to remember what it is and what it will be doing for you. This is a lot like the principles (which are physiological as well as psychological) of mindful eating, by the way:

How To Get More Nutrition From The Same Food

Placebo makes some surprising things evidence-based

We’ve addressed placebo effect sometimes as part of an assessment of a given alternative therapy, often in our “Mythbusting Friday” edition of 10almonds.

• In some cases, placebo is adjuvant to the therapy, i.e. it is one of multiple mechanisms of action (example: chiropractic or acupuncture)
• In some cases, placebo is the only known mechanism of action (example: homeopathy)
• In some cases, even placebo can’t help (example: ear candling)

One other fascinating and far-reaching (in a potentially good way) thing that placebo makes evidence-based is: prayer

…which is particularly interesting for something that is fundamentally faith-based, i.e. the opposite of evidence-based.

Now, we’re a health science publication, not a theological publication, so we’ll consider actual divine intervention to be beyond the scope of mechanisms of action we can examine, but there’s been a lot of research done into the extent to which prayer is beneficial as a therapy, what things it may be beneficial for, and what factors affect whether it helps:

Prayer and healing: A medical and scientific perspective on randomized controlled trials

👆 full paper here, and it is very worthwhile reading if you have time, whether or not you are religious personally

Placebo works best when there’s a clear possibility for psychosomatic effect

We’ve mentioned before, and we’ll mention again:

• psychosomatic effect does not mean: “imagining it”
• psychosomatic effect means: “your brain regulates almost everything else in your body, directly or indirectly, including your autonomic functions, and especially notably when it comes to illness, your immune responses”

So, a placebo might well heal your rash or even shrink a tumor, but it probably won’t regrow a missing limb, for instance.

And, this is important: it’s not about how credible/miraculous the outcome will be!

Rather, it is because we have existing pre-programmed internal bodily processes for healing rashes and shrinking tumors, that just need to be activated—whereas we don’t have existing pre-programmed internal bodily processes for regrowing a missing limb, so that’s not something our brain can just tell our body to do.

So for this reason, in terms of what placebo can and can’t do:

• Get rid of cancer? Yes, sometimes—because the body has a process for doing that; enjoy your remission
• Fix a broken nail? No—because the body has no process for doing that; you’ll just have to cut it and wait for it to grow again

With that in mind, what will you use the not-so-mystical powers of placebo for? What ever you go for… Enjoy, and take care!

Reading, Better

It is relatively uncontroversial to say that reading is good for cognitive health, but we don’t like to make claims without science if we can help it, so let’s get started:

There was a 2021 study, which found that even when controlling for many other factors, including highest level of education, socioeconomic status, and generalized pre-morbid intelligence:

❝high reading activity, as defined by almost daily reading, was associated with lower odds of cognitive decline, compared to low reading activity❞

~ Dr. Carol Chan

Source: Can reading increase cognitive reserve?

However, not all reading is the same. And this isn’t just about complexity or size of vocabulary, either. It’s about engagement.

And that level of engagement remains the key factor, no matter how quickly or slowly someone reads, as the brain tends to automatically adjust reading speed per complexity, because the brain’s “processing speed” remains the same:

Read more: Cognitive coupling during reading

Everyone’s “processing speed” is different (and is associated with generalized intelligence and executive functions), though as a general rule of thumb, the more we practice it, the faster our processing speed gets. So if you balked at the notion of “generalized intelligence” being a factor, be reassured that this association goes both ways.

Read more: The unique contribution of working memory, inhibition, cognitive flexibility, and intelligence to reading comprehension and reading speed

So is the key to just read more?

That’s a great first step! But…

The key factor still remains: engagement.

So what does that mean?

It is not just the text that engages you. You must also engage the text!

This is akin to the difference between learning to drive by watching someone else do it, and learning by getting behind the wheel and having a go.

When it comes to reading, it should not be a purely passive thing. Sure, if you are reading a fiction book at bedtime, get lost in it, by all means. But when it comes to non-fiction reading, engage with it actively!

For example, I (your writer here, hi), when reading non-fiction:

• Read at what is generally considered an unusually fast pace, but
• Write so many notes in the margins of physical books, and
• Write so many notes using the “Notes” function on my Kindle

And this isn’t just like a studious student taking notes. Half the time I am…

• objecting to content (disagreeing with the author), or
• at least questioning it, or which is especially important, or
• noting down questions that came to my mind as a result of what I am reading.

This latter is a bit like:

• when you are reading 10almonds, sometimes you will follow our links and go off down a research rabbit-hole of your own, and that’s great!
• sometimes you will disagree with something and write to tell us, and that’s great too (when this happens, one or the other or all of us will learn something, and yes, we have published corrections before now)!
• sometimes what you read here will prompt a further question, and you’ll send that to us, and guess what, also great! We love questions.

Now, if your enjoyment of 10almonds is entirely passive, don’t let us stop you (we know our readers like quick-and-easy knowledge, and that’s good too), it’s just, the more you actively engage with it, the more you’ll get out of it.

This, by the way, was also a lifelong habit of Leonardo da Vinci, which you can read about here:

How to Think Like Leonardo da Vinci: Seven Steps to Genius Every Day – by Michael J. Gelb

a very good book that we reviewed last year

How you read (i.e. what medium) matters too!

Are you reading this on a desktop/laptop, or a mobile device? That difference could matter more than the difference between paper and digital, according to this study from 2020 that found…

❝The cumulation of evidence from this and previous studies suggests that reading on a tablet affords different interactions between the reader and the text than reading on a computer screen.

Reading on a tablet might be more similar to reading on paper, and this may impact the attentional processes during reading❞

~ Dr. Ugo Ballenghein et al.

Read more: Cognitive engagement during reading on digital tablet: Evidence from concurrent recordings of postural and eye movements

What if my mind wanders easily?

You can either go with it, or train to improve focus.

Going with it: just make sure you have more engaging reading to get distracted by. It’s all good.

Training focus: this is trickier, but worthwhile, as executive function (you will remember from earlier) was an important factor too, and training focus is training executive function.

As for one way to do that…

Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering

If you’d like a primer for getting going with that, then you may enjoy our previous main feature:

No-Frills, Evidence-Based Mindfulness

Enjoy!