Don’t fear placebos (E)

If you could swallow a pill, a blue pill maybe or a red one, and that pill would make you healthier, stronger, faster, smarter, happier, would you take it? What if I told you there were no side effects and that it was close to free? Hey, this is Emily in the Bronx, and you're listening to a special archived episode of A Kimbo. People are afraid of the placebo effect. They don't like to talk about it. It makes their eyes roll into the back of their head. There's some sort of fear that if you understood it, or examined it, or trafficked in it, it might go away. So let's start by looking at the no-cebo effect instead. The no-cebo effect recently studied is the idea that there are things you can do that make you worse. One example, a guy was in a double-blind study of an antidepressant drug. He wasn't taking the antidepressant. He was taking the sugar pills, the placebo, the drug that, quote, "didn't do anything." Well, he was depressed, and he decided to kill himself, and he took 26 of them. He was rushed to the hospital near death. He needed to be put on IV, and it was only after several doctors informed him that he hadn't taken anything but a few spoonfuls of sugar that his condition stabilized. No-cebos are all around us. Things we can do to bum us out, to make us perform worse, to make our heart race. It begins with this. Most of your brain, perhaps 95% of your brain, doesn't speak English. It speaks as much English as a monkey does, or a beaver, or a walrus. That part of your brain, the brain that keeps you alive, the brain that pumps your blood, the brain that makes you afraid, it doesn't speak English. Sometimes it gets a message from the rest of your brain, but here's the simple test. Listen to some spooky violin music. Now, there's no other cues that this violin music is going to hurt you, but already you're just a little bit tenser than you were a minute ago. Go watch a movie, an Italian movie, a French one, one in Swahili. You don't know the language. There are no subtitles. And yet, and yet you've got a pretty good idea of what it's all about, because your brain, your brain doesn't really understand English. Let's add the next thing. There's a ratchet in our lives. When someone tells you something, or shows you something, or predicts something, when you take a placebo and it works, the next time, it's going to work even better, because you just taught your brain a lesson. You taught your brain that when you get that shot, or when you take that pill, or when you plug those cables into your speakers, or when you drink that brand of red wine, it's going to taste better. And the fascinating glitch in our brains is we ignore all the times it doesn't work. We ignore all the times the horoscope is just plain wrong. We ignore all the times the stock tip didn't make sense. We remember the good ones, and so it ratchets, and so it gets more and more powerful. A placebo, then, is pretty simple. It's when one part of our brain, the rational storytelling part of our brain, sends signals to the rest of our brain, signals about fitting in, or expectation, signals about anticipation, or getting better, or worse. A no-cebo, then, is what happens when those signals say we're cooked, it's over, we're not feeling well. Our job, then, as rational, self-improving creatures, is to work with the rational frontal part of our brain, and get it to send those positive, helpful signals to the rest of our brain, because when they arrive, all sorts of good things happen. Or, in the case of the no-cebo, bad things happen. It's up to us, we can figure out how to work with the placebo effect to improve our lives, whether it's enjoying what's around us, getting better, or avoiding getting sick. It turns out that the placebo is extraordinarily powerful, more powerful than most forms of medicine. Don't believe me yet? A study recently published compared people who had knee surgery with people who had a surgeon anesthetize them, cut open their knee and do nothing. It turns out that sham surgery works essentially as well as real surgery on your knees. A major study of back pain found that the best way to cure back pain was acupuncture, and the second best way to cure it, fake acupuncture. Acupuncture, where people basically randomly stick needles in you, way down below were things like surgery and drugs. So, if knee pain worthy of surgery, if back pain, if both of those respond so well to placebos, why do we persist in believing that it's not real? Of course, it's real. What does real even mean? What we know is that our brain is the most powerful thing in our body. It's capable of things we can't even imagine, and it doesn't speak English. It doesn't understand all the science. What it does understand is emotions. What it does respond to are the internal flow of chemicals, electricity, positive thinking, expectation, and those things come from the placebo. It gets even more interesting because it turns out that the placebo isn't just about knee surgery or back surgery. The placebo can also include things like, is this wine delicious? Does this stereo sound great? How am I going to perform on the 100-yard dash today? Yes, they've done studies in which they've injected salt water into the veins of athletes, telling them that it was an illicit drug or a performance-enhancing drug, and you guessed it, those athletes do better than the ones who don't get the intervention. It's simple. Our brain can will us to do things that we couldn't possibly imagine. So here's the question. One, why don't we do it on purpose? And two, when someone points out that you're trafficking in placebos, why does it hurt your feelings? When you say to the person at the health food store or the crystal reading place or the astrologer or the person who's got some other story they want us to engage in or some multi-vitamin they want us to take, when you say to that person, thanks for the placebo, why are their feelings hurt? If it was cheaper than "real medicine," if it worked better than real medicine, if there were no side effects, if no one was taking advantage of you, what's the problem exactly? If buying $30 wine glasses makes your wine taste better, what's wrong with that? And yes, it was shown in a double-blind study that when you wrap the glasses up in wood and duct tape, even the best wine sommelier in the world can't tell them apart. Because the thing is, we're not double-blind. Nobody is. All of us are getting hints and clues and we absorb them and we embrace them. So when the wizard gave the scarecrow a diploma, did it make the scarecrow smarter? Well, that diploma, that piece of paper, certainly made other people think the scarecrow was smarter. Did that make the scarecrow smarter? Drip by drip it adds up the scarecrow smarter. And if he could have saved all those steps on the Yellowbrick Road, he would have been smarter from the start. So the opportunity that we have as receivers of placebos is to seek them out, to understand that there are our best value in increasing the joy that we have from the stuff around us and the safest, easiest way to get better. And as creators of change, as those that seek to help others and alter the culture, we can do it on purpose. Before I get into that, one other aside about this. A lot of people are worried that if we talk about the placebo effect, it will go away. But let's remember that your brain doesn't really speak English very well. It turns out in another study that when a doctor gives a patient some sugar pills and says to her, these are placebos. Please take them every day anyway. The ritual of taking the pills makes the patient better, as much as half of the efficacy of a typical medication, sometimes more, comes from the placebo effect. Even if it's "real medicine," the fact that we know we're taking it matters. And thus, doctors are instructed to be very careful with their language. In one study, they asked some people to do some back-stretching exercises, and half the people were told that they might cause stress or strain, and half were not. You guessed it. If the doctor tells you to expect that it's going to hurt, it's way more likely to hurt. Four ideas that help us bring the placebo effect to those who need it. The first one is comparison. Human beings are really good at comparing A to B, which one's bigger, juicier, more esteemed, more expensive. And marketers, marketers have spent a trillion dollars teaching us that expensive stuff is better, that scarce stuff is better. So, if you want your placebo to have impact, help the person who's using it have a comparison. Help them believe that it's better than the other thing they could have taken. Number two is affiliation. We like to be in tribes, connected to people like us. We like to look up to authority. Who? This person who gave me the placebo. Who are they? What's the packaging like? Is it authorized? Is it endorsed? Did my friends tell me about it? What does the jar look like? If I buy these cables, the ones that cost $300, they connect my speakers to my amp, you know, instead of the $9 ones I could get on Amazon, these $300 cables, what kind of box do they come in? What store did I buy them from? Were they hard to get? The third idea is ritual. Opening the bottle to take the placebo. Having the sommelier come to your table and do that silly dance with the cork and the tasting and all that other stuff. It's not silly. The ritual reminds our brain of something. And what it reminds us of, if we do it right, is the very best time it's ever worked for us before. And the last one, the reason we need all of this is fear. Then what placebos help us do is believe. And that belief helps us get through the fear. And so that athlete who's getting something that's not actually an illicit drug is getting confidence. And confidence might be the antidote to his fear. Comparison, affiliation, ritual, and fear. Then what we have is the opportunity to help the people around us. And we can do it with confidence. And we can do it ethically. Because we are not shortcutting. We are not keeping people from getting something that we know works. We are not charging them more than we should. We are not ripping people off or putting them into a corner so that they lose and we win. Doctors in the United States are forbidden by their ethics from giving people placebos without telling them. The thinking, I think, probably mirrors what an engineer does. And it's this. We're going to make the best thing we can make. We're going to test it scientifically, double-blind. If we get a placebo along the way, it's going to be a bonus. But we want our standard to be that it's quote "real." And that's going to maximize the power of the placebos that come with it. And it's going to ensure that no one cuts corners. And I think that's great as far as it goes. The problem is when we start denying that the placebo even exists. That when we cut placebo corners, when we could instead be using them to maximize results. So yes, I really do want my chocolate to taste better. I really do want my headache medicine to be safe and effective in a double-blind study. But no, don't leave out the placebo part. Don't walk away from that. Don't deny that it's there. And you, if you're somebody who traffics in placebos, acknowledge it. Know that that's what you do. Don't put any junk in it. Don't do anything that's going to hurt me. But embrace the fact that it's just as real to change my mind as it is to change my body. I need to be really clear here. Engineering works. A bridge doesn't stand up just because someone said it will. It stands up because it was well-designed. It's true that if you bring something to the world with lousy side effects, if you tell people, here, this drug will help you with your opioid addiction. No need to get real help. There's a side effect. You were taking, you were stealing, you were doing something unethical. I am not proposing this. I am not suggesting that what we ought to do is very little. What I am saying is that after we've done our best work, after we've done the hard work, the testing, the math, the engineering, then wrap it up in a placebo. Because when you do that, when you bring in the four elements that help us believe, yes, it will work better. When we seek to serve people with a placebo, we are doing something generous. We are helping them work with their brain, not against it, to put all of the forces at their disposal together, to work toward the result that they are seeking, to help them show up as their best self. Because when our brain doesn't understand as much English and math and science and testing as it should, it does understand love and kindness and connection. And that if we can help people find the confidence that they need to get better, to enjoy things more, to make a difference, I think that's a journey worth going on. If you've got questions about this week's episode, I hope that you will visit akimbo.link and click the appropriate button. I'll be back to answer questions from the last episode. Hey Seth, it's Maria. Hey Seth, my name is Kyle. Greetings Seth, this is Stephen out in Madison, Wisconsin. Hi Seth, Alicia from Charleston here. Hi Seth, this is Anupam. Hi, this is Katelyn. Hi Seth, warm greetings from Curacao. Hey Seth, my name is Nick Ryan from Pittsburgh, Pennsylvania. Hey Seth, this is Rex. Hey Seth, hi, this is Vasily from Greece. Hi, this is Roberta Perry. My question is... And that completes my question. Here are three questions that came in about our last episode, Hitzvill. If you've got questions about the next episode, we'd love to hear them. Visit akimbo.link and click the appropriate button. A question back to your episode 5 Hitzvill and specifically playing in the long tail. If you're there and you're thinking about how do you reach your customers, when do you get into this decision about do I go out to them directly or do I go through another party? When is it about the thing that I do versus me building a channel to their customers? This is a great question to start off with. It's got a lot of profound insight in it. Basically, when you're hanging out on the long tail, when you've decided to make something specific for people who seek the specific, when you are forgoing the requirement that you reach everyone, you have hurdles, of course, but some benefits. The biggest benefit is that people will seek you out. If you visit record store day, which is coming up, I think you'll see lines of people going to the record store to buy the special releases. That's because these records, they're out on the long tail. They're not for everyone. So the obsession of the long tail creator must be to create something that people on the edges care about, talk about, go out of their way for. Then it's their job to spread the word. It's the folks who make hits or want to make hits. It's for Hershey's or NBC or even Showtime to try to find other channels to get the word out. But people who live in the long tail, getting the word out doesn't match our budget. Getting the word out isn't the game. The game is to make something worth talking about. In your episode about Hitsville, you talk about finding the right audience. But with my podcast, I want to encourage everyone to become a lifelong learner. Do you find that if you narrow your audience and your focus in the end, your audience actually grows larger than that focus? I love a great question, particularly one that has the germ of the answer built right into it. Yes, you nailed it. The fact is, your cause, your product, your podcast, your service may very well be designed to change the way lots of people behave. But most people aren't seeking you out. Most people don't listen to your podcast. Don't use your product. The goal is to get the people who do use it to have ammunition to tell the others, to have a story to share, that the way culture changes is not from the top down. It's from person to person. People like us do things like this. When we're tempted to water down what we offer, hoping that we'll reach more people, we're probably making an error. At the beginning, especially, what we need to do is be more specific, more direct. Give the people who need us exactly what they need. In considering hits and tribes, what comes first, the tribe or the hit? Of course, a hit makes it a lot easier to build a tribe. J.K. Rowling certainly found this with Harry Potter. But having a tribe means you don't have to count on having a hit. The Grateful Dead only had one top 40 hit their entire career, and it came at the end. And yet, if you look at live touring grosses, for more than 10 years, the Grateful Dead were the number one live band in America. How did they do that? They did that because the tribe showed up, because the tribe told their friends, because the tribe got on the bus. So, if you don't have a lot of choices and you can't count on a hit materializing out of the blue, the right strategy, the strategy that works for most of us, is to build the tribe first. My question is about the power lord distribution and how that works in a business to business world. So, for example, if you've only got, say, 500 or 1000 total possible customers, is it true that you still shouldn't make something for the masses? And thank you for this question about B2B. You are right. The definition of a hit and the definition of the masses get really confused when we're talking about a finite audience of countable individuals. But one thing persists. That group of 1000 B2B customers or even 500, they're not going to move as one. Some of them are neophiliacs. Some of them seek an advantage by going first. Some of them tell themselves a story that they are innovators. If you cannot capture their attention and their trust, you will go nowhere. So, the math is the same. It's just compressed. We begin by being out in the long tail, catering to the weird, finding something that the specifics will like. They'll say, "Oh, yes. That's exactly what I was looking for." But then, and it's a big then, we have to have something that's palatable to everyone. We have to build a ratchet into it, a network effect into it, so that once a few people in the industry begin to use it, it spreads to the others. If you've got questions about this episode, I hope you'll check out akimbo.link and click the appropriate button. We'll listen to your question and if we can, we'll include it in a future episode. See you next time. It's not too late. Hey, it's Seth. About 16 years ago, I wrote my first post about climate change and since then, every single metric has gotten worse, but it's not too late. What we need to do is shift it from a me problem to a we problem and my new project is not my new project. It's our new project. More than 300 volunteers from 40 countries around the world have spent the last bunch of months putting together the carbon almanac. It's not coming out till June, but you, my loyal akimbo listeners, I wanted you to see it and hear about it first. Check out thecarbonalmanac.org for all the details. Thank you for caring enough to make a difference.