Institute For The Future

Take the Blue Pill... Unless You Love Italian Soccer

A Wired Magazine piece on placebos has gained a fair amount of attention for tracing the inexplicable increase in the size of the placebo effect in recent years--as the writer Steve Silberman notes, one estimate suggests the size of the placebo effect has doubled since the 1980s. Nobody knows why, exactly, the placebo effect is increasing, but the list of unusual factors that seem to alter the effects of placebo responses--and highlight how significantly subtle mental factors can impact physical health.

For example, a variety of factors regarding a sugar pill including the size, shape, branding and price can impact how much the sugar helps an average patient improve. Responses to placebos vary by country and culture, not surprisingly, but those responses can shift by disease and other factors. Placebos seem to relieve ulcer problems in Germans, but Germans with hypertension have very little response to placebo. The color of a pill can be critical, too:

 

Soothing blue capsules make more effective tranquilizers than angry red ones, except among Italian men, for whom the color blue is associated with their national soccer team—Forza Azzurri!

 

In other words, the factors altering the effectiveness of the placebo effect range from some reasonably understandable ones--more expensive placebos tend to be more effective than cheap placebos, because we expect expensive things to be better--to the largely unpredictable. Few people would think to look to the color of a soccer team's uniform to understand the reduced impact of a tranquilizer.

Put differently, the placebo effect is a testament of the ability of our conscious and unconscious minds to alter our physical and biological health responses. And unfortunately, these responses can be both positive and negative. The negative responses, known as nocebo effects, can be significant, even deadly:

 

In the 1970s, for example, doctors diagnosed a man with end-stage liver cancer, and told him he had just a few months to live. Though the patient died in the predicted time, an autopsy showed the doctors had been mistaken. There was a tiny tumour, but it had not spread. It seemed the doctors' prognosis had been a death curse...

Tell people a medical procedure will be extremely painful, for example, and they will experience more pain than if you had kept the bad news to yourself. Similarly, experiences of side effects within the placebo groups of drug trials have shown that a doctor's warning about the possible side effects of a medicine makes it much more likely that the patient will report experiencing those effects.

 

Like placebos, nocebos can stem from a range of variables. A doctor's instructions can make a major difference, for example. Telling someone to "just breathe normally" will make them breathe abnormally. Because Americans often say they will "try" to do something when they really mean "I will not be doing that but do not want to admit it," asking someone to "try" to exercise or "try" to take a pill with food can lower the likelihood that the patient will do this. Stress from warnings, the New Scientist notes, can even lead to fatal heart attacks.

All of which suggests a couple key points: The brain has much greater control of our health than many of us realize, but subtle cues, shaped through careful communication and design, can guide these impacts toward more positive responses.