by Gerald Epling

Capricious and unpredictable, like a stack of feathers.  When you push on one side; it changes shape in unexpected ways.  This is one way to describe experiments that yield unexpected results, such as placebo effects.

The Latin word, placebo means “I shall be acceptable or pleasing”.  It is difficult to know all of the things that might be pleasing to  an individual or a group of people.  Sometimes, all it takes is a change in the routine to liven things up.  This is what happens with an effect known as the “Hawthorne effect”.

The Hawthorne effect is named after a factory located just outside of Chicago.  In the 1920’s and 1930’s experimenters tried to boost productivity by changing the work environment in the factory.  There were changes in light levels, work schedules, and other elements of the work environment in order to see if a single change increased or decreased productivity.

The results found at Hawthorne were difficult to gauge.  Increasing light levels temporarily improved worker productivity as did decreasing lighting.  Eventually, a pattern began to emerge.  It didn’t matter so much what changes were made as long as changes were made.

Some interpret the Hawthorn effect as a result of people being observed.  Perhaps, the workers were pleased to have the attention paid to them.  This would mean that the Hawthorn effect is a special case of the placebo effect.

Study of the Hawthorn effect has been extended to the school system.  Changing from one book to another or to a tablet has a temporary beneficial effect.  Changing teachers can be interesting as it may temporarily improve student scores on a test.  Many changes in the classroom environment have been found to temporarily boost student achievement.

In the field of life science, learning is linked to activity of the mind and the brain; which produces long lasting changes in the brain.  Learning is psychological as well as physiological.  Connecting the placebo effect to changes in biochemical markers, like those found in examining blood, always has an effect on the experimenter – especially if they have never personally witnessed such a change.

Medical doctors, who routinely see chemical and surgical interventions make huge improvements in the lives of people.  Therefore, there is little focus on the placebo effect.  This makes sense when you consider that the lions share of benefit that the medical field has to offer to the injured and sick comes by way of personal intervention and chemical manipulation of the systems of the body.

What about benefits for people who are not wounded or ill?  What about people who would like to feel better or loose some weight.  There are things that people can do for themselves and others without medical intervention that will improve their level of wellness.  By example, learning about healthy sleep habits and getting enough sleep is linked to weight loss.  Lack of quality and quantity of sleep is linked to weight gain.

Placebo Effects with Studies

Since the effect of sleep deprivation on weight gain is clear, it makes sense to try to find ways to reduce weight by improving sleep.  In one study, investigators found some interesting changes as participants kept notes on their sleep for the first 80 days.  The study began with a screening, where participants were asked to monitor their sleep for a period of time.  Blood was drawn for a pre-study baseline as a part of the screening process for people who wanted to participate in the study.  Potential participants were asked to keep records of their sleep time.

When the participants returned, after about 80 days, there was a noticeable improvement in biochemistry and waist size.  No intervention had been given at this point and the experimental and control groups were not yet identified.  It was apparent that the trend was an improvement in health by the simple process of screening people and asking them to keep records.  The authors attributed the positive changes to the Hawthorne effect (Cizza, Piaggi, Rother & Csako, 2014).  This 2014 observation of the Hawthorne effect is remarkable, because it may be the first time that we have a good record of biochemical changes associated with the Hawthorne effect.

Biochemical changes associated with the placebo effect should always be a concern for people planning studies.  Placebo effects turn up in many different types of study including psychological interventions, mind training methods, medicine, and nutritional supplement studies.

For medical doctors and lay people, one of the most powerful demonstrations of a placebo effect is found with changes in biochemistry for people receiving a placebo, while others receive the active ingredient.  For those who spend much time focusing on changing the body with powerful chemicals, there is little expectation that a pleasant experience will lead to the same biochemical results as the active ingredient – until they see it with their own eyes.

Until one sees the placebo effect change lives; it can be difficult to believe that an educated, strong-minded person could fall prey to the placebo effect.  The placebo effect is destined to fade over time.  When it does, people receiving a placebo feel deceived.  There may be a sense of embarrassment or a sense that they are somehow weak-minded.

The personal experience of a placebo effect can be viewed as a negative OR it can be embraced as a part of the human experience.

You can’t count on a placebo for long term improvements that good diet and proper sleep provide.  Placebos rarely provide the cure, as offered by active ingredients.  Placebos, that are no more inconvenient than taking a capsule, offer a reasonable way see if the gain of taking a pill exceeds the benefit of taking a placebo.

This complicates studies, because you must wait for the placebo effect to drop off.  One has to ask, is a placebo control really required?  This question takes on added meaning when a surgical intervention is being evaluated.  Especially, if the placebo is a sham surgery.

We can learn from the placebo effect and many are.  The effect taps into our nervous system and even our body’s immune system including the production of primitive cells in the blood.   When we know the advantages and limitations of an experience, it is easier to choose the experiences that suit us.

 

Relevant Reading

Ted J. Kaptchuk, and Franklin G. Miller, Ph.D Placebo Effects in Medicine N Engl J Med 2015; 373:8-9

Cizza, Piaggi, Rother, Csako. Hawthorne effect with transient behavioral and biochemical changes in a randomized controlled sleep extension trial of chronically short-sleeping obese adults: implications for the design and interpretation of clinical studies. PLoS One. 2014 Aug 20;9(8):e104176. doi: 10.1371/journal.pone.0104176. eCollection 2014.