We all swear by something that we know probably doesn't work. Maybe it's vitamin C when everyone at work has a cold, or #bootea while we diet, or compression socks while we run. "Even if it doesn't work, what's the harm?" we tell ourselves. The truth is, it's not harmless, and we're only fooling ourselves. Illustration by Angelica Alzona.
Just because that tablet or tea isn't poisonous doesn't mean it's harmless: you spent money, time and effort on it, effort you could have spent on finding or using something that actually helps. Even worse, if it seems to "work" for you, you may become convinced it's for real. Many of us pour our hopes and wallets into pseudo-medical treatments (or diets or training plans) that don't work at all just because the placebo effect makes us think they do.
How much should this weigh on your mind when you're picking up a bottle of vitamin c at the pharmacy? That's a personal decision, but I'm going to argue that it should be more than zero. If you're going to be open-minded about trying something that's not proven, you should also be open-minded enough to admit to yourself that you may be better off without it.
The Placebo Effect Isn't as Useful as You Think
Long ago, researchers discovered that a pill or syringe with no real medicine could relieve symptoms -- sometimes almost as well as the real thing. The discovery of the "placebo effect" changed how doctors evaluate medicines. Since patients may improve on a fake medicine, drug trials may compare the new medication to a placebo, with the expectation that patients in both groups will improve. The drug doesn't just have to work; it has to work better than placebo.
So if a placebo can make you feel better, why not harness this effect and take a fake drug on purpose? After all, a sugar pill should be cheaper than a real drug and shouldn't cause any serious side effects. If our mind can heal our body (or at least make us feel better about it), isn't that a win?
Unfortunately, that's not how placebos "work". While a brain-body synergy may account for some of the placebo effect, a good chunk of it is based on factors that aren't caused by the placebo at all. In 1997, two German scientists analysed the original 1955 paper that identified the placebo effect as meaningful in medicine. They found that most of the effect was not psychological, but was due to things that would have happened even without a dummy drug. Many of these also apply in everyday life:
- People naturally get better over time. For example, a trial of cold treatments found that people improved within six days on placebo. Since colds only last about seven to ten days, with the worst symptoms lasting about three days, that's what you'd expect even without placebo.
- People take placebos when they're already feeling better. In some studies, patients were only given placebo when their condition was under control; if they were having serious symptoms, they got the real drugs. In that trial, placebo got the credit for keeping patients' symptoms under control. You're doing the same thing if you treat mild symptoms with vitamins or homoeopathy, but go to the doctor when things get serious.
- Placebos may not be the only treatment. People testing cold medicine were allowed to get rest, hot baths and other things that could help them feel better. Along the same lines, if you drink a weight-loss tea while dieting, your weight loss is probably due to the diet and not the tea.
- Symptoms fluctuate. In the trials, placebos got the credit when people got better, but the researchers didn't blame placebos when symptoms got worse. For example, in one trial 21 per cent of stroke patients improved on placebos, but 53 per cent died. The investigators described the placebo as 21 per cent "effective". If you only notice the times a would-be treatment works for you, and conveniently forget the times it doesn't, that's classic confirmation bias.
We are susceptible to errors like these when we evaluate our own experiences. If your muscles are sore, and you drink tart cherry juice and feel better the next day, you may decide that the juice works for you -- even though you would have improved with or without the juice. Falling prey to cognitive biases doesn't mean we're gullible or stupid; it means we're human.
Bottom line, trying something useless in the hopes of profiting from a placebo effect is not a great strategy. Even if a placebo seems to "work", it may not have benefited you at all.
A Waste of Time, Money and Hope isn't Harmless
People spent $US6.4 billion ($8.5 billion) on homoeopathy in 2012, according to market research firm Mintel. In 2008, Australian spent $5.4 million on homoeopathy. Remember, homoeopathy is the medicine that doesn't contain any medicine, and is verifiable garbage.
Meanwhile, according to TABS Analytics, vitamins and nutritional supplements earn nearly $US12 billion ($16 billion) a year in the US. Sports nutrition supplements are $US2.6 billion ($3.4 billion). Or to put it another way, you can spend $US25 ($34) on a FitTea Detox, $US75 ($101) on compression running tights, $US297 ($398) on a course about how to use a homoeopathic medicine kit, $US329 ($441) for a seven-day juice cleanse, €1950 ($2979) for a coloured light that can fix your chakras and so on.
This stuff can get expensive. And there's a continuum from that cheap bottle of vitamin C up to the $US16,995 ($22,790) cancer-(not-)curing energy system. You're not buying it because it works; you're buying it because you hope it works. The only difference between them is what you can afford.
Questionable remedies cost more than money, of course. They also take their toll in time and hope. If you spend a few hours and some mental effort on visiting a practitioner who can't cure what ails you, that's time you could have spent visiting someone who practises evidence-based medicine.
You may have delayed seeking real care (or worse, real care at a time when it could have been most effective), and might not even bother if you conclude that you've "tried everything" and your problem isn't treatable.
Your emotional well-being is worth considering, too: If you get your hopes up, then get bummed when a treatment doesn't work, it's jerking you around and disappointing you. So if you want to try the latest diet or pill or shake or whatever they're putting "smart" in front of these days, evaluate it on its merits and on its potential downsides -- even if it looks like it will do no harm.