Taste the placebo

One of my students asked me if I make the memes that I use in this blog: the answer is "no" - truly, I am too busy grading papers. Fortunately there are a lot of memes floating around social media. Most of the time I start with a meme and then do a literature search to find recent research on that topic. Other times, like this week, I find a great article then search Google Images for a meme to match. Sometimes I stumble upon the perfect combination and reach article/meme perfection:

Would it be mean to trick a hurting person into thinking that a piece of candy is actually a tablet of pain reliever? The answer would be, "yes" if the act of swallowing that orange Skittle would have no effect on her headache - but what if it helped just as much as a real Advil?

Faasse, Martin, Grey, Gamble, and Petrie (2015) conducted a simple experiment to answer a similar question. They recruited 87 New Zealander university students (83% female) who frequently suffered from headaches. The students were each given four identical-looking tablets: two were labeled "Nurofen," a brand name for Ibuprofen - like Advil in the United States, and the other two were labeled "Generic Ibuprofen." Thus, each of them believed that he or she received two brand name pills and two generic pain-relief pills.

However, the researchers had tricked them with some mild deception! For each participant one of the tablets labeled "Nurofen" was actually a placebo (a sugar pill) containing no medicine - much like a Skittle; likewise, one of the tablets labeled "Generic Ibuprofen" was also a placebo. The remaining two tablets were always identical doses (400 mg) of Ibuprofen; there was no difference beyond how they were labeled. This was a within-subjects experiment because all participants experienced all of the possible versions of the tablet: placebo labeled Nurofen; Ibuprofen labeled Nurofen; placebo labeled Generic; Ibuprofen labeled Generic.

The participants were instructed to use the tablets for their next four headaches, and the order of the pills was dictated by the researchers for counter-balancing. Each time the participants got headaches they had to rate the intensity of their pain, take the designated tablet, wait one hour, and then rate the intensity of any remaining pain and note any side effects.

As you would expect, the overall results showed that Ibuprofen did a better job than the placebo at resolving headache pain. What was more interesting to Faasse et al. was that placebo and Ibuprofen tablets labeled Nurofen were rated equally well on pain relief. In this case, the Placebo Effect was clear: just believing that you took brand name Ibuprofen was enough to cure your pain as well as the real medicine would!

Alternatively, when participants took the tablets labeled "Generic Ibuprofen," pain relief was much higher from the actual Ibuprofen than from the placebo. Again participants' beliefs influenced their experiences: in this case a mistrust of off-brand medicines overcame the Placebo Effect.

Side effect data followed a similar trend: when participants believed that they were taking "Generic Ibuprofen" they reported more side effects from the placebo tablets than from the actual Ibuprofen (that really could produce side effects)! When placebos produce negative effects this is call the Nocebo Effect. This Nocebo Effect was limited to the Generic labeled tablets. No difference in side effects was seen between the placebo and Ibuprofen when they were labeled Nurofen, so a mistrust of off-brand medicine encouraged the Nocebo Effect.

Faasse et al.'s experiment would suggest that orange Skittles stored an old Advil bottle would probably fix your sister's headache just as well as actual medicine! On the other hand, if she saw the Skittles come out of a store brand (generic) bottle she might be complaining an hour later: her head would still hurt and the "pills" you gave her are upsetting her stomach. Of course, the side effects of tricking your sister would be far worse than a headache, so please don't try this at home.

Further Reading:

The Faasse et al. (2015) article is available online or can be obtained through your local college library.

Curious about the placebo effect in medicine? Get two perspectives from an article in the New England Journal of Medicine by Drs. Ted Kaptchuk and Franklin Miller, and from a TED talk by Dr. Lissa Rankin.

Orange Skittles resemble Advil: similarities between candy and medicine can lead to accidental poisoning of children. Play the Pill vs Candy game from California Poison Control. Can you tell the difference between a sweet treat and a pharmaceutical?

BONUS:

Our suspicion of generic brands extends to other products as well. Watch some of the Buzzfeed crew attempt to tell the difference between off-brand and brand name cereals.

Driving While Old

My husband and I have made a pact:  when we are Senior Citizens we will remind each other that we probably do not drive as well as we think we do.  As noted in this meme, it is not uncommon for older Seniors to make certain driving errors, such as driving too slowly:

According to the National Institutes of Health, other common driving errors in later life are, "failing to yield the right of way, failing to stay in your lane, misjudging the time or distance needed to turn in front of traffic, failing to stop completely at a stop sign, and speeding...."  Surprisingly, there are not many studies in psychology that link specific age-related changes in thinking (cognition) to specific driving errors.

One such study was done in Australia by Anstey and Wood (2011) who recruited 266 volunteers between the ages of 70-88 who reported that they drove at least once a week on a regular basis.  These Seniors took a battery of cognitive tests and also went for a 50 minute drive supervised by an instructor, and accompanied by an occupational therapist who noted any driving errors that occurred.

Some of their results replicated past research.  For example, all driving errors quadrupled with increasing age of participant - so my husband and I will have less to worry about when we are in our 70s compared to our 80s.  Also, there were no gender effects - so we will not be able to predict if my husband or I will be the safer driver; although women tend to outlive men so I am more likely to make it well into my 80s and thus up my risk of driving errors!

The factor that predicted the majority of the errors was called "Speeded Attention and Switching" and was made up of results from various tests of two specific cognitive processes that slow with aging:  speed of processing and task switching ability.  Speed of processing is how quickly you are able to recognize and understand how to react to new information that is coming your way.  Task switching ability is how well you are able to quickly and accurately switch your attention between two activities.  Because driving causes us all to encounter new information quickly (a dog runs into the street, the car ahead of us suddenly brakes, a cloudburst makes the pavement slick) and provides us many competing tasks (staying in our lane, obeying the speed limit, looking for road signs and stoplights) it is sensible that declines in these skills would correlate with driving errors.

One of these errors, "brake/accelerator problems" - which include driving too quickly or too slowly - returns us to our meme.  The Senior Romeo may be driving too slowly if it takes him longer to know where to focus his attention and longer for him to switch where his attention lies...especially if he is highly motivated to pay attention to his hot date!  By slowing down he may buy himself some time to compensate for these cognitive declines, which may give him the impression that he is still driving safely.

So if you have older relatives (or dates!) you may have some concerns about their driving.  This is especially likely if they are over age 80: "People 80 and older are involved in 5.5 times as many fatal crashes per mile driven as middle-­aged drivers."  However, more concern should be given to the teens in your life: "the crash rate for driver ages 16and 17...is almost nine times as high as that for middle-aged driver."  If you are middle aged you probably make few driving errors, but be careful - you are likely to be distracted as you worry about your Senior parents' and your adolescent children's driving.

Further Reading:

The Anstey and Wood (2011) journal article can be accessed through your local college library.

Test your own Speed of Processing!  The results will report your accuracy and speed at solving these novel problems.

How to talk to a Senior about safe driving. The NIH has some excellent ideas to get the conversation started.

The American Association of Retired Persons (AARP) has an official online dating site for Seniors.  You can talk about today's blog on your first date!