Alchemy

by Rory Sutherland

  We don’t pretend that we can sleep at will or control our levels of contentment, but much of the time we pretend that conscious human agency is the only force that drives our behaviour, and therefore disparage other less obvious behaviours that we have adopted to hack our unconscious processes as if they were irrational, wasteful or absurd. This leads to the same frustration felt by a manual car driver in control of an automatic car for the first time. Someone who has not mastered the technique of oblique influence can only envisage direct intervention to achieve the desired effect, as follows:

  If you want to change gear, you must move the gearstick.

  If you want people to work harder, you must pay them more.

  If you want people to give up smoking, you must tell them it kills them.

  If you want people to take out pensions, you must give them a tax incentive.

  If you want people to pay more for your product, you must make it objectively better.

  If you want to improve a train journey, you must make the trains faster.

  If you want to improve your well-being, you must consume more resources.

  If you want people to get better, you must give them an active drug.

  I owe my explanation of the placebo theory to its author, Nicholas Humphrey. To me, his theory seems to be among the most significant theories in the field of psychology. Indeed, given its potential value to human health, it is inexplicable to me that more use has not been made of it, or at the very least that it has not been more widely investigated. It could potentially change the whole practice of medicine, but I suspect that the reason people seem less than eager to pursue the implications of Humphrey’s ideas is because it contains a whiff of alchemy.

  An article in New Scientist in 2012 examining the nature of the placebo effect described new evidence from a model that offered a possible evolutionary explanation. It suggested that the immune system has ‘an on-off switch controlled by the mind’, an idea first proposed by psychologist Nicholas Humphrey a decade or so earlier.

  Pete Trimmer, a biologist at the University of Bristol, observed that the ability of Siberian hamsters to fight infections varied according to the lighting above their cages – longer hours of light (mimicking summer days) triggered a stronger immune response. Trimmer’s explanation was that the immune system is costly to run, and so as long as an infection is not lethal, it will wait for a signal that fighting it will not endanger the animal in other ways. It seems that the Siberian hamster subconsciously fights infection more energetically in summer because that is when food supplies are sufficiently plentiful to sustain an immune response. Trimmer’s model demonstrated that in challenging environments, animals fared better by weathering infections and conserving resources.

  Humphrey argues that people subconsciously respond to a sham treatment because it assures us that it will weaken the infection without overburdening the body’s resources. In populations where food is plentiful we can, in theory, mount a full immune response at any time, but Humphrey believes that the subconscious switch has not yet adapted to this – thus it takes a placebo to convince the mind that it is the right time for an immune response.

  4.5: How Placebos Help Us Recalibrate for More Benign Conditions

  It’s interesting that Humphrey suggests that our body’s immune system is calibrated to suit a much tougher environment than the one in which we find ourselves.* My parents’ generation lived through the food shortages during the Second World War and the long period of rationing which followed. My aunt, late in life, could still not bring herself to throw food away uneaten, even when the contents of her fridge had decayed to the point of becoming a biohazard – her attitude to waste had been calibrated during a time of great scarcity.

  In the same way, the human immune system has over time been calibrated to promote survival in conditions far harsher than those of today. Previously, you could not risk squandering resources too hastily when there was an ever-present risk that you might starve to death, freeze to death or be immobilised by the body’s immune response.* To recalibrate our immune response to levels appropriate to the more benign conditions we experience in everyday modern life, it may be necessary to deploy some benign bullshit.* This, I suppose, was what my grandfather was doing in the days before antibiotics, when he cheered up his patients with banter and encouraged them to wrap up warmly, stay in bed, feed themselves well and drink medicinal whiskies – perhaps prescribing for good measure some ineffectual pills that nonetheless created enough of an illusion of optimism for the patient’s body to enter ‘healing mode’.

  When I met Nicholas Humphrey at an Indian restaurant in London,* he had by this point expanded his theory beyond health and the immune system: as well as hacking the immune system, he believes that humans regularly deployed oblique methods to generate bodily states and emotions which, like our immune response, we cannot consciously will into action – but which we can coax into existence. In particular, he mentioned bravery placebos, devices designed to achieve higher levels of bravery than could be obtained through conscious will alone.

  Think about this for a moment. Bravery is, for most people, not a consciously determined state – it’s automatic, not manual.* Although your mother might have exhorted you when going to primary school to ‘Be brave’, there is honestly little we can do to effect this condition in ourselves, any more than we can ‘decide to go to sleep’. So, as Humphrey explained, much of the paraphernalia and practice of the military – flags, drums, uniforms, square-bashing, regalia, mascots and so forth – might be effectively bravery placebos, environmental cues designed to foster bravery and solidarity.

  As with getting to sleep, the trick in generating bravery lies in consciously creating the conditions conducive to the emotional state. With sleep this might mean fluffy pillows, darkness and silence;* in the case of bravery it might involve trumpets, drums, banners, uniforms, camaraderie and so on. Soldiers live together, call themselves ‘brothers in arms’, march in lockstep, wear the same clothes and are allocated to ‘fictive-kin’ groups such as platoons, regiments and divisions – much of this fosters the illusion that you might be willing to make the ultimate sacrifice for the people within your group.

  This theory makes sense of much behaviour that initially appears absurd – it is an idea which, once entertained, stays in your mind for years and helps you to view people’s actions in an entirely new light. The strangest aspect of it is that we all spend a considerable amount of time and money essentially signalling to ourselves: many of the things we do are not be intended to advertise anything about ourselves to others – we are, in effect, advertising to ourselves.* The evolutionary psychologist Jonathan Haidt refers to such activities as ‘self-placebbing.’ Once we understand the concept, a great deal of bizarre consumerism will make more sense.

  4.6: The Hidden Purposes Behind Our Behaviour: Why We Buy Clothes, Flowers or Yachts

  There is an important lesson in evaluating human behaviour: never denigrate a behaviour as irrational until you have considered what purpose it really serves. It is clearly irrational to buy a £250,000 Ferrari as a form of everyday transportation, when a perfectly serviceable car can be bought for a fraction of the price. On the other hand, as an aphrodisiac or as a means of humiliating a business rival, it does rather outclass a Honda Civic. I’m not into Ferraris,* but I can understand that they probably confer a kind of confidence on the driver.

  As an interesting thought experiment, I often construct fake advertising slogans for various products – in particular the slogans that they would adopt if they could afford to be completely honest about why people bought them. ‘Flowers – the inexpensive alternative to prostitution’ – that kind of thing. They are rather like the slogans that appear throughout the film The Invention of Lying (2009),* which is set in a world in which everyone initially tells the truth about everything. ‘Pepsi – for when they don't have Coke’.*

  I invent my brutally honest slogans to make the point that most produ
cts have both an ostensible, ‘official’ function and an ulterior function. The main value of a dishwasher, I would argue, is not that it washes dirty dishes, but that it provides you with an out-of-sight place to put them. The main value of having a swimming pool at home is not that you swim in it, but that it allows you to walk around your garden in a bathing costume without feeling like an idiot. A friend who had been invited to spend a week on a luxury yacht explained why they are so popular with megalomaniacs: ‘You can invite your friends to join you on holiday, then spend the week treating them like you are Captain Bligh.’ If you have the most magnificent villa in the world, there is still the risk that your friends and rivals might hire a car and wander off on their own: on a megayacht, however, they are your captives.*

  One problem (of many) with Soviet-style command economies is that they can only work if people know what they want and need, and can define and express their wants adequately. But this is impossible, because not only do people not know what they want, they don’t even know why they like the things they buy. The only way you can discover what people really want (their ‘revealed preferences’, in economic parlance) is through seeing what they actually pay for under a variety of different conditions, in a variety of contexts. This requires trial and error – which requires competitive markets and marketing.

  The intriguing thing about Uber as an innovation was that no one really asked for it before it existed.* Its success lay in a couple of astute psychological hacks: the fact that no money changes hands during a trip is one of the most powerful – it makes using it feel like a service rather than a transaction.*

  Take the control panels in elevators. One of the buttons found on them, the ‘door close’ button, is quite interesting, because on many (and perhaps most) elevators, it is actually a placebo button – it is connected to nothing at all. It is there simply to make impatient people feel better by giving them something to do and the illusion of control. It is, in effect, a civilised alternative to a punchbag. I don’t know if this is a bad thing – it’s definitely a lie, but perhaps it’s a white lie – one whose sole job is to make someone feel better. Since the only possible purpose of a ‘door close’ button is to make impatient people relax, perhaps it makes no difference whether it achieves this end through mental or mechanical means.*

  The use of placebo buttons is more common than we realise. Many pedestrian crossings have buttons that also have no effect at all – the traffic lights are set to a timed sequence.* However, here the presence of the button is a rather more benign lie: how many fewer people would wait for the green man if there were no button to press? And how many more people would wait for the green man if there were a digital display of the seconds to wait before its appearance? In countries including Korea and China, accidents at intersections have been reduced by simply displaying the number of seconds remaining before the lights turn green.*

  This is because the mammalian brain has a deep-set preference for control and certainty. The single best investment ever made by the London Underground in terms of increasing passenger satisfaction was not to do with money spent on faster, more frequent trains – it was the addition of dot matrix displays on platforms to inform travellers of the time outstanding before the next train arrived.

  Let’s apply this insight to something more momentous. If we know that people hate uncertainty, and that men are disproportionately reluctant to undergo medical testing, how can we combine the two insights and come up with a solution? What if the reason men hate undergoing certain tests is that they are unconsciously averse to the uncertainty they experience while waiting for the results? They can’t tell us this, because they don’t know – remember the lenses in the broken binoculars? Logic won’t tell us this, either, but we can test – by seeing what happens if we make a promise: ‘If you have this test, we will text you the results within 24 hours.’ To date, nobody has thought that kind of promise might be relevant: nobody considered that the uncertain delay between having the test and getting the result might influence the human propensity to undergo the test in the first place.

  Credit card companies have discovered this already, with promises like ‘Apply now and get approval within 12 hours’ – they found, through testing, accident or experimentation, that this made a difference to people’s keenness to respond. Whether you’re carrying out market research or using neoclassical economic assumptions, you wouldn’t realise that the amount of time spent in uncertainty might be an important factor.

  A simple thought experiment might help here. If there were a medical device whereby you could press a button and get an immediate reading with an early warning of prostate cancer, I suspect most men would been keen on the idea. By contrast, our willingness to book an appointment, meet a phlebotomist and wait two weeks for a result is very low.

  4.7: On Self-Placebbing

  As we’ve seen, one way to understand military paraphernalia of uniforms, trumpets, drums and regalia is to consider its value as a ‘bravery placebo’. But what are the other emotions that we might wish to hack through the use of a similar ‘Humphrey placebo’? Two spring to mind immediately: the need to inspire confidence in ourselves, and the need to inspire trust in others.

  I have twin 17-year-old daughters and I love them dearly, except when the time comes to leave the house. Their cosmetic regime is beyond ridiculous: before attending any party or function, it isn’t unusual for them to spend an hour and a half getting ready, most of which is dedicated to face painting or eyebrow tweaking of one kind or another. I find it irritating enough to have to shave each morning; how they can put up with this rigmarole is completely beyond me. Evolutionary psychology might explain my daughters’ infuriating behaviour in several ways: they might be trying to enhance their appearance and reproductive fitness by signalling to the opposite sex. They might be seeking to maintain or enhance their status among their own sex. Or they might be doing it to signal to themselves.

  Whichever is right (and they are not mutually exclusive), my offspring are clearly are not alone in their behaviour. I once attended a presentation on the worldwide beauty industry, which includes clothing, perfume and cosmetics. I was briefly confused by a chart that showed billions of US dollars as its scale but which listed annual spending figures in thousands, before realising that the annual expenditure we were discussing ran into trillions of US dollars. It turns out that more is spent on female beauty than on education.*

  Once you understand the placebo, I think you’ll agree that a large part of the two trillion dollars spent on female self-beautification is not spent in order to appeal to the opposite sex; to put it bluntly, as a woman, it simply isn’t that difficult to dress in a way that appeals to men – you just have to wear very little.* There are also some trends in female fashion, high-waisted trousers, for instance, which men find fairly repellent.* It seems likely that a significant part of what you’re doing when you spend two hours on self-grooming is self-administering a confidence placebo to produce emotions that you can’t generate through a conscious act of will.*

  Men have equivalent placebo vices, of course: of these, a love of cars and gadgetry, as I mentioned above, funds and accelerates the development of useful products. However, a fetish for expensive wines seems to me entirely about self-placebbing or status seeking, and little to do with enjoyment – after all, is a great wine really all that much nicer than a good one?*

  The Netflix documentary Sour Grapes is a fascinating insight into this world. A crooked, though brilliant, Indonesian wine connoisseur called Rudy Kurniawan was able to replicate great burgundies by mixing cheaper wines together, before faking the corks and the labels. He was rumbled only when he attempted to fake wines from vintages that did not exist. I am told that it is possible to detect a forged Kurniawan wine by analysing the labels, but not by tasting the wine.

  I hate to say this, but Rudy was an alchemist. Several experts I have talked to in the high-end wine business regard their own field as essentially a placebo market;
one of them admitted that he was relatively uninterested in the products he sold and would sneak off and fetch a beer at premium tastings of burgundies costing thousands of pounds a bottle. Another described himself as ‘the eunuch in the whorehouse’ – someone who was valuable because he was immune to the charms of the product he promoted.*

  4.8: What Makes an Effective Placebo?

  One of Nicholas Humphrey’s rules about what makes an effective placebo is that there must be some effort, scarcity or expense involved. Folk remedies may be effective placebos simply because the plants needed to make them aren’t all that common. If there is one area that is worthy of future scientific research, this is it. At the moment, we spend many billions of dollars each year trying to improve drugs but almost nothing, as far as I can see, is being spent on the better understanding of placebos – they look too much like alchemy. I would also like to find out why the health outcomes for hospital patients appear to be better when they have a bed with a view of some trees. And what stories, I wonder, could doctors tell their patients which would maximise the power of a placebo in a consultation?

  I wrote much of this book’s previous chapter while suffering from an appalling bout of flu.* To reduce the symptoms in the evenings, I took a tincture known as Night Nurse,* a product with a fascinating genesis, and a textbook example of a product which doesn’t define the parameters of success too narrowly, so leaving room for creativity. The scientists who devised it had been briefed to come up with an effective cold and flu medicine: they succeeded, but with one problematic side effect – the formulation led to severe drowsiness. Despairingly, they were at the point of starting again when an alchemist from the marketing department came up with an idea. ‘If we position the product as a night-time cold and flu remedy, the drowsiness isn’t a problem – it’s a selling point. It will not only minimise your cold and flu symptoms, but it will help you sleep through them too.’ Night Nurse was born: a masterclass in the magic of reframing.