Social Placebos

The theoretical psychologist Nicholas Humphrey argues that humans are genetically programmed for caution. As an example of this, he cites the curious effectiveness of placebos.

Consider what happens when the human immune system fights a disease. Suppose you have a disease that causes you to function at 90% of your usual capacity. You could struggle on for weeks at this level, feeling slightly run-down. Or your immune system could mobilize a full attack on the disease, during which you will feel terrible, you may have a raised temperature and other unpleasant symptoms, and you may be unable to carry out your normal activity for a few days. Most of the symptoms of disease are actually caused by the immune system trying to eliminate something or other.

In some situations, a full immune system response might be dangerous, as it makes you vulnerable to all sorts of environmental threats that you would be unable to protect yourself against. So instead of responding instantly to the first signs of a disease, it makes sense for the immune system to wait until the person is in a safe place to undergo this phase. For example, shelter, warmth, supply of food and water, someone else to keep the fire burning and watch out for wolves.

So what kind of signal triggers the immune system to start fighting? We can identify three possible signals. Firstly, when the person stops working hard and enters a period of relaxation. (This is why so many people get ill on holiday and at Christmas.) Secondly, when the person anticipates some future period of stressful hard work. (This is why so many people get ill before exams.) And thirdly, when the weather changes. (Which is why people get ill in the Autumn and Spring.)

According to Humphrey, the placebo acts as another signal of this kind. Especially when provided by a healthcare practitioner with the appropriate bedside manner, it indicates to the immune system that it is safe to mobilize a full response. It is as if the witch doctor is providing some level of "reassurance" to the body.


In a recent article, Humphrey extends this idea to social placebos, or what he calls Placebos at Large (New Scientist, August 2013, subscription required). He suggests that social symbols and rituals perform a similar reassuring function, allowing people (individually and collectively) to take bold action.

People love mocking "health-and-safety" regulations, promoted by the much-derided "nanny state", as if these regulations hold us back from being the enterprising, rebellious souls we would otherwise be. Humphrey quotes the sociologist Frank Furedi, who says, "in a world where safety has become an end in itself, society constantly promotes symbols and rituals to transmit the need for caution".

Humphrey offers a contrarian interpretation. He believes that in many areas of our lives we humans are, by nature, cowards. Left to follow our instincts we tend to be much more cautious than we need be – indeed, more cautious than is good for us.

So we are often presented with warnings that don't tell us anything - such as packets of peanuts that solemnly announce that they "may contain nuts". By laughing at these unnecessary warnings, we are able to project our real fears of alien food onto some bureaucratic Other, and feel (irrationally) reassured in the illusion that packaged food is safe for everyone except those with weird and antisocial food allergies.

Thus the implicit message of these warnings is a paradoxical one - no need to worry, nanny will do all that nasty worrying for us. Nanny as witch-doctor.

And in the corporate world, there is a wealth of corporate signals and rituals that are used to enable corporate change, including the appeal to corporate witch-doctors, also known as consultants. People often complain that corporate placebos and platitudes don't work - but the point is that they actually do work, but in a mysterious way. Isn't this an example of what Margaret Heffernan calls Willful Blindness?

Easier Seddon Done

John Seddon of Vanguard has written a book called Systems Thinking in the Public Sector, criticizing something he calls “The Regime” – by which I think he means the dominant forces within government based on targets. The extracts I’ve read so far indicate that Seddon has been strongly influenced by Deming. I also detect some influence from Stafford Beer’s POSIWID principle when he writes: “the de-facto purpose of the regime [is to] make services worse”.

This kind of analysis is absolutely in line with the kind of analysis we have been doing here on the POSIWID blog. I have ordered a copy of the book, and I look forward to reading it. But are the right people (by which I mean the people who might be able to change things) going to read it?

Some years ago, Seddon originated a concept called “failure demand”. This concept was taken up (and, according to Seddon, completely misunderstood) by the regime. When he wrote to representatives of the regime explaining their error, he got a “snotty, curt reply”. Well, who could have predicted this?

This raises an interesting question. Seddon and his colleagues have some pretty sound insights on the flaws in the regime. But the regime is unable to accept these insights. This is not very surprising – regimes do tend to be resistant if not immune to external criticism. So how can Seddon (or anyone else) use these insights to cause real change? Okay, I’m sure he will be happy to sell more copies of his books, but I don’t think he merely wishes to bask in the warm glow of “I told you so”.

From an insider’s perspective, uninvited “insights” from consultants might possibly seem like unwarranted meddling. I use the word “meddle” deliberately, because this is a word Deming uses for attempts to change a system without systemic understanding. Seddon understands what the regime is doing wrong, and he may well be working brilliantly behind the scenes, but his public interventions to change the regime seem to be based on the optimistic logic that telling people what they are doing wrong is going to persuade them to do things differently.

Sadly, the exact opposite is true. Telling people what they are doing wrong makes them defensive, it encourages them to construct elaborate rationalizations for why they are doing what they are doing, and makes them all the more determined to continue along the same track.

Meanwhile, some organizations have a sophisticated mechanism for resisting alien ideas, which is to introduce these ideas in a deliberately weakened form. This is like vaccination: you expose people to cowpox so they won’t succumb to smallpox. Perhaps some highly intelligent and utterly devious people within the regime deliberately exploited some vagueness in Seddon’s original formulation of “failure demand”, implemented something that conformed to the letter of the concept but not the spirit, and then sat back with smug satisfaction when Seddon protested that his original idea had been misapplied, knowing that the regime cannot now succumb to the original power of “failure demand”.

In situations like this, I believe the would-be agent of change must change weapons – relying not on rhetorical insight but on analytic rigour. Concepts must be razor sharp, evidence must be carefully assembled and meticulously deployed. I hope that’s what I’m going to find when I get hold of the book.


Related posts: Vaccination (September 2004), Notes on the Value of Culture (January 2010), Easier Seddon Done 2 (October 2010)

Childhood Diseases

Should children be protected against minor diseases? Or are childhood diseases a normal (and perhaps even necessary) part of growing up? 

Some doctors are now recommending routine vaccination against chicken pox (varicella) - there is a suggestion that it might be combined with the (already controversial) MMR vaccine to produce MMRV [BBC News November 8th 2007]. 

Chicken pox killed six children in the UK and Irish Republic last year, and there were 112 cases involving severe complications. So there is certainly a risk. But is this risk high enough to warrant action? Each mass vaccination campaign has

• financial costs - could the same resources deployed elsewhere have delivered greater medical benefits to a greater number of people?

• medical side-effects - possible negative reactions to the vaccination itself in some children, reduced protection against related diseases such as shingles

• social costs - fear of side-effects (whether founded or unfounded) reducing the take-up of all vaccines, not just this one

But I have a more general concern. If this proposal makes sense, then it would make sense for every other infectious disease that kills a small number of people every year. Medical researchers think they understand the effect of a single vaccine on the human immune system, or even a compound vaccine such as MMR. But how would it be if a child never got ill, because every possible disease was preempted by vaccination? Would the immune system develop normally, or would it be weak from lack of exercise? Would new diseases emerge to fill the gap? Will medical research tell us the answers to these questions before it is too late? 

Childhood disease involves some suffering, and a tiny risk of complications and even death, and most parents accept that. If I wanted to protect my children totally from any suffering or risk, then they wouldn't learn to cross the road or ride a bicycle or climb trees; they wouldn't be allowed to use the kettle or the toaster, or bathe in more than 3cm of water; and they certainly wouldn't have any contact with the opposite sex until they were at least 25 years old. This is of course ridiculous - I would be condemning them to a life-without-life. 

While my heart goes out to those parents who have lost their children to childhood disease, I don't think the answer is to eliminate childhood disease altogether. It is a normal part of growing up: it develops the immune system, and equally importantly it develops confidence in the immune system. A child can feel poorly one week, with spots all over her face, and then be back at school the following week: this experience engenders a deep belief in your ability to recover, a belief that however bad you feel right now, you should feel better tomorrow. 

What doesn't kill you makes you stronger.

Update

The Chief Executive of RoSPA (Royal Society for the Prevention of Accidents) made a similar point in his 2007 Annual Report.

"Rather than adopt the extremist protectionism of ‘cotton wool kids’ our argument is that a skinned knee or a twisted ankle in a challenging and exciting play environment is not just acceptable, it is a positive necessity in order to educate our children and to prepare them for a complex, dangerous world, in which healthy, robust activity is more a national need than ever before."

Of course this is not an argument dismissing safety precautions altogether, and my blogpost should not be read as an argument against all vaccinations - merely an argument against the extreme idea that we need to vaccinate against every possible condition.

See also

Gever Tulley: 5 dangerous things you should let your kids do (Ted Talks, March 2007)

Screw in a Lightbulb

Seth Godin invites bloggers to blog about compact fluorescent lightbulbs (blog, squidoo lens, initial response).

"Why have only 6% of all US households installed even one CF lightbulb?"

Seth is puzzled. It can't be the economics, it can't be the environmental impact. And it's not the geopolitical impact either. "So, why are people apparently immune to the benefits. I mean, why won't we even try one of the bulbs?"

What is the problem? What is the real problem? Is there a problem at all?

Lots of reasons and excuses have been posted in reply to Seth's original post. Apparently, doing something unusual seems to involve more effort (ÜberEye), and effort isn't cool (The Mostly Honest Truth). CF bulbs may not be compatible with your current fittings (including dimmer switches), so you might need to get the toolbox out (PaleGreen). More excuses from 12 gurus.

Apparently something as simple as changing a lightbulb turns into a major shift in lifestyle - the Happy Burro sees the reluctance to use CF bulbs as a case of a more general problem of bad habits, alongside the fact that "One in eight people who survive a heart attack change their lifestyle to avoid another attack. So the resistance to CF bulbs becomes an example of what Glenn Parton calls The Machine in Our Heads.

Some of Seth's readers have pointed out the commercial role of Wal-Mart in promoting CF bulbs, and the happy alignment of economic and environmental interests in this particular case. BloodHoundBlog sees this as an example of the redemptive power of capitalism. (So it's a pity this kind of alignment doesn't happen more often.)

The adoption of technology typically follows an S-curve. Questions about technology adoption therefore need a timescale. Fairhaven, the River says that Seth's figures date from 1999, and produces figures that suggest we are already further up the S-curve. But not far enough, not quickly enough for marketing people who are often impatient to reach a mass market. (To be fair, Seth doesn't always take this position.)

Let's analyse this properly. The system we are looking at here is the system of technology adoption. This system has a characteristic shape - the S-curve - which is produced from the interaction between a number of forces, including the economic interests of producers and consumers, and including the growing maturity of the product and its production process, relative to available substitutes. And technology substitution follows a double-S-curve.

POSIWID invites us to think about the "purpose" of this S-curve. In fact, the S-curve deals with a lot of the issues raised in the CF bulb case - the risks of new products, difficulties of process and interoperability, ramping up production, ramping down production of earlier products. Marketing people may be impatient with the realities of technology change - but you cannot alter this system without understanding it thoroughly. Merely exhorting people to adopt a new product is not going to make any fundamental change.

Note: Most of the popular theories of technology diffusion, adoption and substitution derive from Rogers (1962) and from Utterback and Abernathy (1978), although they are commonly attributed to more recent authors.

Vaccination

Vaccination means dealing with a serious threat by creating and injecting (or disseminating) a feeble and attenuated version of it.

Someone sent me a notice about a conference called The Joy of Work - about management and spirituality - with a tongue-in-cheek comment suggesting he thought it was dangerous. For my part, my heart sank at the thought of all those earnest and jovial people, waffling knowingly about spirituality in a five-star hotel at some fancy Mexican resort. (Nice work if you can get it, though.)

Such conferences are packaged to make them as undangerous as possible. Business is a complex self-healing system, perfectly capable of neutralizing any really dangerous ideas, including spiritual ones. Let's send a few maverick middle managers off to Mexico to be vaccinated - infused with a weak and warm teabag spirituality - so that they will become immune to the real thing. They can then return to their organizations and spout pseudo-spiritual jargon, which in turn increases the resistance to dangerous ideas within these organizations.

Vaccination works by educating and exercising the immune system. A network security manager might try and persuade staff NOT to open weird email attachments by disseminating an extremely weak software virus -- perhaps one that does something mildly annoying and embarrassing -- Code Pale Pink perhaps.



Related posts: Easier Seddon Done (June 2008), Notes on the Value of Culture (January 2010)