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?

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)