Last year, those rationalist killjoys at the Australian Competition and Consumer Commission prosecuted Reckitt Benckiser over four products: Nurofen Migraine Pain, Nurofen Tension Headache, Nurofen Period Pain and Nurofen Back Pain. Their gripe was that ‘each product claimed to target a specific pain, when in fact it was found that they all contained the same amount of the same active ingredient, ibuprofen lysine.’ These variants were often sold at a higher price than the basic brand, despite being pharmacologically identical.
I am sure the ACCC have their chemistry right; their psychology, however, is wrong. For me, Nurofen didn’t go far enough. I want to see even more specific variants: ‘I Can’t Find My Car Keys Nurofen’, perhaps, or ‘Nurofen for People whose Neighbours Like Reggae’. Again, these need contain no additional ingredients: the only distinguishing feature would be the packaging and the promise.
I’m not being entirely frivolous here. Research into the placebo effect shows that branded analgesics are more effective. Promoting something as a cure for a narrowly defined condition, as Nurofen did, also increases placebo power, as does raising the price or changing the colour. So everything the company was doing added to the efficacy of the product.
It is now impossible to buy expensive aspirin in the UK. Yet it is a waste of a wonder drug to sell it for 79p in drab packaging when you could make it much better by packaging it lavishly, colouring it red and charging more. Sometimes I don’t have a 79p headache; I have a £3.29 headache. I try to stockpile the exotic, pricier brands I buy in the US; I find they work better.
Yes, I know it’s bullshit. But that’s the peculiar thing. Placebos work even if you tell people they are placebos. Or to put it another way, a dock leaf would still soothe a nettle sting on Richard Dawkins’s leg, regardless of any scientific evidence he had of their uselessness.
The psychologist Nicholas Humphrey argues that placebos work by prompting the body to invest more of its limited resources in recovery. He believes that evolution has parsimoniously calibrated our immune system for a harsher environment than the current one, so we need to hack our unconscious into believing the conditions for recovery are especially propitious for our immune system to work at full tilt. The ministrations of doctors (witch or NHS), exotic potions (homeopathic or antibiotic), or the caring presence of relatives and friends can all create this benign illusion.
Yet policymakers hate the idea of any solution which involves such unconscious processes. If you suggested the NHS invested in more elaborate drugs packaging, they’d have conniptions. Too little is spent on researching the placebo effect in proportion to its importance. Why is this?
Most of our leaders today, in business or government, have been trained to see efficiency as the highest virtue. In this they have been led by economists, who understand nothing except efficiency — and for whom efficiency is an end in itself.
Yet the human unconscious has evolved in the opposite direction. We instinctively respond to things which are inefficient. Effective placebos have to be rare, costly, foul-tasting or ideally all three. In manners, in art, in friendship (in advertising, too) we are drawn to the unnecessary, the effortful or the extravagant. Hence most of the efforts of business and government go towards creating organisations we just don’t like very much.
Think about it. If rationality and efficiency were all that valuable in evolutionary terms, accountants would be really sexy.