placebo – The Waiter's Pad

Maybe.

In medical school aspiring doctors say the Hippocratic oath: to first do no harm. I think about that teaching high school business.

I know (most days) that my activity on customer acquisition cost or intellectual property and perfume dupes is not the most important thing. High school students have a lot(!) going on in their lives. My own glasses about high school are rose colored, but I do remember riding my bike to the river, listening to Springsteen, and thinking I’d never recover from a broken heart.

So I try to first do no harm.

Kids learn a lot on their own. The goal in class is to take small steps everyday. Even just one thing. If they only remember that patents have perfect pictures it’s a win.

Windfalls are rare.

Earlier this year was my annual physical. It had been a long time since seeing a doctor. Nothing is wrong but a lack of baselines. In addition to a physical and labs is some knee pain. After a range of motion diagnostic, my PCP said it’s probably my meniscus. We could do physical therapy and go through insurance or I could pay cash for an MRI – the definitive proof. The ultimate outcome, he said, is probably surgery.

The MRI quotes were $500 and the PT appointments were weeks away so using AI, I made my own. Then I read this!

https://www.sensible-med.com/p/bravery-and-humility-is-needed-to

Patients who had a placebo surgery (everything but the actual manipulation of the meniscus) had better outcomes than actual surgery patients. There was no trial to compare PT patient outcomes.

The catalyst is time. If there’s no timeline or deadline there’s no problem. The test is Friday. The race is in December.

And time is arbitrary. It’s like Free Parking. Before a Monopoly game begins the players need to decide on what Free Parking means. Time is just like that.

Have a great Monday.

“When faced with a difficult question, we often answer an easier one instead, usually without noticing the substitution.”
Daniel Kahneman

We probably do this a lot more than we think. Consider how many decisions we face in a day, how many are automatic, and how many switches go unnoticed.

It happens to everyone. In a recent post, Scott Alexander writes about an individual randomized control trial for a sleep supplement. Alexander wanted to know if the supplement helped him sleep better, or if it was a placebo effect.

Placebos are powerful and cheap. If they get the job done, all the better it seems. But Alexander is serious, smart, and curious—so he tested this idea.

A friend disguised the supplements and sugar pills in oversized capsules, flipped a coin to determine the order, and placed the camouflaged pills in a monthly pill planner. To test the effectiveness, Alexander recorded hours of sleep and subjective ratings on how he felt. The results shocked him.

But not for the reason he expected.

I think the active ingredient here was not letting myself look at the clock. Without external cues to tell me how tired I should feel, I was forced to rely on how tired I actually felt, which in many cases was “not tired at all”.
Scott Alexander

In removing the alarm clock, Alexander removed the easier question. If it was before nine, it was too early. Obviously. Or not.

These kinds of tendencies work great for a lot of things, but occasionally work too much and we get interesting results like this.

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Tag: placebo

Should you have meniscus surgery?

Are you tired? Is that really the question?