Placebo Effect: The Wonder (Non-)Drug

I love the placebo effect. It’s like Real Life magic, where something happens that makes no sense, but in a good way, and you can’t explain why or how very well but it’s awesome.

To give a simplified example for the uninitiated: let’s say you have two picky twin cousins who drink only filtered water when clearly tap water is just as good (and often better). Both cousins are thirsty. You’re bring one twin tap water, and the other twin filtered water (because you’re an evil scientist with no regard for ethical considerations). They both think that their water is filtered. The drink it up and say thanks. Ding! Doesn’t matter if the water actually was filtered or not – as long as they think it was, it tastes just as good.

Now there are problems with this small example and it can’t be applied across the board (the difference between a brand name and generic drink might taste different, for example), but it’s a starting point.

Now when doing research with lots of people, we see the placebo effect in groups. We’re trying to figure out whether taking a new medicine is better than not taking it, for a certain group of people. For example, whether taking a new medication will help people feel better more quickly. Let’s say we convince 20 people with headaches to participate in our research experiment. Of the 20 total participants who so graciously are giving us their time, 10 people get the treatment (the new medication) and 10 people get something that looks and tastes like the treatment (the placebo). Maybe we check in with them an hour after taking their pill, and 7 out of 10 people in each group feel better. Those that got the new treatment (the new medication), we might think they feel better because of taking it, but those who got the placebo and feel better…what’s their deal? As a researcher, you might get a little diddly-ish.

It’s brain magic. And um, feeeelings.

There’s some new research showing that different personality traits may be associated with higher likelihood for experiencing the placebo effect, and that sometimes even placebo surgery can be just as good as real surgery.

It’s also a big surprise because it messes with, subverts, troubles our understanding of how things work. You have a headache, so if this pill makes headaches better, and you take the pill, your headache should go away. Real simple, right? But what if you just think the pill works, and you take what you think is the pill, and your headache goes away. Then what? Then placebo, yo. Your brain and body conspired to make your headache go away. You thought it would, and it did. Go, brain, go body, it’s your birthday. (In the sense that every day is your body’s birthday because it’s producing new cells and stuff alllll the time.)

TL;DR: The brain and the brain-body connection is all kinds of awesome. Doing something to try to improve your health may work, even if it’s not clear why that particular something works. As long as you believe in the treatment (and it’s harmless), it might be enough.

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Post-Gastroenterology Observations: New Reasons to Be Thankful

It’s funny how spending a couple of hours observing how other people live, — hearing about their experiences of living in and with their body –, how that insight can radically change my own perspective. After spending some time around people with gastroenterology issues, I have several new items to add to my list of things I’m thankful for:

– the ability to produce saliva, which allows me to consume food without it getting stuck in my throat and allows me to speak without pain

– not having h. pylori

– working in a field where I can wear fashionable shoes to work instead of clogs

– not being constipated for 3 days or going to the bathroom 20 times a day

– not having to resist the persuasive enthusiasm and at times moral concerns inherent in interactions with drug reps

– that every pain I’ve experienced has been temporary and treatable

– that I didn’t spend my birthday or holiday hours away from my home in a waiting room

– that there really are compassionate and clear providers, with good bedside manner who can communicate well with people who are hurting

– that not every doctor has bad handwriting (some are not only legible but even pleasant to the eye!)

How to Like Your Job Or Be a Better Manager: Book Review of The Three Signs of a Miserable Job

Thanks to the glorious public library, I recently finished The Three Signs of a Miserable Job. The book should really be a pamphlet, and the title should be “3 Things That Make People Do Good Work.” The ideas are that simple, and the majority of the book is that fluffy. I found the fable Lencioni uses to convey the ideas long-winded and cutesy, but I’ve also experienced good management, so maybe for neophytes it’s a good way to grasp the ideas.

Without further ado, here are the 3 things:

1. Know the people you work with.

The book calls this the problem of “anonymity” and suggests managers ask, “Do I really know my people? Their interests? How they spend their spare time? Where they are in their lives?”

It’s not just about knowing work-y things about each other; on the contrary, actually it’s the non-work things that are most important. Knowing what makes someone tick, what makes them excited or worried – those are the things that help you navigate the relationship, that help you conspire to work better, to produce better results. It’s knowing the person’s other commitments, being understanding and supportive of them, making a connection beyond the workplace, so you can communicate better.

I’m not suggesting managers start watching the same TV shows as their employees, or following them to the gym. Rather, finding some commonality to talk about makes work more pleasant for everyone, especially if the commonality is something deeper than a favorite sports team. Even if there’s nothing in common between you, knowing how the other person is doing, showing that you care about them as a person, that helps build empathy and trust, which makes someone be a better worker.

2. Know why your work matters.

The book calls this the problem of “irrelevance” and suggests managers ask, “Do  my employees know who their work impacts, and how?”

Sometimes it’s easy to see why the work matters. When I was a camp counselor, when I was a teacher, whenever I was around young people, I thought I had the most important job in the world. Maybe because that is the most important job in the world. Or maybe I just always think that my work is important.

Not everyone has that luxury. It’s pretty basic though: why does your work matter? Maybe it’s not so dramatic as saving someone from a fire or doing surgery. Life isn’t all made up of big events like that. It’s the simple acts, of repeatedly making someone else’s work easier, of brightening someone’s day, of teaching someone a skill over time. Creating meaning, sometimes out of very little things.

3. Know how to evaluate your work.

The book calls this the problem of “immeasurement” and suggests managers ask, “Do  my employees know how to assess their own progress or success?”

“Immeasurement” is not a word, obvi. If it were though, lots of professors might use it to describe two common problems among research students: how are you measuring and is that a good measure?

Hint: productivity isn’t related to meetings. It’s about deciding what best reflects what you’re doing day-to-day, counting it and reflecting about the numbers. If you’re a server in the restaurant business, it might be as obvious as tips and the time it takes to turn around a table. Not everything is so easy to quantify though. And I’m a mixed-methods devotee anyway. You have to pick a variable that makes sense for the work you do. One you can define and count by yourself.

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In summary: No need to read the book. If you want people to do good work, you have to know them, care about them, show them why they matter and help them measure, on their own, how they’re doing.

Welcome Columbia University Public Health Blog Readers!

If you’re here from the Columbia University Mailman School of Public Health blog, I’m grateful for your interest. Here are a couple posts to get you caught up:

Maybe you’re wondering about me, where I’m fromwhat I’m doing, where, and why. Or maybe you just want to know about Colombia, the hospitable people, where to go, what to do. Perhaps you’re curious about non-work things, like dance class, food and food poisoning or if you should live close to your practica. Take a look around!

The truth is, I’ve been lackadaisical lately. My last post was in October…and it’s past the middle of November already. I’m not as negligent as a certain medical student I know, nor am I as regular as an esteemed graduate student adviser. I’m somewhere in between. I’ve been collecting data, analyzing data, preparing instruments for submission to the institutional review board (IRB). The usual excuses.

Nonetheless, I’d like to write with more regularity and this little, unexpected spotlight makes me want to write more. What would you like to read about? I have a post in the works about Zipaquira, the local transportation system, and about the logistics of research. I’m happy to field questions or focus on a particular aspect of public health, living abroad, or evaluation research. Questions and suggestions are welcome in the comments!

Focus Groups with Women: Things Left Unsaid

I started focus groups with contraceptive users yesterday. It’s been providers only before, gathering data for my practicum. Women, contraceptive users, clients – however you call them, are completely different. Their stories get into your heart, their words are less precise, their qualms don’t fit into charts and tables.

It’s draining. I had two groups today, maybe that’s why I want to crawl into bed and eat Rocky Road ice cream with potato chips. For a week. While watching addicting bad tv.

Maybe it’s because I had a million things I wanted to tell them, clarify, provide resources. But focus groups aren’t about that. I can observe and try to improve things later on, but in the moment I am helpless to change anything. I agree and accept all sorts of responses, reactions I wouldn’t dream of encouraging if I were presenting, teaching, training.

The things I wish I could have said pile up throughout the hour or two, linger in my head at the end, when the women leave alone or in pairs, thanking me or walking out quietly. This happened in DR too, when I did life story interviews there. (Much messier, completely unstructured, unsupervised, ultimately unused.) So much I wish I could have said, could say.  If wishes were horses…here is what I would have said, were it possible, were it up to me:

1. Your body is yours. Not your lover’s, not your husband’s, not your children’s. Yours. You are responsible for it, for doing what is right for you, for ensuring – at times, forcefully – that others respect this right, your decisions, your needs.

2. Whether or not you want to be pregnant is your choice. Yours alone. My heart aches for you that your experience has been one of disassociation, abandonment, fear, resignation. You deserve to be happy.

3. I don’t know how to help. I very much wish I did. I am working on things that might maybe end up helping you, or women like you, sometime in the future. But this moment? I am at a loss.

Lessons from My First Focus Group

1. Use your local experts

I didn’t sleep well the night before. It felt like Christmas. I had gone over the focus group guide with my local version of Linda Cushman three times. We were playing with the order of the questions, the wording, the probes. Key stakeholders had reviewed the guide, suggested edits, reworded questions. I reviewed my Research Design and Data Collection class notes.

Take a seat wherever you’d like.

2. Check, double check

The table was set with pencils, paper, and name tags. I had my consent forms, focus group guide, and pen. The two digital records had fresh batteries and had been checked. The large butcher paper and markers were at the ready. The corner table had drinking water and glasses. My assistant had been prepped.

I was ready.

This is me looking ready.

3. Breathe

It was 3 pm. Then 3:05. I started fiddling with the chairs, nametags, recorders. I went to ask the front desk if my participants had arrived, if they were in that day, if we could call them.

4. Send Reminders

At 3:10, four out of six had arrived. The other two weren’t available. We went on without them. Sometimes I was flustered, awkward, spoke too fast. Overall, it was okay. We laughed. We understood each other. It felt like teaching, like presenting, like interviewing. All these things I like to do mixed together.

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I tried writing a post before having my first focus group, but all I got was: OMGz sdkjfer029irflkdjlfkjslkfj. Really. That incomprehensible onomatopoeic string was the entire post.

Happy One Month Birfday, Blog!

I published my first post a month ago.

Her face is a good approximation of my feelings.

It felt like a big deal. Back then, I thought I’d be including a video with every post. I thought I’d be writing in-depth, critical analysis, biting commentary, Important Things. Instead I’ve written about toilet paper and threadbare leggings.

I have 8 loyal subscribers. My readers are my family, my Global Health track cohort, friends back home. I have readers in Russia, Burkina Faso, Rwanda, Nicaragua, Senegal, and Uganda. In the US, I have readers who study medicine, birth babies, and drive cross-country.

It’s a little creepy having all this information, knowing so much about my blog’s visitors. But it’s nice to be acknowledged, right? I appreciate y’all sticking around and reading.

So, ever-patient reader, What  would you change? What do you want to read about in the next month?