New Knowledge

My Baby's BookI still have the book that tracked my infant development after I was born. It’s a little time-capsule of medical opinion from a different age.

At the three months mark, my mum was advised to provide me with fresh fruit juice. These days, the Australian government offers a different medical recommendation:

exclusive breastfeeding for 6 months is the optimal way of feeding infants.

Although, perhaps things will change again soon. The Australian Society of Clinical Immunology and Allergy publishes a fact sheet on infant feeding with a different view again:

Based on the currently available evidence, many experts across Europe, Australia and North America recommend introducing complementary solid foods from around 4-6 months.

Similarly, I was told by a colleague that when they were a parent some decades ago, the sleeping recommendation was to place babies on their stomach (I guess to minimise any inadvertent shaping of their heads while they are still soft?). However, the Australian government offers different guidance these days:

Put your baby to sleep on its back and use light cotton blankets.

Well, aside from being confusing when parents get differing advice from their own parents compared with the government, this is actually a good thing: when the medical facts change, the medical community changes its collective mind. And while there’s a good chance that the recommendations aren’t perfect and may change again, at least the new recommendations are better than the old recommendations.

Of course, this is old hat for anyone familiar with scientific method.

Unfortunately, there doesn’t appear to be a similar evolution of knowledge when it comes to recommendations for best managing people. When I have taken courses designed to impart the best new thinking around management, a less useful approach is followed.

There is often an unwillingness to state that prior management recommendations are wrong and should be replaced with better ones. In fact, new techniques have typically been presented to me as new “tools” that can be added to my “toolkit“. This toolkit apparently can grow without limit, and it is largely up to my discretion as to when, where and to whom I should apply a given technique.

I grant that there is difficulty in running experiments needed to show that a particular technique is better than another, and dealing with people is a messier problem-space than dealing with germs or injuries. Also, sure, management science is a relatively new discipline. Still, it feels like a cop out.

I hope that one day, looking at today’s management courseware will seem as quaint as looking at my old baby book.

Placebos and Advertising

It isn’t just that expensive wine is more enjoyable, but actually paying more for wine makes it more enjoyable. Researchers from CalTech and Stanford found that the brain’s pleasure centre has more activity when tasting $90 wine compared with $10 wine, even when it is exactly the same wine.

I find it amazing that the brain has such sway over the body, but it’s something that the advertising industry has known for ages.

In Malcolm Gladwell’s Blink, I first read about the work of Louis Cheskin, whose work in advertising since the 1930s was revolutionary. His theory of sensation transference was used to design product packaging that would change the way people felt about, and even experienced the product. In one example with underarm deodorants, Cheskin sent the same identical formulation to testers in three different packs with unique colour schemes. The testers consistently reported differences in fragrance and effectiveness, and one colour scheme even resulted in rashes. Cheskin’s consultancy group was named the Color Research Institute, for obvious reasons.

So, given this background, I shouldn’t have been surprised by a recent article in Wired Magazine on placebos. It reported that the “placebo effect” is not a single effect at all, and using different colours or shapes of a pill can make that pill more or less effective in its treatment, even if that pill is just a sugar pill. In other words, the packaging of drugs, whether it is the form of the pills, or the design of the box, or how the medical practitioner gives it to a patient, can change how well a drug works.

While the placebo effect is associated with snake oil, it is considered to operate equally on legitimate drugs. That’s why in clinical trials, the main hurdle is to achieve levels of effectiveness higher than a placebo. But since the placebo effect itself can be made stronger or weaker, or achieve particular effects, you could imagine a trial where the placebo is chosen to have a weak effect so the drug stands a better chance of succeeding at trial. In fact, the Wired article claims that the placebo effect has become stronger recently, making it harder for drug trials to succeed. I can see a more worthwhile application of the placebo effect being to tailor packaging so that not only does it add to the drug’s effectiveness, but may even offset side-effects.

Perhaps in the future, the list of active ingredients on a drug’s packaging will also need to include aspects of the packaging like colour or shape. I may choose to avoid my paracetamol tablets if they are blue because it upsets my stomach. However, there’s one piece of information that’s already on the packaging that may yet be proven to work for other drugs (as it works for alcohol): the price.

And I will leave you with the thought that if more expensive drugs turn out to be more effective (purely on that basis), then may heavy subsidies of certain drugs be causing more harm than good?