Believe yourself better

Deception in healthcare

Despite the promise of the pilot study, it is still very early days and one must take care to ensure that such a deceptive intervention is truly effective. In 2010 Asbjørn Hróbjartsson and Peter C Gøtzsche conducted a meta-analysis of over 200 studies designed to assess the effectiveness of placebo and concluded that “placebo treatments produced no major health benefits, although on average they had a modest effect on outcomes reported by patients, such as pain”.

In other words, a placebo has no effect on disease, but it can temporarily alter a patient’s perception of their condition. If after further large-scale studies Olson’s work is proven to buck this trend, then he may well be on to something. But even if he was, is the use of deception to make someone feel better ethical?

The academic Professor Edzard Ernst would argue that placebos can never be ethical when the treatment is not medicinal in any way. He would state that the initial deception runs counter to the notion of informed consent and patient autonomy, a cornerstone of medical practice. For me though, his most compelling argument against its use is that the short-term alleviation of symptoms through a placebo could mask a serious condition that needs urgent treatment.

But he is also quick to point out that this doesn’t mean that placebo shouldn’t still be used together with medicine that has a proven effect. Ernst observes that an accomplished medical practitioner should be able to elicit a form of placebo effect through their care and compassion for their patient, an interaction that is the most important form of science engagement most of us are ever likely to experience.

Tell yourself a new story

What placebo studies tell us then is that for some, symptoms of illness can be altered positively (and negatively) through a deceptive suggestion in the short term. However, what if such strategies were instead used to change ‘unhealthy’ behaviours as well as disease? Could the effects last longer? 

Between 2005 and 2013 false-memory researchers discovered that past memories of food and drink can be substantially altered to affect behaviour. In a series of experiments they took the known techniques of creating false memories through suggestion (which I explored in Part 3) and used them to generate positive memories of healthy eating and negative memories of consuming unhealthy food and drink.

They found that those who developed false beliefs and memories of getting ill from consuming hard‐boiled eggs, strawberry ice cream, dill pickles, vodka and rum subsequently reported less interest in consuming them again. Similarly, people who developed false childhood beliefs or memories of loving asparagus reported a stronger preference for that food.

Although the details of our autobiographical memories shift over time, the long-term effects of a remembered life event are continuous, so there is a possibility that such false, behaviour-changing beliefs could have a lasting impact.

We also know that negative memories, false or otherwise, can have a damaging impact on identity and personal relationships. So what if there was a form of false-memory therapy that used deceptive suggestions to put a positive spin on your past? Could deceptively changing the stories a suffering or unhealthy patient tells about themselves ever be an ethical pursuit?

If public perceptions are anything to go by, using our propensity to self-deceive to improve wellbeing may not, in the future, be as far-fetched as it seems. In a 2016 study, 48 per cent thought that such an intervention would be fine. In another study, over half the respondents claimed that they would like to be given the option of using memory-dampening drugs to negate a traumatic experience.

The challenge now for researchers is to establish whether such cognitive tinkering could ever be justified – if it’s accepted practice to use pharmaceuticals to subdue negative behaviours, then why shouldn’t we use memory manipulation? My instinctive response is that it feels like a step too far, but then maybe my beliefs have been too influenced by the fictional dystopias that critique such a notion to see the truth of the matter.

Final thoughts

Throughout this series I have attempted to bring together real-world examples where deceptive strategies are used in order to reveal something fundamental about the nature of human experience. In our era of so-called ‘fake news’, ‘alternative facts’ and ‘post-truth’ politics (all risible terms in their own right), I believe it is still possible to use our vulnerability to misinformation usefully. Whether through making art, magical conjuring, political protest, in the psychology lab or in healthcare, now is the time for us to wrest back control of deception from the frauds and the reactionaries. 

Malign misinformation is not new; however, the way in which it is communicated is, so there is a heavy burden of responsibility on our politicians, celebrities, influencers, technologists and media to be rigorous and considered when calling upon the ‘evidence’. But this may never happen, so in the meantime we all have a responsibility to be aware of our vulnerabilities and to become more effective and critical consumers of information.