Lying to Make Athletes Stronger: The Placebo Story
By Andrew Richardson
Immediate Disclaimer:
I never lie to my athletes, I have never used a placebo or placebos on them as
it is unethical due to it not being in a lab/sports science setting under
controlled conditions with participants consent to be part of a controlled study.
What if I told you there was a way to get stronger, bigger,
faster, learner, jacked and tanned, or just better at anything and everything?
Well there is but you may have already experienced without being told it.
There is something called a “Placebo” which you may of heard
of. Not the band called Placebo (still great but wrong context for this
article). A placebo can be described as “something fake which is believed by
someone to make it very real”, “a substance that has a positive effect as a
result of a patient’s perception that it is beneficial rather than as a result
of a causative ingredient”, “an inactive substance or preparation used as a
control in an experiment or test to determine the effectiveness of a medical
drug”. “Something of no intrinsic remedial value that is used to appease or
reassure another”.
Placebos can be used on a variety of situations and have
been known to be used for a very long time. Some theorist’s believe Stonehenge
in England was the first “Placebo Hospital” as people would come to see it for
the stones magic healing powers. Another example of a Placebo is when a child
falls and hurts their leg (small cut nothing serious) they scream for help. Mum
appears she calsm the child and kisses the leg better. The child feels better
even tho the mum didn’t do anything (medically speaking) to take away the pain.
It was all in the head or unless mums have superpowers.
Doctors have described placebos as a mistake as we are
letting our guard down to get something done. In Research particularly Sports Science it is
a controversial subject. One lecturer I recall saying to a student “You want to
do a study on Placebo’s Effecting Sport Performance? Hahah Good luck funding
that one”.
Top Ten Facts
about Placebo’s
1/ Designed to get Consumers. The Supplement Industry uses
this so much.
2/ It has physical and psychological responses
3/ The Bigger the production the bigger the effect: What
this means is if someone takes a white pill it has an effect, if the pill
changes shape that effect is increased, then if the colour of the pill is
changed, again the effect of the placebo increases. Then if someone has an
injection the placebo effect is dramatically increased. Then of course if you
have surgery then this is increased tenfold compared to the pill.
4/ Placebo’s can affect fertility rates: One study was
trying to help women get pregnant as they were struggling to do so. 2 groups of
33 women took part one used a sugar pill the other used actual drugs. The
placebo group only got 5 pregnant and the actual test group got 7 pregnant
proving that the placebo was useless.
5/ Can negate the effects of drugs
6/ Price of treatment affects results: The increased price
means to consumers, it costs more so it must be better where in fact it’s the
same thing you are just paying for the labelling.
7/ Brand names affect results: Some sprinters feel faster in
specific brands of clothing.
8/ Placebos work better than ever before: No one knows why
this is the case maybe we like being told what we want to be told.
9/ If you know it’s a placebo you can still get better: Some
study groups have shown this but most (including an example later on) will
disprove this point.
10/ Placebo surgery is effective: This is used heavily in
cartilage surgery where they take the patient to surgery and open them up but
don’t do anything.
The Research
Athletes look for any product, technology, or process that
might provide tem a competitive advantage. This leads some athletes to use
illegal and potentially harmful drugs. Resulting in 73 documented deaths of
athletes using PED’s in sport.
Counterintuitive Suggestion?
A small number of athlete’s who have failed drug tests have
claimed that they did not know they had taken the drug. One athlete stated that
a drug is only fully effective if the individual is aware that they have taken
it
This lent some support by medical staff and was consistent
with recent findings in medicine (Benedetti et al 2009). A placebo effect is a
desirable outcome resulting from the belief that treatment has been received.
A Placebo Effect V Placebo Control
- A neurophysiological event driven by expectation of conditioning
- An experimental conditioning used to control for a range of potential confounds.
Below is an image by Dr Chris
Beedie from Aberystwyth Uni where it compares experimental designs using
caffeine in sports performance.
The balanced placebo is the most interesting as it has 4
different levels = 4 different sets of results as the group has been
manipulated in 4 variables.
Reviews from studies (Beedie & Ford 2009, Berdiet et al
2011) indicate a moderate overall effect size for placebo studies in sport
performance (n=14).
Wide Range of Interventions involving Placebos
- Anabolic steroids (Ariel et al 1972 and Maganaris et al 2000)
- Morphine (Benedetti et al 2007)
- Carbohydrate (Clarke et al 2000, Hulson & Jeukendrup 2009)
- Caffeine (Beedie et al 2006, Foal et al 2008)
- Sodium Bicarbonate (McClung & Collins 2007)
How Large is the Placebo Effect on Performance?
- Sustainal Varaibility
- Generaly < 10% above baseline
- Possible substance – response relationship (Beedie & Ford 2007, Berdiet et al 2011)
- Anabolic Steroids (Ariel et al 1972 and Maganaris et al 2000)
- Morphine (Benedetti et al 2007)
- Carbohydrate (Clarke et al 2000)
- Caffeine (Beedie et al 2006, Foal et al 2008)
- Sodium Bicarbonate (McClung & Collins 2007)
Can a Placebo have a Negative Effect on Performance?
- Athlete expectation predicts effect
- Positive placebo effect driven by positive expectation
- Negative expectation can lead to negative outcomes (Beedie et al 2006, Foal et al 2008, Beedie et al 2007, Beedie 2007, Benetti & Hopkins 2009, Duncan 2010.
- Novebo Effect
Isn’t the Placebo Effect in Sport Simply the result of
Increased Motivation?
- Motivation is a factor yes
- Increased motivation is associated with increased load
- Evidence for improved performance in absence of;1: Increased physiological load (Foad et al 2008, McClung & Collins 2007)2: Increased perception of effort (Beedie et al 2006, Beedie et al 2007)
- Same level of performance at;1: Reduced physiological load (Foad et al 2008, McClung & Collins 2007)2: Love Perceived Effort (Foad et al 2008, McClung & Collins 2007)
Placebo Response unlikely a stable characteristic of
athlete (Beedie et al 2006, Beedie 2007)
- Personality did not predict placebo responding (beedie et al 2008)
- Athletes respond to placebo in one experimental trial but not another (beedie et al 2006)
Can the Placebo effect help and Athlete in Competition?
- Placebo effects as laboratory phenomenon (Hopkins 1999)
- Much anecdotal evidence for real world placebo effects
- Hurst et al 2013, investigated the placebo effects of caffeine on a competitive 5km track time trial
- Used balanced placebo design (shown earlier)
- Both CP & CC associated with enhanced performance over PP & PC
Can a Placebo Enhance Performances even when the athlete knows
it is a Placebo?
- Athletes underperform in “open labelled” conditions (Beedie et al 2006, Foal et al 2008, Hurst et al 2013)
- However positive effects of open labelled placebos in medicine recently demonstrated (Kaptchuk 2010)
- Open labelled placebo “this is a placebo”. Placebos have been found to improve sports performance by up to 5% in a number of scientific studies.
- Pilot study (n=12) used Cooper test
- Mean improvement of 2.8%
British Cycling Head Coach Dave Brailsford sought to make up
the 5% gap of which PED’s create over the drug free cyclists. This involved
improving every aspect of the cycling team’s performance by 1%. It included the
following;
- Own team bus
- Own chef to meal prep at all hotels and venues
- Own bed sheets and pillows brought to each hotel to improve sleep quality
- De-Humidifiers in each room to make sure the air humidity was perfect for each athlete
- Bikes all custom made to fit each athlete
- All bikes made lighter
- All athletes changed their riding positon to create less resistance when riding
- Clothing was lighter as well
- Team Psychologists for each athlete to make sure they are in the correct mental state
With all these personalised improvements perhaps one can
speculate a placebo effect was created as the athletes felt they would get
better simply by being a part of Team Sky’s plan. They have won 3 Tour De
Frances in the last 5 years so something must be working.
What do Athletes believe are the Mechanism’s of the
Placebo effect in Sport?
- Self report data (questionnaire & interview usually post study) (Beedie et al 2006, Foal et al 2008, Beedie et al 2007, Beedie 2007, Hurst et al 2015.
- Motivation “I just felt more up for it”
- Pain reduction “The pain just went away”
- Emotion “I felt calmer & less tense”
- Pacing “I went out harder & was able to hold it there”
- Physiology “My body seemed to swtich into a different mode, it just did things more efficiently”
What are the potential Applications of Placebo Effect in
Research?
- Anti-Doping: education re the role of the mind in drug effects (McClung & Collins 2007).1: previous cases (Maganaris et al 2000)2: debrief interviews (Beedie et al 2006, Foal et al 2008, Beedie 2007)
- Sport Psychology: placebo responsiveness as indicator of sub optimal status?
- Research: better interpretation of findings in placebo controlled performance studies
Current Anti-Doping Research (Hurst, Foal, Coleman &
Beedie )
Evaluate athletes existing Attitude Towards;
1: Drug Effectiveness
2: Drug Mechanism’s
3: Likelihood of future drug use
This feeds into the following,
Expose Athlete to Either:
1: First hand experience of placebo effect on sports
performance (experience intervention) n=400
2: Educational material relating to the placebo effect on
sports performance (education intervention) n=100.
This feeds into the following;
Evaluate any changes in Attitude towards;
1: Drug effectiveness
2: Drug mechanics
3: Likelihood of future drug use
- Most studies use legal substances (caffeine, creatine, sodium bicarbonate)
- Only 1 studies have used illegal (morphine) (Benedetti et al 2007)
- Problems with both (Method & Testing)
- Anti-Doping Application’s likely only relevant if placebo effects associated with drugs athletes abuse.
- A definitive study of placebo & real abuse (biological) effects of an illegal performance enhancing drug is required.
Placebo Effect and
Anabolic Steroids
Two studies
1/ Ariel et al (1972) “Anabolic Steroids: The Physiological
Effects of Placebo’s”. Medicine & Science in Sports. Vol 4. 124-26.
In this study 15 male lifters were told the subjects who
make the best progress/gains on the strength training protocol would be chosen
to go on a course of anabolic steroids for 4 weeks after the 4 week protocol.
This group have the extrinsic motivation to train hard to
get the drugs however, they are unaware that the steroids are actually sugar
pills. (hahahah gutting for the 15 guys but all for the pursuit for good data
in science)
The strength protocol was training on seated shoulder press,
military press and bench press. So these 15 guys trained their asses off and
after 4 weeks of training 6 of the 15 where chosen as they made the best
progress averaging out 11kg over the 3 lifts. The 6 then began the “sugar
pill/steroid medication”.
After the 4 week training/medicated cycle using the same
training protocol as before, the results showed they gained an average of 45kg
(about 100 pounds) between the three lifts. That compared to the 24 pounds
total in the first 4 weeks between the lifts. Making someone believe they are
on drugs, they expect to gain strength and size quickly. The human mind is a
great tool in a training arsenal if used correctly.
2/ Maganaris et al (2000). “Expectancy Effects &
Strength Training: Do Steroids make a difference? Sport Psychologist. Vol 14.
No 3. 272-278.
11 national level powerlifters from Great Britain were all
looking to get stronger through illegal means. They asked their coach if he
could get them some PED’s. The coach being very smart and sly agreed to getting
them the stuff, but what the athletes didn’t know was the coach had other
ideas.
The coach gave all the athletes a saccharine pill or as he
told the athletes “an oral steroid which is fast acting”. I can’t believe they
believed him as anything orally taken usually gets destroyed by protein enzymes
and stomach acid during digestion.
11 athletes took the pill they then went and immediately
tested their maxes on Squat Bench and Deadlift. All improved by 4-5% on their
lifts. Now National level lifters beating their PB’s by 4-5% (that’s a lot).
They group kept training for another 2 weeks taking the pill and relying
feeback to their coach. The reports showed they kept hitting training PB’s and
volume Pb’s each session being on this “pill”.
After the 2 weeks they came in again to test, but before
they did the group was split into 6 and 5. The 5 where told they weren’t on
gear all along but a sugar pill. The 6 weren’t told anything but given more
pills. The 6 improved again however the 5 regressed back to their old PB’s even
tho they weren’t using drugs.
How I Would Use a
Placebo:
- Build trust with a group of clients
- Tell them about a programme that is aimed at their goals
- Get a list of references and exaggerate the results to make it seem it brings craxy results
- Give them an incentive to train harder. Part A of the programme 20 people do and all fight for 10 secret prizes that will make them even bigger/stronger
- Another motivating factor for all participants is using money. The ten who put on the most muscle get £100 per person
- Those that get into the 10 spots (based on how much they gained off the programme) are given a top nutrition plan (a simple plan just labelled highly scientific with fancy words and graphs)
- Now you have two groups 10 who got the nutrition plan and 10 who didn’t. Within the nutritional plan split it into 2 groups of 5. Both still receive the same nutritional plan however one is given a sugar pill labelled as a muscle gain pill which has been approved by the IOC.
- From this all groups run the same training protocol and seen from the three variables who packs on the most muscle.
- The placebo group with the sugar pill will probably pack on the most as they are led to believe they have been giving a muscle building drug closely followed by the nutritional plan group.
BUT…..
I couldn’t do this as it is unethical and if I did people
would complain that I lied to them even tho I made them better. This feeds into
the ethics of placebo trials.
An Ethical
Dilemma?
To placebo or not to placebo? That is perhaps a question
each coach/trainer/physio/doctor may ultimately have to answer individually.
- Given the potentially placebo-inducing advertising in the sport, health & fitness industry (think sleazy advertising), should the coach consider it part of his job to influence his athlete’s perceptions of supplements. Mean if a kid came in saying he got a weight gainer all happy and excited (looking convinced it would make him into a freak) should we tell him he doesn’t need it or encourage him as it will give him the placebo effect?
- Is lying to athletes morally defensive if one’s intentions are good, especially if most high level athletes are willing to be deceived if it would improve performance (Berdi et al 2014)
I personally believe placebos are linked with what can and
can’t be done regarding certain tasks. If we remove all perception of what is
possible and impossible form the task then is there a need for a placebo. One
case is the story of Cliff Young.
Cliff
Young: Sheep Farmer to Ultra Endurance Legend
Cliff Young 61 year old sheep farmer wins 1993
ultra-endurance race in Australia. This was 543.7 miles from Sydney to
Melbourne.
He turned up in boots and overalls and entered the race.
People looked at him to the professional youthful athletes in shock. Cliff said
he could do it, all the other competitor’s laughed at him. They asked him why
he thought he could do it. Cliff replied “Yes I can, you see I grew up and
worked on a farm where I still do to this day. On this farm we have 2,000 acres
with 2,000 sheep. I would spend 2-3 days at a time running after the sheep. It
took a long time but I would always catch them”.
When the race started the pro’s quickly left Cliff. Cliff
also didn’t run, he shuffled the whole way. Post race analysis of Cliff’s
running mechanics/gait showed it was very energy efficient. This style of
running for this event has made a lot of pro’s change their style to this one.
The pro’s knew it took 5 days to finish the race, in order
to compete they decided to run 18 hours at a time then sleep 6 hours at a time.
The thing was Cliff didn’t know that he just ran all through it.
Cliff literally meant he would spend 2-3 days running after
his sheep. Everyone was surprised when Cliff said he was going to run it
straight with no rest. By the final night he passed all the competitor’s and
won the race well ahead of anyone. Set a new World Record in the process. Years
later after competitor’s adopted Cliff’s outlook and style of running another
day has been taken off his time.
Summary: Placebos
& Drugs in the Real World
In the absence of a biological intervention
- Belief that you have taken a drug might result in a therapeutic outcome
- Negative expectations of the drug might result in a undesirable response
In the presence of a biological intervention
- Knowledge that you have taken the drug might augment the biological effect
- Ignorance of having taken the drug might offset some of the biological effect
- Negative expectations of the drug might antigonise the biological effect
The human mind is very powerful if we believe something
works even tho it has no significance on the outcome it will still work.
I hope you enjoyed reading this
Take care
Andrew
Andrew Richardson, Founder of Strength is Never a Weakness Blog
I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University.
Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019.
I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.
My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.
My most recent publications:
My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning.
Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering.
I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness.
I had my own business for providing training plans for teams and athletes.
I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships,
in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge.
Contact details below;
Facebook: Andrew Richardson (search for)
Facebook Page: @StrengthisNeveraWeakness
Twitter: @arichie17
Instagram: @arichiepowerlifting
Snapchat: @andypowerlifter
Email: a.s.richardson@tees.ac.uk
Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278
Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7
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