Everyday buttons that only provide the illusion of control


It is a reflex born of years of habit: You see a button, press it and then something happens.

The world is filled with them, such as doorbells, vending machines, calculators and telephones.

But some buttons we regularly rely on to get results are mere artifices — placebos that promote an illusion of control but that in reality do not work.

No matter how long or how hard you press, it will not change the outcome. Be prepared to be surprised — and disappointed — by some of these examples.

Door-close buttons on elevators

Pressing the door-close button on an elevator might make you feel better, but it will do nothing to hasten your trip.

Karen W. Penafiel, executive director of National Elevator Industry Inc., a trade group, said the close-door feature faded into obsolescence a few years after the enactment of the Americans With Disabilities Act in 1990.

The legislation required that elevator doors remain open long enough for anyone who uses crutches, a cane or wheelchair to get on board, Ms. Penafiel said in an interview on Tuesday. “The riding public would not be able to make those doors close any faster,” she said.

The buttons can be operated by firefighters and maintenance workers who have the proper keys or codes.

No figures were available for the number of elevators still in operation with functioning door-close buttons. Given that the estimated useful life of an elevator is 25 years, it is likely that most elevators in service today have been modernized or refurbished, rendering the door-close buttons a thing of the past for riders, Ms. Penafiel said.

Take heart, though: The door-open buttons do work when you press them.

Crosswalk signals

New Yorkers (those who don’t jaywalk, that is) have for years dutifully followed the instructions on the metal signs affixed to crosswalk poles:

To Cross Street

Push Button

Wait for Walk Signal

But as The New York Times reported in 2004, the city deactivated most of the pedestrian buttons long ago with the emergence of computer-controlled traffic signals. More than 2,500 of the 3,250 walk buttons that were in place at the time existed as mechanical placebos. Today there are 120 working signals, the city said.

About 500 were removed during major construction projects. But it was estimated that it would cost $1 million to dismantle the nonfunctioning mechanisms, so city officials decided to keep them in place.

Most of the buttons were scattered throughout the city, mainly outside of Manhattan. They were relics of the 1970s, before computers began choreographing traffic signal patterns on major arteries.

ABC News reported in 2010 that it found only one functioning crosswalk button in a survey of signals in Austin, Tex.; Gainesville, Fla.; and Syracuse.

Office thermostats

The same problem that confronts couples at home — one person’s perception that a room is too cold is another’s that it is too warm — faces office workers as well.

Depending on where you work, you might find the thermostat in a plastic case under lock and key, but if you’re lucky you might have control over one.

Well, you might think you have control.

The Air Conditioning, Heating and Refrigeration News reported in 2003 that it asked readers in an informal online survey whether they had ever installed “dummy thermostats.” Of 70 who responded, 51 said they had.

One respondent, David Trimble of Fort Collins, Colo., wrote The News that people “felt better” that they could control the temperature in their work space after a nonfunctioning thermostat was installed. “This cut down the number of service calls by over 75 percent,” he wrote.
Sense of control

Though these buttons may not function, they do serve a function for our mental health, Ellen J. Langer, a psychology professor at Harvard University who has studied the illusion of control, said in an email.

“Perceived control is very important,” she said. “It diminishes stress and promotes well being.”

John Kounios, a psychology professor at Drexel University in Philadelphia, said in an email there was no harm in the “white lie” that these buttons present. Referring to the door-close button on an elevator, he said, “A perceived lack of control is associated with depression, so perhaps this is mildly therapeutic.”

Knowing that pushing these buttons is futile does not mean it will stop people from trying, he added. The reward of the elevator door closing always occurs eventually, he said.

“If the door never closed, we would stop pressing the button,” he continued. “But in that case, of course, we would stop using the elevator altogether. So, that habit is here to stay. Similarly, even though I have grave doubts about the traffic light buttons, I always press them. After all, I’ve got nothing else to do while waiting. So why not press the button on the off chance that this one will work?”


A more expensive placebo works better than a cheaper one.

Results of a small study suggest that Parkinson’s patients seem to improve if they think they’re taking a costly medication. The findings have been published online Jan. 28 in Neurology.

In the study, 12 patients had their movement symptoms evaluated hourly, for about four hours after receiving each of the placebos. On average, patients had bigger short-term improvements in symptoms like tremor and muscle stiffness when they were told they were getting the costlier of two drugs. In reality, both “drugs” were nothing more than saline, given by injection. But the study patients were told that one drug was a new medication priced at $1,500 a dose, while the other cost just $100 — though, the researchers assured them, the medications were expected to have similar effects.

Yet, the researchers found that when patients’ movement symptoms were evaluated in the hours after receiving the fake drugs, they showed greater improvements with the pricey placebo. What’s more, magnetic resonance imaging scans showed differences in the patients’ brain activity, depending on which placebo they’d received. The patients in the study didn’t get as much relief from the two placebos as they did from their regular medication, levodopa. But the magnitude of the expensive placebo’s benefit was about halfway between that of the cheap placebo and levodopa. What’s more, patients’ brain activity on the pricey placebo was similar to what was seen with levodopa.

And this effect is “not exclusive to Parkinson’s,” according to Peter LeWitt, M.D., a neurologist at the Henry Ford West Bloomfield Hospital in Michigan, who wrote an editorial published with the study. Research has documented the placebo effect in various medical conditions, he told HealthDay. “The main message here is that medication effects can be modulated by factors that consumers are not aware of — including perceptions of price.”


Placebo Effect May Account for Half of Drug’s Efficacy


Even when a medication works, half of its impact on a patient may be due to one aspect of the placebo effect: the positive message that a doctor provides when prescribing the treatment, according to a new study.

Researchers designed an elaborate study, in which 66 people suffering from migraine headaches were given either a placebo, or a common migraine drug called Maxalt. However, for each migraine attack the participants had during the study period, they were told something different. For example, they were told they were taking a placebo when they were actually taking Maxalt, or vice versa, and sometimes they were told the pill could be either Maxalt or a placebo.

The pain-relieving benefits of the migraine drug increased when patients were told they were taking an effective drug for the treatment of acute migraine. And when the identities of Maxalt tablets and placebo pills were switched, patients reported similar pain relief from placebo pills labeled as Maxalt as from Maxalt tablets labeled as a placebo, according to the study published January 8 in the journal Science Translational Medicine.

The results suggest that the information people have is as important as the effects of the drug in reducing pain, the researchers said.

“In many conditions, placebo effect is a big part of the effect of the drug,” said study researcher, Ted Kaptchuk, a professor of medicine at Harvard Medical School. In the new study, 50 percent of the drug’s effect could be attributed to the placebo effect, he said.

“Themore you give a positive message, the more a drug works. In this case, our message was just as important as the pharmacology of the drug,” Kaptchuk said.

In other words, patients may benefit from optimistic messages from their doctors, which may enhance the effectiveness of a good pharmaceutical, the researchers said.

“When doctors set patients’ expectations high, Maxalt [or, potentially, other migraine drugs] becomes more effective,” said study researcher Rami Burstein, a professor of anesthesia at Harvard Medical School. “Increased effectiveness means shorter migraine attacks and shorter migraine attacks mean that less medication is needed,” Burstein said.

However, physicians should be realistic when prescribing a treatment, Kaptchuk said.

“The medical community should consider what’s the positive message that is still accurate, and not an exaggeration that verges on deception,” he told LiveScience.

Migraine attacks are throbbing headaches, usually accompanied by nausea, vomiting and sensitivity to light and sound. The researchers decided to look at migraine, because it is a recurring condition, and responds well to medication, Kaptchuk said.

During the study, the participants had a total of 450 migraine attacks. Each time they were provided with one of the six available treatments: two were made with positive expectations (envelopes labeled “Maxalt”), two were made with negative expectations (envelopes labeled “placebo”), and two were made with neutral expectations (envelopes labeled “Maxalt or placebo”).

But within each of these conditions, the envelopes contained either the placebo or Maxalt. The patients then reported their pain experiences.

“When patients received Maxalt labeled as placebo, they were being treated by the medication — but without any positive expectation,” Burstein said.

For both placebo and Maxalt, patients reported great pain-relieving effects when the envelope was labeled “Maxalt.” This suggests that a positive message and a powerful medication are both important for effective clinical care, the researchers said.
The placebo effect is centered on the idea that a person’s expectations and beliefs drive changes in symptoms, even though they have received a sugar pill or a sham treatment with no effect. Knowing that they have received a placebo changes their expectations, which is expected to alter the placebo effect.

However, people in the study also reported pain relief even when they knew the pill they were receiving was a placebo, compared with no treatment at all.

This finding “contradicts the medical beliefs,” Kaptchuk said. “Because in medicine, we think you have to think it’s a real drug for placebo to work. But apparently, the body has memories, or an embodied awareness, which operates below the level of consciousness.”

One possible mechanism for this effect could be that the body is conditioned to react positively in medical situations, Kaptchuk said.

“We know from other studies that the symbols, the rituals and the words of medicine activate the brain to release neurotransmitters that change the experience of illness. It activates centers in the brain that modulate many symptoms like pain and nausea and fatigue,” he said.


Placebos Work Better for Nice People


Having an agreeable personality might make you popular at work and lucky in love. It may also enhance your brain’s built-in painkilling powers, boosting the placebo effect.

Researchers at the University of Michigan, the University of North Carolina and the University of Maryland administered standard personality tests to 50 healthy volunteers, identifying general traits such as resiliency, straightforwardness, altruism and hostility. Each volunteer then received a painful injection, followed by a placebo—a sham painkiller. The volunteers who were resilient, straightforward or altruistic experienced a greater reduction in pain from the placebo compared with volunteers who had a so-called angry hostility personality trait.