Strange and Surprising Facts About Placebos

In June 2010, in true Sheldon Cooper form, a group of scientific researchers studied coffee and wrote a paper with this cryptic title:



Association of the Anxiogenic and Alerting Effects of Caffeine with ADORA2A and ADORA1 Polymorphisms and Habitual Level of Caffeine Consumption



Which, in the language of mere mortals who speak English, I think translates something close to:



Does caffeine make you more nervous and alert?



Their conclusions can be seen by clicking the link above - as long as you are prepared to read a Sheldon Cooperesque version.  A quick summary, in English, in the sequence reported (note: those in bold are simply WRONG):







1. - people with a specific genetic marker are more likely to have anxiety effects from caffeine, 

2.  people with that specific genetic marker tend to consume more caffeine on average.

3. - people who consume more caffeine have less anxiety from caffeine consumption, even if they are more genetically disposed to high anxiety from caffeine. 

4. - other genetic groups studied had no enhanced symptoms from caffeine consumption

5. - placebos, when taken by people who consume a lot of caffeine, 'caused' a decrease in alertness and headaches. Duh. 

6. - if you do not consume caffeine regularly, it does not make you more alert

7. - if you regularly consume caffeine, you develop tolerance to the anxiety effects

8. - caffeine abstinence reduces alertness

9. - caffeine consumption after a few hours of withdrawal returns alertness to normal



Ok, let's look at the simple (BOLD) errors first.  There were two simple errors reported in this study.  Two 'facts' that are completely WRONG, points 5 and 8.  How can this happen in a scientific report prepared by many people, and supposedly reviewed by an editing panel before it was published?



Let's look at the text in the actual summary, to make sure we are not making a similar mistake:



5. Placebos: "Placebo administration in MH participants decreased alertness and increased headache."



Seriously?  Let's take some MH people, people who regularly consume moderate or heavy amounts of caffeine.  In the morning, we give them a placebo instead of their morning caffeine shot.  They show decreased alertness and increased headache.  Is it clear that the placebo 'decreased alertness and increased headache'?  Just give me some damn coffee and throw your placebo conclusion in the garbage.



8. Abstinence: "caffeine abstinence reduces alertness".  Now I had to go to a dictionary to look up abstinence to make sure I'm reading this correctly.  Here's what Merriam-Webster has to say:



ABSTINENCE:  

a) voluntary forbearance especially from indulgence of an appetite or craving or from eating some foods

or b) habitual abstaining from intoxicating beverages



Put simply, there was no 'abstinence'.  Abstinence was not tested.  The subjects did not voluntarily abstain, they were administered caffeine or a placebo. And the so called 'abstinence' was not 'habitual', it was scheduled to the hour.



Ok.  Two out of nine conclusions are TOTALLY WRONG.  What else might be wrong? Did the researchers only make two mistakes?  Not likely.



Let's simplify by ignoring the 'genetic marker' side issue, and summarize what the researchers learned in general.



1. Caffeine makes us more anxious - according to the test designed to test anxiety.  It has the same effect on all of use, some more, some less.

2. Caffeine does not make us more alert.  Unless we are already suffering withdrawal symptoms from caffeine.



Neither of these conclusions were stated directly, but these simplified conclusions can be validated by reading the complete text of the summary report.  Take your time, it is written in Sheldon Cooperesque English.



So why didn't the researchers report this news?  Well, because they were doing significant scientific research, and results of significant scientific research are necessarily complex.



Or is it, simply, that these conclusions are WRONG as well?   Yes they are. Sorry about that, all of you who rely on clinical studies for 'strong scientific evidence'.



The conclusions lead us to believe that caffeine does not make us more alert, it just makes us more anxious - and maybe we mistake that 'anxiousness' for 'alertness'.  Is that true?



Let's suppose you want to drive your car late at night, or are a guard to working the night shift, or a nurse monitoring a seriously ill patient through the night?  Should you drink caffeine to make yourself more alert?  Or should you believe the researchers who say that 'caffeine doesn't make you more alert'?



If you are asleep, because you didn't consume caffeine - are you more or less alert?  If you are awake, because you did consume caffeine - are you less alert than if you were asleep?



Ah, the power of scientific testing.  The researchers made a classic error.  They woke people up in the morning, measured their anxiety, alertness and headache.  Gave them some caffeine.  Waited an hour or so, and measured their anxiety, alertness and headache again.  duh....



But when do people drink coffee?  If you are thinking about drinking coffee (or coke) to stay awake, are you going to do it in the morning?  Not unless you worked (or partied) all night.  But the researchers didn't test 'normal behavior', they tested a scientific situation that is not relevant in real life. No wonder the results are nonsense.



With a report title of "Association of the Anxiogenic and Alerting Effects of Caffeine", the researchers somehow failed to note that caffeine keeps us awake at night - anxious? maybe, but definitely alert.



But it gets worse.  Once the researchers 'learned' that drinking caffeine doesn't make us more alert, it just makes us more 'anxious'.  They didn't ask some obvious questions:

 - do normal people mistake anxiousness for alertness?

 - does the scientific test for anxiousness actually measure a type of alertness that is more important to normal people than the 'alertness' that was tested by science?

 - do people take caffeine to be more alert?  Or to stay awake?  And which is more effective in keeping us awake: anxiousness, or alertness?

 - did we (the scientists) screw up completely, designing a test that doesn't measure reality?



The trouble with science is that it so often confuses theory and practice.  A good friend once gave me a very clear definition of the difference between theory and practice.



In theory, theory and practice are the same.

In practice, they are not the same.



The scientists who did this study tried to understand the theory of why people consume caffeine. They created a complex scientific series of tests to validate the theory, without bothering to ensure their theory matched 'practice'.



They took great care to use 'caffeine', not coffee, not cola, because those are less easily 'controlled' and results might be challenged.  They added in a 'genetic' factor (possibly to assist in funding?) because, after all, the initial study is so simple that even Sheldon Cooper couldn't screw it up.



And then they screwed it up. They made their experiments so simple, that the results are irrelevant. They tightened the noose of science so tight, that the truth escaped.  Like the novice trying to hold water tighter and finding that the tighter you hold it - the less you have.



The Truth: Frankly, no-one cares about the scientific effects of two doses of concentrated caffeine taken a few hours apart, mid-day, measured in dimensions of anxiety, alertness and headaches.  Those who drink coffee (or coke) want to know if it is improving our overall healthiness, short term, medium term, and long term, and also want to know if it is harming our healthiness, short term, medium term, and long term.  And we recognize that both might be true. Few of us drink our coffee straight or in pure form. We might drink it with sugar, milk, cream, or perhaps even with pepper or alcohol. But these scientists were not interested in healthiness, or perhaps did not think it exists as something that might be measurable. They chose to study the very short term effects of caffeine, as a drug, not as a healthicine.



The point: The most shameful is the fact that, after making many clear errors, they still managed to publish a research paper in a prestigious medical publication, one that apparently didn't bother to do any analysis of their conclusions, which are simply wrong, except perhaps for the  genetic ones, which are simply useless.



The Truth about Coffee?  We won't know the truth about coffee, truths we actually care about, until we begin to study the health effects, positive and negative, of coffee consumption over the long term.



This blog is about Health Freedom.  I believe that:



Everyone has a right to life, liberty, and the pursuit of healthiness. 



One of many reasons I believe we all have this right, and need this right, is due to the fact that nonsense, like that published in this scientific report (and reported unchallenged by the newsmedia and other scientists) is to easy to mistake for reality.  We each need to take care, and make our own decisions.  And we have that right.



to your health, tracy

personalhealthfreedom.blogspot.com

Tracy is the author of two book about healthicine: