The Placebo Effect
by Michael J. Keyes, M.D.

A recent New England Journal of Medicine (NEJM) article praised the virtues of a drug called “obecalp,” stating it had up to a 30% chance of improving almost every medical problem it was tested on, was very cheap and the proprietary version — Cebo-Cap #1 (the blue one) — was the best at bringing on these positive changes. Those of you in the medical business will recognize this medicine as a placebo, once called “sugar pills.”

The crux of the NEJM piece was placebos are powerful medicine. Patients in medical trials are often given placebos that look just like the medication under investigation so the effects of the trial medication can be distinguished from random chance. But over the years, a number of observations, including looking at quackery and over-the-counter remedies, have shown there is a remarkable power to these so-called sugar pills that can’t be explained very well. The closest observers can come to an explanation is the brain is a powerful organ that affects the whole body.

Of course, if you have done any reading at all on mental training, you already knew this. Hard work, relaxation and visualization often account for the majority of improvement in competitive shooting. In past articles I have talked about how the brain improves and some of the science behind that improvement. I don’t pretend to know how placebos work, but I can guess. But how does placebo concern shotgun shooters?

All of us have had the experience of a sudden and positive improvement in our shooting. If you look at some of the surrounding events when this happened, often it is in response to a peripheral change. A good example is the acquisition of a new shotgun. How many times has this happened to you or a friend? More than once, I’ll wager.

Similar occurrences happen with new ammunition, a new shade of glasses, a better shooting vest, the list goes on. Yet, why should these changes cause a fundamental improvement in our performance? On the other hand, similar changes can cause your performance to go right in the toilet. I suspect both phenomena occur for approximately the same reasons.

There are a couple ways to look at the “placebo effect.” First there is a true positive effect directly related to the change made. This happens because the substance used is not inactive; it somehow affects a change in whatever system it is introduced to and that effect can be reproduced. There are several famous cases in medicine in which the placebo actually caused therapeutic change. (These “mistakes” usually were for the better, I might add.) In shooting, there are instances in which a fundamental change can have an immediate positive effect. Fitting a gun is a good example.

Part of good technique is consistency. We know if a shooter shoots each shot in a consistent manner, consistent results will occur. So, if you are capable of shooting 80% of all the targets thrown and have a consistent (but still not perfected) technique, you can predict what your score will be. The problem is, no one really shoots that way until they reach the master level. Most of the time we are unaware of our inconsistencies or ignore them. Because we don’t shoot the same way each time, we make errors (as in “margin of error”) that bring our shot inside the path of the target. Eliminating those inconsistencies is the goal of training. A good-fitting shotgun helps considerably in making sure inconsistencies are eliminated.

Think about it. If your gun is too long or too short, your head will be in a different place on the stock each time you mount unless you pay very close attention to what you are doing. By adding that one extra worry, you handicap yourself because you are not able to focus on the target. On the other hand, if you are at the same place on the stock every time you mount the gun, you don’t have to think about that anymore and are more able to focus. A good fit does that for you, but it also does a lot more.

This is where I think the placebo effect comes in. The placebo effect is real and can account for up to 30% of change from the previous state. We hope the effect is positive; sometimes it is not for some reason, so it can go either way. Most of this seems to be related to expectations. The addition of an agent of change probably triggers the effect and, if your expectations are positive, most likely the change will be, too.

One reason for this is we all use what computer people call “compression.” We tend to work with incomplete information in all our perceptions. This is especially true with vision. A number of studies have shown the eye is not a camera taking in every pixel of information out there. Instead, and at best, we get the outlines of the things we perceive. People who have sight for the first time after years of blindness have to be taught how to see because, initially, they just see random stuff that makes no sense. The brain has to process what is brought in and make sense of it. This is where compression comes in.

Those of you who know about computers know pictures sent over the internet can be extremely large if they contain every bit of information the camera recorded. There are algorithms that look at areas of a picture that are repetitive, like a blue sky, take a short picture of that, eliminate most of the blue sky while outlining it and, when the picture is reproduced, repaint it according to the small picture it took of the sky. The result is a picture that does not have all the original information but looks close enough for human use.

The brain does the same thing, it fills in the outlines our eyes bring into it. This filling-in process has several origins, including experience with similar sights and our expectations. If you look hard enough, there is a wonderful YouTube video (www.youtube.com) that starts out by telling the viewer something extraordinary is going to occur. The person in the video does a simple magic trick changing a ball into a coin. What you don’t realize until the trick is over and the announcer points it out is the person’s shirt changed color, the table cloth changed and the background also changed. Once you are told this, it is obvious. But because you are so focused on the person’s hands, you miss it completely. In order to enhance performance, we have to tell our brain what to expect and how to deal with it. The best way to do this is to practice in a consistent and orderly manner that not only gives the brain the algorithms needed to fill in the gaps but also makes those gaps a little smaller for the specific task you are trying to improve. That way, your brain has to make fewer decisions and you have to make almost none.

Changes in our environment change the expectations of our brain. When we introduce a new aspect to our shooting, it can often have an effect. If that new thing (say, gun fit) also has a positive effect, there can be an added placebo effect, too. Expectations and the state of our brain lead to that extra 30% of improved performance as a result.

The filling-in process is a major part of the way our brains work. By having a positive emotional tag on our expectations, we can often produce a positive result, and this result will affect both mind and body.

“If Placebo was a drug, it would no doubt be pure heroin -- dangerous, mysterious and totally addictive.”

Brian Molko

The neat thing about the placebo effect is you can know about it and it still works, in many cases. Patients are usually not told they are going to be taking an inert pill that will work anyway, but they are told “I don’t know if this will work, but it has in some cases and will not harm you.” Advertisers tell you the same thing but in more positive tones. We are all aware of this, but we still buy into the product because it may just work in spite of the total lack of proof.

Another thing the placebo effect probably does is induce a sense of relaxation. This is part of your expectations (which is reflected in an automatic response by the brain, unknown to you). Being positive about a change will counter the usual negative thoughts that can accompany match stress. If you “know” the slightly different shade of purple in your glasses will make you see the target better, it probably will. In addition, as you consistently use that shade of purple, you will begin to see more than just the outline of the target. Instead, you will see the target in great detail Of course, in the evolution of your training, that is the goal anyway, but if it helps to wear purple glasses, more power to you.

The basics, used consistently, are the key to shooting well. But it is, of course, never that easy. You have to teach yourself to shoot well and, in the process, change what your brain uses as the fill-in and, in addition, develop parts of your brain and body to be more consistent and closer to perfection.

The brain has a number of mechanisms that can change the body and mind to improve performance, some of which we know very little about. This includes the placebo effect. The secret, if that is the word, is even though we don’t know what it is, we do know it exists and more or less how to use it. The trick is to find the “sugar pill” that works for you and keep on using it.

When I was a young physician just starting out, I didn’t think very much about the placebo effect. To me, it was for those patients who didn’t understand science very well and only responded to superstition. Over the years, however, I have found it is a powerful force that often helps improve persons who are sick and can have a profound effect on the body and mind. Now I consider it an ally in dealing with disease. You can use the placebo effect to help your performance improve. Just take two and call me in the morning.

Dr. Keyes has written over 200 articles on mental training for Shotgun Sports and authored the book Mental Training For The Shotgun Sports here. He is a former physician for the U.S. Shooting Team, retired Colonel from the Army Reserve and a veteran of Viet Nam and Operation Desert Storm. A Tennessee state pistol champion and coach of several national championship teams, he currently practices in Fond du Lac, Wisconsin. You can e-mail him at mikeyes@charter.net.