The Corpus Callosum

Placebos for Performance Enhancement

Athletic regulatory bodies have a new headache.
 This time, the pain is being caused by placebos (an
unexpected side effect!)  

As reported
in New Scientist
, athletes have found
that they can exert themselves to a greater extent, while under the
influence of opioid pain killers.  That is not permitted in
competition, of course, but there is a wrinkle.  If they train
while under the influence, then get a placebo prior to competition,
their brains react to the placebo as if it were the real thing.
 Thus, they are less limited by pain during the competition.

The regulatory agencies are aware of this, but do not know what to do.
 They can’t ban placebos, and there is no urine test to detect
them, anyway…

If there were such a test, you can bet an entire cottage
industry would spring up to find a way to fool the test.  And
people would pay for it.

The thing is, what the athletes are doing is not really making use of
the placebo effect.  Rather, they are undergoing a conditioned
response.  A minor point, perhaps, but a purist would not call
this a placebo effect.

Regardless of the terminology, it is a bit of a problem.  In
the USA, it is unethical for a physician to prescribe an opioid in the
absence of an appropriate medical condition.  And of course it
is illegal for someone to use an opioid without a prescription.
 Clearly, that makes it wrong.  

It also is reckless.  Pain does serve a function, after all.
 As we’ve seen from some tragedies involving marathon runners
recently, excessive exertion can be fatal.

In my opinion, it is foolish and senseless to do this.  But
then, there are no Olympic medals for common sense.

There is no easy way to detect a short-acting opioid more than a few
days after administration.  So unless you are going to screen
the athletes every few days, there is no good way to tell if someone is
doing it.

Hair samples can be used to detect heroin use up to 90 days out, but
there are a lot of opioids, and it would get to be very expensive to do
screening that way.  To complicate matters, there are
legitimate uses for opioids, so even a positive test would not tell you
for sure that there had been an infraction.  I have to think
that if someone can get such drugs in the first place, then getting a
fake doctor’s note to explain it would be no problem.

I guess the question is, does it make sense to impose a ban that cannot
be enforced?


  1. #1 Anon
    November 8, 2007

    The thing is, what the athletes are doing is not really making use of the placebo effect. Rather, they are undergoing a conditioned response. A minor point, perhaps, but a purist would not call this a placebo effect.

    Depends on your purist. There is ongoing debate in the literature as to whether a placebo effect is based on classical conditioning, on expectancy, on some combination of the two, or what. At least some of the literature which suggests that CC is not responsible for placebo effects is relying on an inadequate understanding of CC (e.g., assuming a stimulus-substitution model that is decades out of date). At least some of the literature that supports an expectancy model is defining “expectancy” circularly.

    Yes, it is a minor point, but I don’t think the article can be said to be wrong on it.

  2. #2 qetzal
    November 8, 2007

    In this study, subjects were never told they were getting placebo injections. In every case, they were told the injections were morphine.

    In a competitive situation, though, an athlete would have to know we was receiving a placebo injection on the day of the competition. Otherwise, he’d think he was cheating and risked being tested and disqualified.

    Would the placebo injection still have an effect under those conditions? Unfortunately, the study design doesn’t address that situation.

    Also, as a commentor pointed out on the New Scientist page, subjects who received morphine during the conditioning trials were able to excercise longer than subjects who did not. Thus, their ability to excercise longer during the test run could be due to increased physical conditioning, rather than placebo effect. Again, the study design doesn’t really address this possibility.

    In summary, this seems like an intriguing study, but it doesn’t necessarily show what the authors’ claim. At least, not IMO.

  3. #3 Janne
    November 8, 2007

    qetzal, it would very likely work. The learning/association is low-level, and the athlete being aware that it’s not the real thing will not stop his body from reacting, any more than you can avoid very real fear reactions from seeing a scary movie.

    And in general I think this will be very hard to even find a way to stop. First of all, opioid prescription is correct if the patient is in real pain – which he easily can accomplish by training very hard. Or just wait until there’s a real honest-to-god unintended, painful injury (top athletes have them all the time) and take the opportunity. Second, I’m willing to bet there’s ways of inducing this with conditioning, using suggestion and autoshaping, without ever having to administer anything stronger than aspirin.

    And really, where do you draw the line? This is as much like “previsualizing” and other mental tricks of the trade as it is doping. Do you forbid athletes from imagining getting a powerful shot with a big needle when they’re out there and hurting?

  4. #4 Greg P
    November 8, 2007

    I just was listening to the audio version of The Economist about this very thing.
    For the purposes of the study, it did work, and no, the athletes (apparently) couldn’t tell they’d gotten placebo.

    Before one gets carried away with this, though, as they said in The Economist, this is all dependent on the athletes thinking that they were getting the real thing, so if it became common practice, and drug screens were subsequently found to show no drugs, there goes the subsequent placebo effect.

    One thing countering the idea of some kind of true performance enhancement from training with morphine is that those given naloxone instead of placebo did not get the placebo effect, thus suggesting there may be some endogenous morphine-like effect responsible.

    At the least, one wonders if this study can be replicated by others.

  5. #5 Janne
    November 9, 2007

    Greg, it is, AFAIK, a physiological conditioning – you’re not fooling them, you’re fooling their bodies. And so I’d exepct the effect to be substantial even if they know the pill or injection is fake; their body doesn’t know, and reacts as intended.

  6. #6 Greg P
    November 9, 2007

    This is coming from someone who has something against drug testing of athletes, so it has a bit of an edge to it.
    There are many ways to fudge a study…

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