The Finnish patients who received sham surgery (and recovered) | Nudge Newsletter


Placebos And Marketing

Read online


From December 2007 to January 2012, 146 men participated in an eye-opening study¹.

All men had persistent knee pain.

All had visited public hospitals in Finland and asked for help.

Here's where the study started.

Half underwent arthroscopic partial meniscectomy (removal of damaged meniscus tissue). That's the appropriate treatment.

The other half underwent sham surgery (anaesthesia and incisions but no tissue removed). It was a placebo surgery.

The sham group believed they'd had tissue removed, even though they hadn't.

So, what happened?

After 12 months, there was no difference between those who had real surgery and those who only thought they had surgery.

Both had the same amount of reduced pain.

Five years later, researchers followed up and found the same result.

The placebo group recovered 1) at the same rate, and 2) to the same degree.

The expectation of treatment was as effective as the treatment itself.

Is marketing a placebo?

That fake surgery is a type of marketing.

It built expectations around the service, which influenced the perceptions.

Similarly, Anton de Craen² reviewed 12 studies and found red painkillers are perceived as more potent than white ones.

The two painkillers are the same, but the colouring influences perception.

Despite this, only 14% of painkillers in pharmacies are red.

We assume customers are rational.

We think there's no way a headache can be cured by colouring.

But the sham surgery proves that's not true. Marketing alters our perception.

My point is, if Finnish blokes can psychically recover from knee pain with a sham surgery, imagine how good marketing could change how people enjoy you: food, software, guitar lessons, art, pottery, conference talks, etc.

What do you think? — Phill

P.S. Thanks to Gareth Harvey for sharing this study on LinkedIn.

¹Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Kalske, J., Nurmi, H., Kumm, J., Sillanpää, N., Kiekara, T., Turkiewicz, A., Toivonen, P., Englund, M., Taimela, S., & Järvinen, T. (2013). Arthroscopic partial meniscectomy for a degenerative meniscus tear: A 5-year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. British Journal of Sports Medicine.

²Shotton, R. (2018). The choice factory: 25 behavioural biases that influence what we buy. London: Harriman House.

As a behavioural science practitioner, I believe in the peak-end rule*

Tune into Nudge | Advertise with Nudge | Unsubscribe

Nudge Newsletter

I spend 18 hours each week turning marketing psychology into readable newsletters.

Read more from Nudge Newsletter

The Red Bull Story Read online Dietrich Mateschitz discovered an energy drink in Thailand. It was cheap and used by factory workers to stay awake. Mateschitz took it back to Austria and set up focus group taste tests. They didn't go well. Red Bull was described¹ as: "Awful", "horrible to taste", and "disgusting". And yet, this "disgusting" drink sells 12.6 billion cans a year. Here are three possible reasons why. Anchoring Price can act as a signal of quality. Rather than charging the Thai...

AI + Psychology Read online There’s a 2023¹ study I think of whenever I read about AI. The scientists ran four experiments and found that social proof massively improved AI suggestions. For example, people were: 17.6% more likely to buy a pair of sneakers when the AI explained, “It’s the most purchased item.” To me, it showed that to succeed, AI needs to understand human psychology. And if you’re working with AI, so do you. Adobe's London Summit Adobe was kind enough to invite me to their...

The Anchoring Effect Read online Let's start with an experiment. Consider the following two calculations and attempt to guess the answer. Don't use a calculator, take 10 seconds, and make your guess. 1 x 2 x 3 x 4 x 5 x 6 x 7 x 8 = ? 8 x 7 x 6 x 5 x 4 x 3 x 2 x 1 = ? What did you guess? Were your guesses different? The average guess for the first sum is 512, for the second it's 2,250 (4x higher). Many of you will have figured out that the actual answer is exactly the same. It's 40,320 for...