A few weeks ago Reebok unveiled a walking shoe purported to tone muscles to a greater extent than your average sneaker. All you had to do was slip on a pair of EasyTone and the rest would take care of itself.

Exercise without exercise? Great!

Considering the abracadabra-like quality of the shoe, it’s no surprise that it’s been selling like hotcakes. The question of course is “ does it work”?

According to a recent New York Times article on the topic, Reebok has accumulated “15,000 hours’ worth of wear-test data from shoe users who say they notice the difference.” (The company also quotes a study as support, but it’s one they commissioned themselves and only carries a sample size of five.) The two women quoted in the article further echo this sentiment.

Reebok’s head of advanced innovation (and EasyTone mastermind), Bill McInnis, says the shoe works because it offers the kind of imbalance that you get with stability balls at the gym. Unlike other sneakers, which are made flat with comfort in mind, the EasyTone is purposely outfitted with air-filled toe-and-heal “balance pods” in order to simulate the muscle engagement required to walk through sand. With every step, air shifts from one pod to the other, causing the person’s foot to sink and forcing their leg and backside muscles into a workout.

But as the Times article proposes at the end (without explicitly using the term), the shoe’s success could instead come from the placebo effect. Thanks to Reebok’s marketing efforts, buyers pick up the shoes already convinced of their success, a mind frame that may then cause them to walk faster or harder or longer, thereby producing the expected workout – just not for the expected reason.

And there are some reasons to suspect this kind of placebo effect:  In a paper by Alia Crum and Ellen Langer. Titled “Mind-Set Matters: Exercise and the Placebo Effect.” In their research they told some maids working in hotels that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General’s recommendations for an active lifestyle. Other maids were not given this information. 4 weeks later, the informed group perceived themselves to be getting significantly more exercise than before, their weight was lower and they even showed a decrease in blood pressure, body fat, waist-to-hip ratio, and body mass index.

So, maybe exercise affects health are part placebo?

Irrationally Yours

Dan

P.S. If you’ve had the opportunity to try the shoe, leave a comment and let us know what you thought.

Here are a few suggestions I gave for eating less on thanksgiving:
1) “Move to chopsticks!” Or, barring that, smaller plates and utensils.

2) Place the food “far away,” so people have to work (i.e., walk to the kitchen) to get another serving.

3) Start with a soup course, and serve other foods that are filling but low in calories.

4) Limit the number of courses.

Variety stimulates appetite. As evidence, consider a study conducted on mice. A male mouse and a female mouse will soon tire of mating with each other. But put new partners into the cage, and it turns out they weren’t tired at all. They were just bored. So, too, with food. “Imagine you only had one dish,” he says. “How much could you eat?”
5) Make the food yourself. That way you know what’s in it.

6) “Wear a very tight shirt.”

Enjoy

This advice also appeared here

Reflecting back on our recent economic history bring to my mind a two sad surprises.

Even as a behavioral economist who generally believes in the prevalence of irrationality in our every day life, I place some stock in the main mechanism that should have maintained the efficiency of the financial markets: competition. In principle, the drive for competition among individuals, banks, and financial institutions should get the actors in the market to do the right thing for their clients as they fight to outdo their competition. After the Wall Street fiasco, I expected and hoped that in the spirit of competition some financial institutions would change their way given the new information about the risks they were talking and self-impose restrictions on themselves. I did not expect that they would do so because they were benevolent, but because they wanted to get the business of those who have lost trust in the financial institutions.

Surprise one: Sadly, the forces of competition do not seem to have any effect on the functioning of our financial institutions and Wall Street seems to be back to is pre-fiasco structure.

We are now discussing the possibility of health care reform, which arguably is even more messed up than our financial institutions (about 18 percent of GDP, bad incentives, bad intuitions, and the leading cause for bankruptcy before the current housing problem). When I look at the health care debate, it seems to be fueled by ideological beliefs about the importance of competition and freedom of choice on one hand, and the evilness of regulations and limits on the other. As someone who loves data beyond theories, it is surprising to me how little we know about the effectiveness of different versions of health care, and how sure people are in their own beliefs — which makes it an ideological and not a very useful debate (this is just a small surprise).

But what is the most surprising to me is that the tremendously expensive lessons we have experienced about the efficiency of markets and self interest do not seem to carry to the health care debate. As a society, we still seem to be enamored with the ideology of free markets, and have not seemed to update our beliefs in their efficiency despite the evidence. On the bright side, it looks like behavioral economists will have a lot of work for the foreseeable future.

A few people have been asking me if there is a good way to self diagnose the swine flu.

Luckily there is a highly accurate test (with accuracy above 99.9%).

Step 1: ask yourself: do I have the swine flu?

Step 2: scroll to the bottom of this screen

Congratulations!  You don’t have the swine flu

Here’s a very interesting piece from the New York Times’ Review of Books: “Drug Companies & Doctors: A Story of Corruption.”

The basic story is that whereas only a few decades ago physicians generally lacked any lucrative ties to pharmaceutical companies, these days such conflicts of interest permeate the field, and debase it.

Take the example of Dr. Charles B. Nemeroff, the psychiatry department chair at Emory University. He received a NIMH grant to study drugs made by GlaxoSmithKline AND at the same time he also got $500,000 in fees from GlaxoSmithKline. Talk about a conflict of interest!

That’s not the only egregious case – there are many.  As it turns out a recent survey found that about two thirds of academic medical centers hold equity interest in companies that sponsor research within the same institution… And here is another one:  Of the 170 contributors to the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), ninety-five had financial ties to drug companies.  The top dogs aside, many physicians accept hefty salaries to consult for drug companies, and most accept pharmaceutical gifts like pens and free lunches.

So the medical profession is teeming with conflicts of interest – but it doesn’t stop there. Look at politics, wall street, consulting — it is everywhere and I worry that unless we  understand just how big this problem is,  we are not going to deal with it.

Can it be that adding food makes people believe they are eating less?

A recent study by Brian Wansink and Pierre Chandon report that this can indeed be the case (this version of the study was done with John Tierney of the NYT)

Half of the people were shown pictures of a meal consisting of an Applebee’s Oriental Chicken Salad and a 20-ounce cup of regular Pepsi and they were asked to estimate the amount of calories in the entire meal. The other participants were shown the same salad and drink plus two Fortt’s crackers prominently labeled “Trans Fat Free.” The crackers added 100 calories to the meal, but given that they were “diet” how will their presence influence the estimated amount of calories in the entire meal?

The first group estimated that the meal contained 1,011 calories, which was a little high. The meal actually contained 934 calories — 714 from the salad and 220 from the drink.  But, the second group  estimated the total amount of calories to go down.  Now the average estimate for the whole meal was only 835 calories — 199 calories less than the actual calorie count, and 176 calories less than the average estimate by the other group for the same meal without crackers.

The original study was interpreted as a halo effect of items labeled as diet.  I suspect that this is correct, but I think that it is also possible that people have a hard time computing totals and that instead they compute averages – which makes the estimation when the crackers are present to be lower.

The New York Times today had a story about Jennifer Buettner, who is trying to make a placebo pill for kids, but maybe for all of us.

Is this a good idea?

We know that in many cases placebos do work, and we also know that they have very few side effects — a point for placebo pills! (more…)

The market for medicine is incredibly interesting. Almost every day we learn something new about a treatment that we thought would work but does not, or about a treatment that we didn’t think would work but does. Beyond the particular fascination, I think that the medicine market can also teach us important lessons about rationality, economics, and by analogy, also about the stock market. (more…)

The nights in the burn department were always difficult, and many of the patients would regularly ask (beg) for more painkillers to help them fall sleep. One afternoon I overheard the doctors tell the nurses not to give a certain patient any more morphine. A few hours later, when the same patient started begging for painkillers I saw the nurse go to her room with an injection and a few seconds later the patient quietly went to sleep. When the nurse stopped by my room, I asked her about it and with a smile she told me that she had given the patient IV fluid.This was the first time I experienced (secondhand) the power of placebo. I am not sure if they ever treated me with the same method, but it is certainly possible.Years later I became even more impressed with placebos when I learned that a placebo for pain has a very clear physiology. When we expect to get pain relief, our brain secretes a substance that is very much like morphine and this substance makes the pain go away. This means that even if the injection contains no painkiller we can still get pain relief courtesy of our own brain.Yesterday we published a study in The Journal of the American Medical Association about placebos. In this study we showed that when people get more expensive painkillers (placebos in our case) they expect a lot and get a lot of pain relief, but when the price of these pills is discounted, the expectations are lowered and so is their efficacy. As it turns out, with painkillers, we sometimes get what we pay for.For a story in the NYT see this link