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Tuesday, January 11, 2011

Power balance, placebo and perceptions

"It works, who cares why?" vs "The fraud of Power Balance bracelets"

Last week a big debate started up on the Power Balance bracelets, whose holographic technology is supposed to "work with your body's natural energy field", "resonating and responding to the natural energy field" to improve balance, strength, endurance and flexibility.  Too good to be true?  Apparently, yes, because in the last week, the fraudulent advertising claims made by the company have been poked and exposed by numerous sources.

The debate began in Australia, where an advertising commission ruled that Power Balance must refund any unhappy consumers after finding no evidence.  Power Balance themselves issued a statement saying there was "no credible scientific evidence" that the bands worked at all.  That was followed by a class-action lawsuit in Los Angeles, a 300,000 Euro fine in Italy for false advertising, and an NIH conclusion that the scientific evidence was lacking.  Here in South Africa, the local newspapers have picked up the story, I did an interview or two on the radio yesterday, so at the very least, the debate has now begun. 

Prior to this, the bracelet was a sensation - the best selling item at a big local sports store in South Africa, and I'm told, a million-dollar industry.  CNBC named it "Sports Product of 2010" and it was a best-seller on Amazon.com.  Considering that you can place a bulk order for 500 bands for $475, and then sell the band for the equivalent of about $70, you can tell that someone is basically printing money off the advertising claims made by the company.  Those advertising claims and people's gullibility have set more than a few people up for life.

"It works.  And I don't care why" - the placebo effect, and why it does matter

Among its target market, opinion is divided.  Many are saying "about time they were exposed", while others are standing by their purchases.  The most common defense, of course, and one that is worth discussing, is that the bracelet seems to work, so who cares why it works?  Perception is reality, after all...

Of course, when you have paid R500, the equivalent of $70 for a piece of plastic, then you're more invested in the band than you probably want to realize.  The pricing is in fact an important part of the overall marketing strategy - you don't promise such amazing benefits and then charge only $10 for them. The more people pay, the more "effective" the band will be, and the more vociferously they will defend it, regardless of whether your advertising promise is true or not!

Scientifically, opinion is less divided - for example, our friend Inigo Mujika wrote the following on his website:  "I have no other choice but to admit that my academic education is insufficient to be able to interpret what appears to be nothing but a bunch of nonsense."  Most scientific opinions I have seen dismiss the band as a placebo effect.  The placebo effect is a phenomenon where even an "ineffective" intervention (like a sugar tablet in a medicine trial, for example) will have an effect because of the subject's belief that it will work.  For more on the placebo effect, there is a fascinating and comprehensive chapter in Ben Goldacre's book, Bad Science.  Well worth reading.

A targeted, deliberate scheme using science as the hook

But what do we make of this position that it doesn't matter why the bracelet works, as long as it does?  I think that to fully answer this, you need to understand a little about the targeting strategy and the market that Power Balance has positioned itself for.  In the early phases, when the bracelet first came out, there was a very definite "scientific" promise of what the band offered, as well as "proof" that it worked.

This proof took the form a demonstration of how the bracelet could improve your strength or flexiblity and usually took the form of a test where someone would have you stand in front of them with your arms spread wide, and they would push down on one arm causing you to lose balance.  Then, they hand you the miracle hologram bracelet, repeat the test, and magically, you were now more stable and able to resist their pressure!  There were other tests - flexibility and balance, but the principle is the same.

This "applied kinesiology" test is discussed and explained more below, but basically, what you're seeing there is clever application of force using different angles and torques, combined with your body's immediate adaptation, because it prepares for the second push.  The learning effect can't be understand - pre-activation effectively braces the body and even in the absence of deliberate manipulation by the tester, this is what is primarily responsible for the improvement in the second test (which always co-incides with holding the bracelet, of course).  But of course the conditions under which the demo is done doesn't allow this to be obvious, and the consumer is sold - seeing is believing, after all, and so actually experiencing the effect - that's highly convincing, it's marketing that money can't buy...

The point here is that many people, Power Balance's "early adopters" or "lighthouse customers", were sold the bracelet on this basis - the science was tangible, supposedly credible - they experienced it.  The placebo effect was in fact created in the consumer, because the company "proved" that it the band worked!  It's not as though people liked the look of a silver hologram and figured they'd believe that it worked - they were told, and shown, that it worked.

This first group would be followed by those who figured it can't hurt to try, who believe that if it works for them, it'll work for me.  These people are simply following, and might not even know why they're buying it in many instances.  Then, if you're Power Balance, what you really need are high-profile names to wear your band, since they are your opinion leaders.  Enter celebrities and sports stars, who are particularly vulnerable to this kind of promise - sports stars in particular lean towards superstition all the time, and the promise of better balance, strength and flexibility is too good to resist, especially if it comes without any training.

In no time at all, everyone is wearing one and so then you absolutely must follow suit, because even if you don't really believe that it works, there's a small voice that says "it might, and I'm on the only person without it".  This is why it becomes so pervasive in sport - most sports people will do something without any basis, unless there is a potential downside.  A hologram bracelet brings no obvious downside, so they wear it, and don't care whether there's scientific proof or not behind it.

So too, the majority of consumers will wear it in hope, or belief, regardless of the facts.  All of which is perfectly fine - until you trace back that the whole promise behind the bracelet is that it works as a result of some 'scientific' theory that was shown to be true using those demonstrations.  Then you realize that at its origins, your perceptions and beliefs have been manipulated in a planned, controlled strategy by a company who are making upwards of a 3000% profit margin!  If that doesn't strike you as reprehensible, then nothing will.

If I was that consumer, who had parted with R500 of my money to buy a hologram that I was told worked for a reason that was clearly false, then purely from a moral standpoint, I'd be upset to learn that science proves that claim completely bogus.  I did not spend R500 to buy something I believed worked, I did not invest in my own placebo effect.  The commercialization is part of the problem, but more than this, it is the notion that a company has promised something to me, conned me into believing "science" that does not exist that makes this so important to put out into the open.

To those who have worn it and honestly believe that they're getting more value out of their training as a result, that's great.  These later adopters, each individual, may be benefiting and they're right, it doesn't really matter why.  But if you step back and view the big picture, then it matters, because at its source, the whole market was lied to.  Science will tell you that you could just as well put a pink ribbon in your hair before you train and achieve the same result, provided you spend enough money on it to believe that it works.  Of course, if I designed an impressive website and wore a white lab-coat and staked my scientific reputation on its effectiveness, then it would help even more.

But to the individuals, even the sports stars, who wear it simply because "everyone else is" and because they believe it works, that's fine, and I don't mean to be critical of them.  The criticism should be directed at:
a) the company, who have exploited belief to make huge profits, and
b) scientists, strength & conditioning coaches and health practitioners who have sacrificed their own integrity to sell the product, to wear the bracelet and endorse what is at best 'junk science'.

The research and the testing - conspicuous by its absence

The lack of research, as I've said before, is conspicuous by its absence, saying more about the company than any study could.  I cannot stress enough how relatively simple a study on Power Balance bracelets would be.  If the company was at all interested, they would have done this study years ago, and it would have been repeated by many different research groups (all independent), and published widely in peer-reviewed scientific journals.  But there is nothing of the sort - some impromptu studies have been done to show that the effect is purely placebo, but these are not in scientific journals either - all I have are news links here and here.

Now, these studies are not published either, and that's largely because no one really has the incentive to conduct and then publish research disproving a gimmick.  The onus would be on Power Balance to prove that their product works, yet years of marketing have not seen fit to do so. Why?  Because science doesn't matter, marketing does, so they're more invested in a viral campaign that gets big names into the bracelet than actually proving the effect.  However, when it comes to promotion and advertising, then the "science" suddenly becomes important.  It is not for nothing that decades and generations have passed with this concept of "natural energy fields", yet not a shred of scientific proof under controlled conditions exists.  It's a scam, and it has cost you money.

In case Power Balance is reading this, the study you need to do to show that the bracelet works is simple - all you need is one real and one fake bracelet, a group of 50 volunteers, and a "tester", who doesn't even need to be independent.  In other words, Power Balance can send along one of their own people to conduct their "tests", and as long as that person doesn't know whether the volunteer is holding the real bracelet of the fake one, the result is blinded.  The hypothesis would be an improvement in flexibility (easy to measure), strength (equally objective) and balance (not quite as simple, but possible, provided the tester is the same each time).  Then, each volunteer has to be tested under both conditions - the real and the fake bracelet, and the order of testing has to be randomized so that half do the fake bracelet first, half the real one - this would take care of a 'learning effect' and the neural adaptation that takes place with all those tests.

This kind of double-blind study would very quickly establish whether the hologram does anything, or whether simply wearing the band is the difference.  It's so easy to do that students have done it on the fly, but Power Balance still have not.

The tests that are done, incidentally, are themselves extremely dodgy, because they're so easy to "cheat", and the video below looks at how this field succeeds at doing this.  It's a little overplayed - too much sarcasm, and long-winded (jump to just before 5:00 to see the bit about how the tests actually work, where the 'con' is exposed), but it's accurate and very interesting.

My first encounter with Power Balance bracelets was in fact observing these very tests - it was at the Two Oceans Marathon expo last year, where the company had a stand and was conducting these demonstrations on passers-by.  People were amazed when suddenly, holding a bracelet with a hologram would improve their balance or strength or stability, and the company was very clearly using science as the bait to lure the consumer in.  The video above addresses, at least in part, that method of selling the bracelet.

When the hypothesis becomes advertising without proof - enter science

Lastly, there will always be criticism when science dismisses the "unknown" - there are many things that have not been proven.  Either they can't be (too difficult to prove scientifically), or it's too early.  And it would be equally bad science to dismiss any claims simply because of a lack of proof.  But science exists for a reason - it challenges statements and hypotheses, tests them and then confirms of refutes them.  Good science is skeptical by nature, but still open minded about possibilities.

However, when a hypothesis (the bracelet improves balance and flexibility, for example) became an advertising claim, without any proof at all, then science is right to criticize it.  Especially when those claims have existed for a long time, yet still no proof exists.  It's different if a company brings out a revolutionary vest to help athletes stay cool during exercise in the heat - that's a product that is new, and should be tested.  But this kind of promise has existed for years, and no one can find proof.

Therefore, the criticism that science is being closed-minded is unjustified.  If that proof existed, it would have been found by now.  It hasn't, and short of being too open-minded, it doesn't exist.

I leave you with a video, a song by Tim Minchim.  Question everything, but don't be too open-minded, sometimes science has already spoken.