Background
Those who promote enhanced water (and similar) products recognize (and
profit from) a simple truth that exasperates many scientists—the
products work. To more accurately
rephrase the statement: people hear about the benefits of enhanced water;
they listen to exotic stories about how it was discovered, tested, and produced;
they try it; they experience a perceived benefit; they
purchase it; they tell their friends how great it is, and the
cycle continues. Despite the use of theories and processes that
are not accepted by the scientific community, many people experience the
promised benefits. True, not everyone benefits from these products, but
enough do to keep hundreds of enhanced water products on the market. For those who benefit from these products,
arguments "that it is scientifically impossible for water
enhancement processes to work" are moot—their own experience validates the
processes and the health claims.
Consequently, individual testimonials are universally used to validate both claims for enhanced water products and the esoteric theories and processes allegedly used to create them. In contrast, scientific claims are validated, not by individual, uncontrolled testimonials, but by rigorous (often blinded) observations and experiments that are carefully documented, peer reviewed, published in respectable journals, and perhaps most importantly can be replicated by others.
The human mind is a powerful entity , capable of influencing the rest of the physical body and its emotional status. A person's belief and expectation about how a health treatment method (process or product) will work can dramatically influence the treatment outcome.
Research regularly demonstrates that a positive attitude and expectation about the effectiveness of treatment methods for many health problems can frequently create a measurable improvement in over 30% of study participants even though they were actually administered a completely inactive treatment—the fabled sugar pill.1-8 A small 2008 blinded study actually documented a decrease of perceived pain in a remarkable 85.4% of participants who believed in the effectiveness of an inactive substance they were told would reduce their perception of pain.9 Although this fact is recognized by traditional scientific and medical communities, it is often treated as a peripheral issue—an annoyance which complicates even the most routine study of product (or process) effectiveness. This fact, that belief and expectation can influence outcome, dictates that all experimental studies that explore the physical or mental effects of a product or process on the body must be blinded.
Rather than ignore the 30% or more of people who experience health benefits which are largely caused by their belief in a treatment method and their expectation of positive outcome, alternative medicine has embraced them and provides a rich assortment of options to treat a number of health problems—treatment options designed to increase a patient's belief in the treatment and their expectation of a positive outcome—treatment options that are often effective.
The acronym BEET is proposed to refer to a person's Beliefs and Expectations of an Effective Treatment for any product or process for which a health claim is made.
The bottom line is that BEETs influence a person's perception of an event and ultimately create their unique experience of reality. This leads to a quandary where the "reality" of a scientist who, for example, disputes the claim that alkaline water has a smaller water-cluster size and increased hydration rate is different from the "reality" of someone who feels better after drinking alkaline water. Most scientists would have low BEETs from drinking alkaline water based on their training and experience. Conversely, a proponent of alternative therapies who has experienced a benefit from drinking alkaline water would have a higher BEET based on their training and experiences.
Alternative treatments which inspire high BEETs and are thus perceived to be effective by many who use them (though they may have little scientific credibility) have a significant advantage over conventional medical treatment methods because they are non-invasive and non-pharmacological. The alternative treatment options are thus free from the risk of harmful side effects that accompany many conventional medical treatments. The one major disadvantage of these alternative treatments is that many health problems do not respond favorably, and patients may wait too long to seek effective conventional medical treatment for a serious health problem.
BEET Factors: What then are the
characteristics of a treatment that has
a high BEET? Nicholas Humphrey11 provides a starting
place to identify
BEET
Factors by
describing three "hope-generating
factors." These characteristics
operate in concert to increase a person's belief in a
treatment method and an expectation of a
positive outcome.
1) Personal experience: Someone believes she is going to recover after a treatment because it has worked for her before.
2)
Rational argument: Someone believes in a treatment because she reckons she understands something about the causal basis. “I know that if a medical treatment is to work it must be strong medicine, the kind that tastes nasty, or hurts or is very expensive
{or} ...I can’t expect to get better unless I myself take positive action and do something.
3) External Authority: Someone believes in a treatment because she trusts the word
of someone else. “Everyone I know swears by homeopathy. Presumably it will work for me as well.” “The doctor has a degree from Harvard. Obviously he’ll give me the best treatment going.”
4) In addition to the three ideas proposed
by Humphrey, a forth
BEET
Factor is "The Story".
A sizable proportion of alternative
treatments create a mythology around the
discovery, development, testing, and
production of the
treatment product or process—the origin of a
treatment method
for example, might be shrouded in the mists
of time, encountered by chance in an exotic location,
and/or discovered by a unique community of
people. Like any well written tale, an
effective story will engage the listener/reader and
establishes an emotional connection with the
product. A skillfully crafted "Story"
will strengthen the effectiveness of "hope-generating factors"
two and three.
5) A fifth
BEET
Factor is "The
Talisman". Many treatment processes
and products rely on an object to transmit
the "healing power" of the
treatment to the patient. Words,
music, and/or gestures can also be used
alone or in conjunction with a physical
object. "The Talisman" is typically
described and given meaning in "The Story".
6) The sixth
BEET
Factor is the
perceived degree
of interaction, the perceived level of
caring, and the perceived effectiveness of
communication of the treatment
provider by the person who received the
treatment. This is an extension of
"External Authority", but studies12-15 indicate
that the amount of time a treatment provider
spends with a patient and a perception by
the patient that the treatment provider
actually cares about them can positively
influence the treatment's outcome—by
extension that would include the
effectiveness of prescribed treatment
methods and products.
7) A final proposed
BEET
Factor would
be the "A Priori Element (APE)".—an adjustment factor, adding to or
reducing the final BEET for a specific
treatment method. Everyone brings
their own unique personal history to the
design of their health treatment strategy.
This history will influence every decision
about every aspect of treatment from the
type of health care sought and the treatment
provider to the treatment
methods they will agree to receive.
All experiences and education will
contribute to how the potential care providers and treatment
methods are evaluated. A skeptical
scientist might be expected have a negative
"APE" regarding an alternative treatment,
but the other BEET Factors might be strong
enough that the product is given a try. Anup Malani
suggests that patients might actively modify
their BEET at any time with his question, "...do patients invest in {their own} research so as to develop optimistic beliefs that maximize their returns from
{medical} treatment?"10
A person evaluating various treatment methods will consciously and unconsciously consider all BEET Factors and probably select those with the highest perceived BEET.
An Experimental Design To Test The BEET Theory: This study is designed to test the idea that a BEET Score can be objectively developed for any product and marketing strategy by varying the BEET Factors used in the marketing and distribution process, then testing the different combinations on groups of people, and obtaining feedback on perceived effectiveness for each combination of BEET Factors.
A hypothesis can be stated that even ordinary water can be packaged and marketed in a manner that would boost the BEET for a significant number of people who drank it so they would experience a feeling of increased hydration, more energy a greater overall feeling of wellbeing and improvement in the condition of several common, relatively minor symptoms like headache, stress, etc. A BEET Score could be created to provide an objective measure of the marketing/distribution effectiveness.
Alpha Water will be the name of the experimental water product. Sealed generic bottled water will be used with the original labels replaced by experimental labels.
"The Story" will be developed that describes how Alpha-Water was discovered by accident years ago when Tibetan monks chanting by a remote spring and small waterfall noticed that vegetation seemed to become more luxuriant after their chanting marathons. Monks who drank the water often reported relief from headaches, greater stamina, and other health benefits. Just recently a visitor heard a rumor about the spring, tracked down the monestary, and sent samples of the water and recordings of the chants to a laboratory for analysis. After several years of experimentation a method was developed that used natural processes (swirling to mimic the waterfall, contact with rocks from the spring, and exposure to light and chant recordings) to duplicate the structure of the spring water and produce water the same health benefits.
A colorful brochure will be professionally designed and printed that details the Alpha Water story. The brochure will include pictures of a beautiful, lush spring with waterfall and smiling, healthy-looking people drinking the water, list the health benefits that people who drank the water reported throughout the years, and provide several "Testimonials" that describe relief of headache symptoms, better hydration, and feelings of increased energy.
Two sets of labels will be designed and printed: The control label will have only the name, Alpha Water, (and the required list of ingredients) in black block letters. Labels for the experimental Alpha Water bottles will be colorful and professionally designed for maximum visual appeal. The experimental label would include a picture of the spring and waterfall, a sentence summarizing "The Story", and a summary of the health benefits that could be experienced from drinking the water
A data collection form will be designed that includes questions rating energy and thirst levels, and several emotional and health measures on 10-point scales before and after drinking the water. Other questions would include an overall rating of satisfaction with the product and a question about whether they had heard about Alpha Water previously. Each forms will have a unique, randomly assigned number that will link it to a specific bottle of water.
One third of the bottles will have their labels
replaced with the control Alpha Water label.
Two thirds of the bottles will have their labels replaced by the colorful
experimental Alpha Water label.
Each bottle will be randomly paired with a data collection form and the form
number will be written on the bottom of the bottle.
Control water bottles will be distributed at public events or locations where free water samples are frequently provided. No information will be provided about the water, but recipients will be requested to fill out the data collection form and send it in (or fill in an online substitute) as part of an experiment to determine how drinking water influences how people feel. With this group there would be few if any BEET Factors in evidence, and It is hypothesized that the BEET Score for water in this group would be low, and the only marker that would show significant improvement would be the thirst level.
Half of the experimental Alpha Water bottles will also be distributed at public events or locations—similar to the controls but separated temporally &/or geographically from the control water distribution. In contrast to the control group, the brochures will be handed out with the water bottles and data collection forms. The individuals distributing the water will be encouraged to discuss the exciting new water product in detail, describe benefits people have experienced from drinking it, and encourage water recipients to persuade their friends to stop by for a drink of the enhanced water. A BEET Score for water in this group is hypothesized to be relatively high since a number of the BEET Factors have been incorporated in the marketing and distribution process.
The other half of the experimental Alpha Water bottles will be distributed in an alternative health clinic. Clinicians would take time during patients' routine visits to describe Alpha Water, go over the brochure, ask if they would like to try it, and request that they report the benefits they experience. Given the additional level of Authority, this group would be expected to have a BEET Score higher than the other experimental group.
Variations of the study could include comparing effectiveness of Alpha Water that is given away free with Alpha Water sold at a discount price ($0.20) and sold at full price ($1.89).
BEET is a an interesting observation, and although this discussion is focused on alternative treatments, there is no reason to believe that the BEET, BEET Factors, and BEET Scores can not be applied equally well to conventional health care settings and treatments to enhance the care provided and the results experienced by patients.
References:
1
Placebo effects on human mu-opioid activity during pain: Wager TD et. al. Proc Natl Acad Sci U S A. 2007 Jun 26;104(26)
:11056-61.
Free article
2
Expectations and associations that heal: Pacheco-López G. et. al. Brain Behav Immun. 2006 Sep;20(5):430-46.
3
Neurobiological mechanisms of the placebo effect: Benedetti F. et. al. J Neurosci. 2005 Nov 9;25(45):10390-402.
Free article
4
The Neural Bases of Placebo Effects in Pain: Wager TD. Current Directions in
Psychological Science 2005;14(4)175-9
Free article
5 Treatment of dysthymia and
minor depression in primary care: Barrett
JE et. al. J Fam Pract. 2001 May;50(5):405-12.
6 Does 'healing' benefit patients with chronic symptoms? A quasi-randomized trial in general practice: Dixon M. J R Soc
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Free article
7
The significance of belief and expectancy within the spiritual healing encounter: Wirth DP. Soc Sci Med. 1995 Jul;41(2)
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8
Symptom relief and the placebo effect in the trial of an anti-peptic drug: MacDonald AJ. et. al. Gut. 1981 Apr;22(4):323-6.
Free article
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Commercial Features of Placebo and
Therapeutic Efficacy: Waber RL. et. al. JAMA. 2008 Mar 5;299(9):1016-7.
Free article
10 Identifying Placebo Effects
with Data from Clinical Trials: Malani A.
Journal of Political Economy 114.2 (2006):
236-256.
Free article
11
Great Expectations: The evolutionary Psychology of Faithhealing and the Placebo effect:
Humphrey, N. "The Mind Made
Flesh," Chapt19pp255-288 Oxford University Press, 2002.
Free article
12
Patient satisfaction with primary care: an observational study comparing anthroposophic and conventional care. Esch
BM et.al. Health Qual Life Outcomes. 2008 Sep 30;6:74.
Free article
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Patient satisfaction and side effects in primary care: an observational study comparing homeopathy and conventional
medicine. Marian F, et. al. BMC Complement Altern Med. 2008 Sep 18;8:52.
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The role of the physician in the emerging health care environment. DiMatteo MR. West J Med. 1998 May;168(5):328-33.
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Patient trust: is it related to patient-centered behavior of primary care physicians? Fiscella K. et. al. Med Care. 2004
Nov;42(11):1049-55.
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