Placebo design.

Did you know that cyclists perform athletically better when they are ‘told’ they have taken a caffeine enhancement over when they actually do take a caffeine enhancement (Beedie et al, 2006). Also, people who thought they were drinking Vodka all night performed significantly worse on tests of memory — even though they were actually only drinking plain tonic water (Garry, 2003). And amazingly, in a study of angina patients, those who had sham chest surgery (opening the chest and cutting near the arteries, but not actually doing anything that would create an effect), reported the exact same beneficial effects as those who had the real operation (Cobb et al, 1959).

Photo by Zhen Hu on Unsplash

Placebo effects make great stories because we can’t quite believe it, probably even thinking how stupid people are for falling for it. However, it is likely that you’ve been given a medical placebo at sometime in your life, and it may even have worked. What’s interesting is that we tend to think of placebos being used just in a health context, but the effect itself is much broader. Tyler Cowen has recently suggested in his blog,, that education could be explained as a type of placebo — that education doesn’t work by actually teaching you, but rather it gives you the impression you have had a good education, which gives you the confidence to go on and be successful in life. Well, if other areas of life can be influenced by the placebo effect, could there be such a thing as placebo design?

To see if design could possibly have a placebo-type effect lurking around somewhere, let’s first look a little more at medical evidence on placebos. Hundreds, if not thousands, of studies have been carried out and they reliably show that the placebo effect is stronger:

• The more expensive the pill;

• The more invasive the procedure;

• The more side-effects it has;

• For different colour pills;

• The more the “doctor” looks like a doctor (i.e. white lab coat and stethoscope).


High-priced pills or expensive medical intervention is always more effective as a placebo than cheap or free medicines. If you’re paying this much for something, it must be good — is the general feeling. When you look at the design industry, you could draw parallels between the large agencies pulling in big hourly fees who smatter clients with account managers galore and copious presentations; and the smaller agency or freelancer who can’t offer the big boardroom or lobster lunches but may have an equal amount of design talent. Undoubtedly, this ‘theatre of design’ offered by the bigger agencies makes the client feel more wanted and ‘loved’ but does it actually create an objectively better design, or just the feeling of a better design?

In psychology, the term cognitive dissonance is used when referring to an internal psychological contradiction people have when faced with two opposing attitudes or beliefs. “Smoking kills you, and I smoke two packs a day” is a classic example of cognitive dissonance. The result is that often the person holding these two opposing beliefs will try and reduce the distance between them by saying things like “They relax me, and they stop me putting on weight.” What’s interesting is people who experience cognitive dissonance will often reinterpret their feelings to reduce their internal angst. A classic study asked people to engage in a meaningless and painfully dull task, one group were paid a modest fee but another group did it for free. When asked afterwards about the task they’d just undertaken the group who got paid were all too happy to exclaim their boredom, but the group who did it for free actually felt the task was OK, and even that they would be happy to do it again. This study, and many others like it, show that when you have invested a cost into something (in the experiment above, the cost was their time) they experience a cognitive dissonance, something like “I spent two hours performing a dull task for no reward”. To lessen the dissonance, they apply a post-hoc rationalisation by convincing themselves that the task couldn’t have been that bad, otherwise why did they do it? The other group could easily explain that the only reason they took part was for the money.

Dilbert cartoon strip

So when the cost is high, you could start to experience this dissonance in design too. “We’re paying £1500 a day for this, the design must be good.” However, designers have the ability to market themselves in whatever manner they like, after all this is where their skills lie. Creating a website that is just as beautiful as the big agencies with just as many scrolling parallax effects is easy to do and wording the site so that it sounds like you’re bigger than you are is simple (c’mon we’ve all used the words “we” when it should be ”I”). I’ve known lots of freelancers who promote themselves as bigger than they are, but with a lower price tag attached, thinking that the offer of the same level of design for a lower price is a no-brainer for clients. When you think in terms of cognitive dissonance though you see the mistake.

“Here are several design companies who look like they offer similar design services, but one is much cheaper than the others.”

In this situation, it doesn’t always lead to the response of “well, I’ll go to the cheaper company” as people are suspicious of what’s missing. One reason low-cost airlines, such as easyJet and Ryan Air, are successful is that they communicate to people what is being compromised in order to account for the low prices. People understand that they are relinquishing the frills of on-board meals, free nuts and leg room for a cheaper deal. If Ryan Air said they offered all the luxury of British Airways but at a far cheaper rate, you’d start to wonder where the costs are being cut and worry that they hire pilots who only scraped through their flight exams. Overtly letting people know where the savings are being made (or at least, creating the perception of letting people know) is enough to reduce the dissonance. If freelance designers communicated the reason for being more competitive on price is that they work from home and don’t hire project mangers, then potential clients are less likely to assume that it’s because the design is sub-standard.


In a medical context, a placebo that incurs more invasion or effort shows more beneficial effects. Sham surgery generates better effects than a hard-to-swallow capsule, and a hard-to-swallow capsule shows more positive benefits than an easy-to-swallow pill. Also, if the patient is engaged in the process somehow, for example rubbing in the medicine themselves, then the placebo effect is larger.

In the world of design you could suggest that the process of co-design might be explained in terms of a placebo. The more you engage the client or end-users in the process with focus groups, brainstorming and participatory design processes the more likely that same group will judge the outcome favourably. Of course, this won’t effect outside groups but often the actual effect of a design on the intended audiences after launch isn’t measured.

“A term, short for collaborative design, that means a community centred methodology that designers use to develop a partnership with a product or service’s end users, in order to make their solution more effective.” — Taken from the Design Council, Design Glossary

I wrote more about the psychology of co-design in a previous ¡Design Thinkers! article here.

The designer look

Stereotypes get a bad press. The word itself is almost always used with negative connotation, normally side-by-side with ‘discrimination’. However, stereotypes do have a strong effect in placebos, medical research showing that a placebo is more effective when it’s administered from a stereotypical-looking doctor. So is there such a thing as a stereotypical-looking designer and will this change the efficacy of a design in the eyes of the client?

In the past, when explaining to friends or relatives why I don’t wear a suit to meetings, I explain that my thinking is the person hiring you doesn’t want somebody to walk in who looks like them. They are hiring you for a set of skills they don’t possess and they respond well to this being visually reinforced by somebody who is dressed more creatively than themselves. Think back to school and conjure up a picture in your mind of your art teacher and I would suspect they differed in their style to the science teachers. We like our artists to look, and act, like Andy Warhol or Tracy Emin, not like Donald Trump or Marissa Mayer.

Looking back at the old-school of design greats you can certainly see a similarity of style.

Wally Olins, Michael Wolff and Dieter Rams
Wally Olins, Michael Wolff and Dieter Rams

And for the young designer brigade, well walk around the Shoreditch area of London or the cool parts of New York and you’ll probably be able to compile a quick list of the fashion traits that signal “I’m a designer” without too much trouble. Rather than just pretentiousness or pack mentality, if the placebo effect does kick-in, this convergence of style may serve a practical purpose.

Colour placebo

What wine do you prefer, red or white? Most of us will have a preference, even if we’re not up to sommelier standards, but can you really tell the difference between them? “Of course I can” you may scoff, but a recent study has cast doubt on this very fact.

Glass of red and white wine

In 2001, Frédéric Brochet at the University of Bordeaux conducted a fiendish experiment. He gathered fifty-four wine experts to give their opinion on two glasses of wine, one red and one white. Through the tasting the red wine was described with language such as ‘deep, woody and rich’ where the white elicited exclamations of ‘delicate, fresh and crisp’. The only problem was that both were identical white wines, one having been tinted with food colouring.

Back to the medical world and it has been repeatedly shown that the colour of the placebo pill has a large impact in different situations. For general pain, white pills are better (possibly through their association with aspirin); red or orange pills promote stimulation; and blue and green pills make for more effective tranquillisers (de Craen et al, 1996).

So the perception of a colour can have a huge impact on our actual experience, so do the colours you select for designs have the same effect and, by doing so, are you actually facilitating a placebo effect? After all, there’s a reason most environmental company brands are green or blue and energy drinks are heavy on the reds. In a 2006 study, researchers found that up to 90% of snap judgments made about products can be based on colour alone (Singh, 2006).

Not for everyone

Whilst the effects of a placebo are strong, the striking feature is that they are highly variable across the population. Trivers (2011) suggests that toughly one-third of people show a very strong effect, one-third show moderate effects and one-third will be completely immune to the placebos. Perhaps not so weirdly is the effectiveness of a placebo is roughly correlated with a person’s ease of being hypnotised (Benedetti, 2009), leading to the idea that placebos are linked to a person’s suggestibility. However, suggestibility isn’t the same as gullibility, as it can be argued that people who are susceptible to the placebo effect achieve the same result and with less side-effects.

Where they do suffer is when branded remedies are seen as more effective than generic medicines, and so brands like Nurofen can charge up to nine times more than generic Ibuprofen (for more on this see Justin Small’s article dated Jan 12, 2012).

“What the Nurofen example seems to confirm is that we consumers want and expect branding. We do not want generic products and we will pay a lot more for branded products that pretend to understand our needs and wants and solve them quicker, better and with more care.” — Justin Small

For those that are susceptible, the placebo effect isn’t illusionary. The mere belief that a pain reliever has been received is sufficient to induce the production of endorphins that, in turn, reduce the sensation of pain.

“What the brain expects to happen in the near future affects its physiological state. It anticipates, and you can gain the benefit of that anticipation. The tendency of Alzheimer’s patients not to experience placebo effects may be related to their inability to anticipate the future.” — Paul Trivers, Deceit & Self-Deception

The medical treatment that people receive can be likened to conditioning trials. The doctor’s white coat, the voice of the caring person, the smell of a hospital or practice, the swallowing of the pill have all acquired specific meaning through previous experience, leading to an expectation of pain relief. So could the designer’s style, the jargon of the confident project manager, the studio’s art-infused environment and the swallowing of the bill all lead a client towards the expectation of a successful design?

Of course, design is not just about pleasing the client (or at least it should be). Design needs to prove itself in the laboratory of the marketplace and only then will its efficacy be established. In the long-run, if placebo design does exist, it will be unmasked quickly and cruelly by the consumer and the choices they make — but how many examples can you think of where a design/brand has passed with flying colours in focus groups and marketing studies only to disappear without a trace upon launch?

Bottle of Dasani water