In the name of full disclosure, I work in marketing. So I’m technically obliged to say that marketing is great.

And it is, of course. Sort of in the sense that God or a charismatic dictator is great… infinitely powerful, manically crazy, and for the most part, outright terrifying. It changes your cognition and neural responses in ways to which even the most seasoned behavioral researcher is not immune.

It’s safe to say that there’s enough going on in the world of advertising and marketing today to make any reasonable human squirm. So much so that some of the more reasonable amongst us have, in fact, been squirming their way into class action lawsuits for improper tracking online. Dig below the surface a bit, and you’ll find the seedy underbelly of a digital society where your behavioral data is collected and sold freely to the highest bidders. Like an old piece of gum spat out by a celebrity that sells for thousands of dollars on eBay, your discarded bits of data debris are helping pay some enterprising seller’s beer money, and then some. The end result is nothing short of unsettling. Those ads in your browser or in your junk mail? They often know your preferences better than your loved ones do.

But marketing is a funny thing; for all of its dubious tactics, it works. Fantastically well. It can exuberantly overwrite your existing memories and surreptitiously plant false ones. If plain sugar water can make the brain’s pleasure circuitry flicker like a promotional LED keychain, then sugar water with just the right logo on it can make it light up like the goddamn Vegas strip (hookers and cocaine controlled for as confounding variables). Good marketing propagates a consumerist placebo effect, disproportionately increasing our pleasure and subjective experience of the goods we interact with. So, what if we applied more of this black magic to the things that matter most? Like our health? If marketing and labeling can trick the pleasure centers of our brain into thinking dirty swill wine is a fine vintage worthy of a candle-lit dinner, then why can’t we leverage it to “lifehack” our tangible ills? To make us feel better when sick? To make us both subjectively and physiologically more well?

Well, we can. The only problem is that — like a classic tragedy of the commons — it would eventually erode the very foundation of medicine that we stand upon. In the process of increasing short-term placebo outcomes for the individual via false advertising and false medical advice, we would inevitably crash the faith in treatment that allows the effect to exist.

Someone call Hippocrates, because his oath has encountered a moral hazard.

The thing is, the placebo effect is real, and it works. Like, actually works. In some ways, similar to how a real pharmaceutical substance would work. It engages in heavy underground construction to modulate the loop of neurological, biological, and hormonal interactions that we experience up above as the subjective psychological experience of feeling better. And while not all people are equally susceptible to the effect, it’s overwhelmingly confirmed to exist. But there’s an inherent Catch-22: using more placebos in clinical practice could certainly help the average individual, giving them the instant benefit of feeling better without overuse of medication. But by increasing the prevalence of placebo use in general medicine, we would eventually alter the average expectations of the public at large. In a bad way.

Expectancy, after all, is one of the core perpetrators of the placebo effect… as well as the foundation for enhanced positive benefits in real drugs. If you really trust and expect something to work, it often does, regardless of its true pharmacological impact. But there’s a flip side: if you go to a doctor knowing there’s a 50/50 chance that the pill you’re prescribed is a dirty sham, you’re that much less likely to be expectant of a positive effect. Expectancy goes down, placebo effects are deadened, and over time, you’re left with a healthcare dystopia where there’s little faith or trust in the efficacy of medical intervention. Sometimes a sugar pill is just a sugar pill, especially if you foment a cultural expectation that doctors may be lying, or that the treatment is likely a fake. In fact, patient distrust and skepticism are likely to summon the placebo effect’s nefarious fraternal twin: the nocebo.

Medical practice constantly has to adjust to new technology and advances, balancing like a high-wire walker teetering between the desire to assure the best possible outcomes for patients and the critical need to maintain their trust and cooperation. Since the majority of people seeking medical counsel are in no position to fully understand the science behind their conditions and treatments, the physician becomes a default source of ultimate truth. So it’s a doctor’s duty to not lie to patients, right? Not necessarily. Medical ethics are fraught with the delicate struggle between keeping spirits up and being realistically direct. And it’s a two-way psychological street to treatment: both the patient’s expectations and the physician’s emotional sensitivity are linked to patient satisfaction and actual medical outcomes.

Trust is essential for patients’ prognoses, and is fundamental to the placebo effect. So it’s a shame that the placebo effect itself relies on lies. By design, such a triangular relationship cannot go on forever.

That’s all fine and well, but it’s just a thought experiment, no? So far, medical practice seems to hum along at a steady clip with the placebo effect as an incidental and positive byproduct of the system. How can this be? It’s because most placebos in clinical practice are NOT fraudulent little capsules, but rather much more complex and contextual in nature. “Pure” placebos, in the form of a biologically inert dose, are relatively rare: only about 12% of general practitioners admit to ever administering one in their entire career. Generic clinical placebo effects, on the other hand, are much more common and tend to have more than one source. Most are unintentional. Verbal communication from the doctor, patient mood and expectations, past experiences, conditioning, and even depictions of medicine in the media can all converge to create placebo effects on the individual level. My placebo effect may have very different causative influences than yours. And just because you ask a patient to pee into a cup doesn’t mean that there’s an ethical pissing match at hand. Most doctors are truly dedicated to long-term patient outcomes, dodging any blatant deception. Everyone benefits, getting to have their placebo and eat it too.

However, there IS already an excellent example of how a very specific and defined placebo use is currently undermining global health: they’re called antibiotics. Curious things begin to happen when the patients themselves start begging to be actively misled.

Unbeknownst to the majority of patients themselves, unwitting demands for placebo effects are helping accelerate the overuse of antibiotics, which in turn spawns more resistant strains of bacteria such as MRSA and the hilariously-nicknamed “ThunderClap.” Needless to say, antibiotics themselves aren’t inherently placebos. The problem is partially ours: we’ve justifiably extolled antibiotics as saviors of humanity. They just so happen to take on the role of placebos when they’re prescribed to treat illnesses that aren’t bacterial. If antibiotics’ biological mechanisms were simply limited to wishful thinking, the bubonic plague wouldn’t be just an occasional sensationalist story, and Hawaii’s Kalaupapa National Historical Park would probably still be called “Kalaupapa National Leper Colony.” Antibiotics positively changed the course of history: you’d be pretty hard-pressed to find a dissenting opinion. However, an antibiotic used against a virus is essentially a sugar pill.

Nevertheless, people go to the doctor to get better, and they don’t particularly care whether the malady making them miserable is bacterial or viral. They feel cheated by medical science’s glorious advances when they walk away with nothing but the suggestion of “plenty of rest and fluids.” Ergo, they press on like the script of a bad porno, asking, “Oh but doctor, isn’t there ANYTHING you can do for me?” And boom: antibiotics. They’re cheap, they’re pervasive, and they’re marginally more ethical than sexing up a patient right then and there on the exam table. Add in the fact that the most common ones generally have tame side effects to the individual, and you have a recipe for overuse. A medicine handed out by someone in a white coat inspires more credibility than Nanna’s chicken soup. Besides, at the end of the day, medical practitioners are people too, subject to the same ego depletion that drives us to eat terribly when stressed during finals. After a long day and compounded late appointments, they are subject to the same psychological drive to take the route of least resistance. Unfortunately, in their case, the course of least resistance is often simultaneously the course of most resistance… at least for the bacteria involved.

But wait, there’s more. Incentives can wreak havoc on behavior in unexpected ways, and doctors have no special immunity to the ills of human nature. One of the most powerful of these incentives is the looming threat of a malpractice suit; despite most physicians’ having professional insurance, a malpractice case is a messy nuisance at best. People are, by nature, loss-averse: a potential loss always looms larger than an equally-sized potential gain, contorting behavior accordingly. Even for doctors in low-risk specialties, the chance of facing a suit over the course of a professional lifetime is an overwhelming 75%. For overachieving colleagues in high-risk fields, it’s 99%. Add in the fact that that live cultures can take several days to confirm a bacterial infection, and there is always the portentous uncertainty that even the best medical professionals can make an incorrect diagnosis.

The psychological soothing of prescribing an antibiotic can provide gap-coverage insurance for covering one’s own ass in the context of malpractice. For however certain the doctor is that someone has a standard-issue flu, those little pills can help account for the (statistically improbable) chance that it wasn’t. The patient gets to walk away from the clinic with a placebo-driven spring in her step, while the doctor sleeps more soundly that night. At the individual level, it’s a net gain. But in the case of bacterial resistance, everyone eventually sinks into the red: the toll is paid gradually and cumulatively, borne collectively by the vast expanse of humanity at large.

However complex the causes of antibiotic overuse may be, one thing is clear: it needs to stop. The rising chorus of patient antibiotic requests for inappropriate conditions has become so cacophonous that the CDC has enacted an entire ad campaign to preempt the abusive relationship that contributes to bacterial resistance. By stepping in with consumer advertising tactics, authoritative bodies are hoping to intervene as a neutral third-party to circumnavigate the turbulent waters and psychological malaise that would result from unnecessarily blunt doctor-patient discussions. It’s not entirely a demographic issue, either. Lest you assume that the misunderstanding of antibiotic mechanisms is confined to select socioenomic strata, it’s clearly not. The emotional disquiet that rises in physical duress has tendency to bring equal but opposite quiescence to logical reasoning. Pain represents the ultimate cross-cutting cleavage, uniting all in its path. But market segmentation marches on, deeply rooted in business and non-profit psyche, with the keenly-accumulated knowledge that individuals respond most acutely when they feel connected to those of the same in-group affiliation.

The medical marketing materials have responded accordingly. There’s a CDC ad For African Americans. For savvy, Spanish-fluent caretakers. For parents of ugly babies. For aficionados of turtleneck couture. And, of course, for the ubiquitous white Millennial drama queens who “just can’t EVEN” handle this case of the sniffles. Collective marketing has had the power to instill a faith so unassailable in the omnipotence of antibiotics that patients now demand them when they are useless. So now, the CDC will damned well do its best to reverse this belief via yet more marketing. Perhaps it’s about time. What the marketer have giveth, the marketer hath taketh away.

So why not then, as a logical next step, use aggressive advertising to purposely mislead consumers, thereby extracting more placebo effects for the mutual benefit of all? If we get people to believe that a certain “medication” can alleviate their cold and flu much better than an antibiotic, it doesn’t really matter if it’s inert, since they were simply seeking a placebo effect to begin with. They will flock to the new substance, getting the same perceived benefits as before without the cumulative damage of overuse, since there’s nothing biologically-based to be overused. Unfortunately, to do so via advertising would erode the fragile, marketing-based foundation that allows pharmaceutical placebos to exist in the first place. In fact, it’s the very restrictions on medical marketing that subsequently help it earn credibility in the public eye, elevating the buyer-seller relationship to more of a doctor-patient one.

The FDA has much to do with all of this. To put it succinctly, they’re a buzzkill. And they should be, because it’s their goddamn job. For every tantalizing buzz that they make available to the collective reach of the public, they are tasked with defending against its abuse and preventing pharmaceutical companies from claiming to offer more bang for their buck than they actually provide. Pharma research and development is notoriously expensive, making it all the more tempting to use dubious claims in order to gain the upper hand over competing companies with similar products. So the FDA steps in as a referee, ensuring that there are standards sufficient to ensure that consumers have relative confidence in the accuracy and scientific rigor of the information being relayed to them.

FDA advertising regulations are undoubtedly a circus, at least for those with the wherewithal and tolerance for the sort of rambling legalese that I’ve extensively discussed before. For the brave few seeking reference (or masochistic punishment), you can find them all here. But for everyone else, they’re a boorish bore. There’s simply too much to detail involved to nest that discussion within the context of another topic. Writing about all of them here would be akin to paying for an extended vacation to Disney World, and then spending the entirety of you week-long stay cloistered within a Library of Congress replica in the US corner of Epcot. Missing the point. So I’ll save you the trouble, and perhaps stash their wild and wacky world for a later time. The regulations are sprawling, specific, and place immense constraints on the normally fluid word of advertising creativity… by enumerating guidelines on everything from font size to acceptable age of cited research. The result is an acceptably consistent (albeit boring) advertising sphere that garners relative trust from the public.

So here we are, stuck with listening to comically-exhaustive ramblings of potential side effects for allergy drugs, and seeing couples sitting in separate bathtubs to euphemistically depict middle-age boning. No one said being honest is mutually exclusive to being weird.

The point is, current regulations do not permit blatantly deceptive claims within pharmaceutical ads. And ironically, it’s the faith and trust that heavy regulation instills in the public that actually allows the placebo effect to run rampant in the way that it does. Patients are accustomed to knowing that they won’t be outright lied to — even by consumer pharmaceutical advertising — and that feeling of trust amplifies their experience of the placebo effect. But then again, they also don’t fully understand most of the information being relayed to them.

As a result, modern medicine often attains a quasi-religious aura, and the extensive use of abstruse terminology and listing of complicated side effects serve to further underscore the perception that the substances being sold are immensely, incomprehensibly powerful. The masses don’t fully grasp the exact chemical and biological interactions that help them feel better, and thus the experienced effects become evangelical in nature. Commitment to traditional religion may be declining, but we’ve replaced it with another type of blind trust. Loosely imply that your non-FDA regulated supplement has been “scientifically tested” and people swoon with belief, whether deserved or not. Vague allusions to science are used as a heuristic for truth. Entire industries thrive upon it, using placebo effects as a primary source of income. Thus, placebo effects continue to frolic everywhere, happily intermingling and piggybacking off of the tangible and biologically-vetted mechanisms that real medicine has to offer.

Trying to “lifehack” the placebo effect on a mass scale might extinguish the mechanisms that allow it to flourish. It’s a perilously delicate balance. For the time being, it’s probably a good thing that both regulated standards and generally-accepted ethics do not permit the rampant application of our Latin-rooted friend to “please” us too much.

Ah, yes, but you still feel sick? At least you can always grab some Airborne® and get better the proven way… or maybe not.