Podcast | Should GPs prescribe placebos? - NASGP | The art of GP locuming

NASGP

Mrs Jones likes blue pills; they work better than those pink ones – even though they are the same drug. But she wouldn’t touch blue mashed potato. Wine buffs rate a wine higher if they believe it is expensive. Consumers are sure that a brand name product is superior to an identical generic, whether it be atenolol or cornflakes. The kids won’t eat burned sausages at home but round a campfire they taste wonderful. Turn on a red light, and your blood pressure and heart rate will increase. We know we are influenced by experience, by context, by sensory input, by our expectations, but most of us don’t realise how open to manipulation our judgments are. Take food. There is an art to creating expectations of food. And a science too. Oxford psychologist Charles Spence’s field is gastrophysics. All our senses are involved in our appreciation of food and drink – not surprising since without them we would not survive. So Spence is investigating how our experience is shaped by our sensory input. A £275 ‘ticket’ (plus drinks and service) buys you ‘A Journey’ that a celebrity chef has contrived in a laboratory in conjunction with Professor Spence and transferred to his restaurant. There’s no shortage of customers. Spence’s research also guides multinational food producers. A reassuring crunch as you open the packet makes even stale crisps taste good. Soft drinks and pre-prepared meals, and their packaging, are designed to appeal to the purchaser’s senses before the product reaches their palate. And who wouldn’t be grateful that insights from gastrophysics about the effect of altitude and engine rumble on taste have led airlines to serve more enjoyable food. In a world that faces food insecurity, overcoming cultural yuck factors could be literally vital. We all like crunchy food, and insects are an underexploited source of nutrition. It’s a matter of presentation. Gastrophysics has lessons for health care. After 70, our sense of smell deteriorates. Odour contributes far more to taste than our taste buds, so food needs more flavour. Increasing the contribution of the other senses can make a huge difference to how much a frail, elderly and perhaps demented person eats. Cue mealtimes and boost the appetite by wafting the aroma of a favourite meal from a plug-in. Consider the lighting. Play sounds that have positive associations with food. Mozart for some, Meatloaf for others. Make the food more appetising by replacing soft grey glop on a white plate with coloured food or contrasting coloured crockery. Add crunch, aurally if her teeth aren’t up to toast. Chat with her over her meal. And in hospitals, colour-coded trays for different diets may help staff get the right meal to the right patient, but research shows that if the tray is red, less of the food gets eaten. There’s something disturbing about how our ‘objective’ responses can be manipulated. It’s a subject of ethical debate, and our views depend on whether we know it is happening. And on whose behaviour is being manipulated. Doctors, who aren’t big consumers of fizzy drinks, generally support measures to reduce their consumption. After all, people need to be protected from themselves. The libertarian right disagrees, and orchestrates public outrage against ‘nanny state’. So governments study behavioural economics and look at nudging, priming – changing subconscious cues – and other non-coercive influences on our behaviour. It has been demonstrated that customers don’t notice when the sugar or salt content of products is reduced gradually. Health by stealth works. Increasing the contribution of the other senses can make a huge difference to how much a frail, elderly and perhaps demented person eats. Some of the strategies which could arise from gastrophysics research suggest that it might be possible to massage our senses to the degree that we don’t actually have to eat anything at all to feel well-fed.