The weird power of the placebo effect, explained

Over the last several years, doctors noticed a mystifying trend: Fewer and fewer new pain drugs were getting through double-blind placebo control trials, the gold standard for testing a drug’s effectiveness.

https://www.vox.com/science-and-health/2017/7/7/15792188/placebo-effect-explained

Over the last several years, doctors noticed a mystifying trend: Fewer and fewer new pain drugs were getting through double-blind placebo control trials, the gold standard for testing a drug’s effectiveness.

In these trials, neither doctors nor patients know who is on the active drug and who is taking an inert pill. At the end of the trial, the two groups are compared. If those who actually took the drug report significantly greater improvement than those on placebo, then it’s worth prescribing.

When researchers started looking closely at pain-drug clinical trials, they found that an average of 27 percent of patients in 1996 reported pain reduction from a new drug compared to placebo. In 2013, it was 9 percent.

What this showed was not that the drugs were getting worse, but that “the placebo response is growing bigger over time,” but only in the US, explains Jeffrey Mogil, the McGill University pain researcher who co-discovered the trend. And it’s not just growing stronger in pain medicine. Placebos are growing in strength in antidepressants and anti-psychotic studies as well.

“The placebo effect is the most interesting phenomenon in all of science,” Mogil says. “It’s at the precise interface of biology and psychology,” and is subject to everything from the drug ads we see to our interactions with health care providers to the length of a clinical trial.

Scientists have been studying this incredibly complex interface in great detail over the past 15 years, and they’re finding that sugar pills are stranger and more useful than we’ve previously imagined. The new science of placebo is bringing new understanding to why alternative treatments — like acupuncture and reiki — help some people. And it could also potentially allow us to one day prescribe smaller doses of pain drugs to help address the opioid crisis currently ravaging America.

Most instructively, the science finds that since we can’t separate a medicine from the placebo effect, shouldn’t we use it to our advantage?

There is no one placebo response. It’s a family of overlapping psychological phenomena.

Belief is the oldest medicine known to man.

For millennia, doctors, caregivers, and healers had known that sham treatments made for happy customers. Thomas Jefferson himself marveled at the genius behind the placebo. “One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, powders of hickory ashes than of all other medicines put together,” Jefferson wrote in 1807. “It was certainly a pious fraud.”

These days, placebo — Latin for “I shall please” — is much more than a pious fraud.

As Ted Kaptchuk at Harvard, who is regarded as one of the world’s leading experts on placebo, put it to me in a recent interview, the study of the placebo effect is about “finding out what is it that’s usually not paid attention to in medicine — the intangible that we often forget when we rely on good drugs and procedures. The placebo effect is a surrogate marker for everything that surrounds a pill. And that includes rituals, symbols, doctor-patient encounters.”

And it’s not just one thing. “I see the placebo effect as a kind of loose family of different phenomena that are just yoked together by this term,” says Franklin Miller, a retired NIH bioethicist who has edited a volume on the subject. “Sooner or later we’ll get rid of the term,” he says, and talk more specifically about each of its components.

The family of placebo effects ranges from the common sense to some head scratchers. Let’s start off with the simplest.

1) Regression to the mean

When people first go to a doctor or start on a clinical trial, their symptoms might be particularly bad (why else would they have sought treatment?). But in the natural course of an illness, symptoms may get better all on their own. In depression clinical studies, for instance, researchers find around one-third of patients get better without drugs or placebo. In other words, time itself is a kind of placebo that heals.

Sugar pills and active drugs can both change the way patients report symptoms.

2) Confirmation bias

A patient may hope to get better when they’re in treatment, so they will change their focus. They’ll pay closer attention to signs that they’re getting better and ignore signs that they’re getting worse. (Relatedly, there’s the Hawthorne effect: We change our behavior when we know we’re being watched.)

But as we’ve seen, the placebo effect is more than just bias. There’s also:

3) Expectations and learning

The placebo response is something we learn via cause and effect. When we take an active drug, we often feel better. That’s a memory we revisit and recreate when on placebo.

Luana Colloca, a physician and researcher at University of Maryland, has conducted a number of studies on this phenomenon. And they typically go like this: She’ll often hook up a study participant to an electroshock machine. For each strong, painful shock, she’ll flash a red light on a screen the participant is looking at. For mild shocks, she’ll flash a green light. By the end of the experiment, when the participants see the green light, they feel less pain, even when the shocks are set to the highest setting.

The lesson: We get cues about how we should respond to pain — and medicine — from our environments.

Take morphine, a powerful drug that acts directly on neurochemical receptors in the brain. You can become addicted to it. But its analgesic powers grow when we know we’re taking it, and know a caring professional is giving it to us.

Studies show that post-operative patients whose painkillers are distributed by a hidden robot pump at an undisclosed time need twice as much drug to get the same pain-relieving effect as when the drug is injected by a nurse they could see. So awareness that you’re being given something that’s supposed to relieve pain seems to impact perception of it working.

Pain relief is stronger and more immediate when morphine is injected out in the open.

 The Lancet Neurology

The research also suggests that fake surgeries — where doctors make some incisions but don’t actually change anything — are an even stronger placebo than pills. A 2014 systematic reviewof surgery placebos found that the fake surgery led to improvements 75 percent of the time. In the case of surgeries to relieve pain, one meta-review found essentially no difference in outcomes between the real surgeries and the fake ones.

There is such thing as the nocebo effect: where negative expectations make people feel worse. Some researchers think this is what’s fueling the gluten-free diet fad. People have developed a negative expectation that eating gluten will make them feel bad. And so it does, even though they may not have any biological gluten sensitivity.

4) Pharmacological conditioning

This is where things get a little weird.

Colloca has conducted many studies where for several days, a patient will be on a drug to combat pain or deal with the symptoms of Parkinson’s disease. Then one day, she’ll surreptitiously switch the patient over to a placebo. And lo and behold, they still feel healing effects.

On that fifth day, it seems the placebo triggers a similar response in the brain as the real drug. “You can see brain locations associated with chronic pain and chronic psychiatric disease” acting like there are drugs in the system, she says. For instance, Colloca has found that individual neurons in the brains of patients with Parkinson’s disease will still respond to placebos as though they are actual anti-Parkinson’s drugs after such conditioning has taken place.

The brain can learn to associate taking a pill with relief, and produce the same brain chemicals when drug is replaced with placebo.

What’s going on here? Learning. Just like Pavlov’s dogs learned to associate the sound of a bell with food and would start to salivate in anticipation, our brains learn to associate taking a pill with relief, and start to produce the brain chemicals to kick-start that relief.

This pharmacological conditioning only works if the drug is acting on a process that the brain can do naturally. “You can condition pain relief because there are endogenous pain-relieving mechanisms,” Miller says. Painkillers activate the opioid system in the brain. Taking a pill you think is a painkiller can activate that system (to a lesser degree).

And some studies do suggest that the placebo effect’s powers may possibly move beyond the brain.

Researchers have used flavored drinks to condition an immune response to placebo.

In a 2012 study, participants were given a sweet drink along with a pill that contained an immune suppressant drug for a few days. Without notice, the drug was swapped with placebo on one of the trial days. And their bodies still showed a decreased immune response. Their bodies had learned to associate the sweet drink with decreased production of interleukin, a key protein in our immune systems, which is produced in many cells outside the brain.

Results like these show “we are talking about a neurobiological phenomenon,” Colloca says.

5) Social learning

When study participants see another patient get relief from a placebo treatment (like in the electroshock experiment described above), they have a greater placebo response when they’re hooked up to the machine.

6) A human connection

Irritable bowel syndrome is an incredibly hard condition to treat. People with it live with debilitating stomach cramps, and there are few effective treatments. And doctors aren’t sure of the underlying biological cause.

It’s the type of ailment that’s sometimes derided as “all in their head,” or a diagnosis given when all others fail. In the early 2000s, Harvard’s Ted Kaptchuk and colleagues conducted an experiment to see if usually intangible traits like warmth and empathy help make patients feel better.

In the experiment, 260 participants were split into three groups. One group received sham acupuncture from a practitioner who took extra time asking the patient about their life and struggles. He or she took pains to say things like, “I can understand how difficult IBS must be for you.” A second group got sham acupuncture from a practitioner who did minimal talking. A third group was just put on a waiting list for treatment.

A caring provider can create a stronger placebo response than an apathetic one.

The warm, friendly acupuncturist was able to produce better relief of symptoms. “These results indicate that such factors as warmth, empathy, duration of interaction, and the communication of positive expectation might indeed significantly affect clinical outcome,” the study concluded.

Participants in the “augmented” condition — the one in which the caregivers were extra attentive — reported better outcomes at the end of the three-week trial, compared with both participants who received treatment as normal and those waiting for treatment.

 BMJ

This may be the least-understood component of placebo: It’s not just about pills. It’s about the environment a pill is taken in. It’s about the person who gave it to you — and the rituals and encounters associated with them.

What placebos can, and can’t, do

Placebos seem to have the greatest power over symptoms that lie at the murky boundary between the physical and psychological.

A 2010 systematic review looked at 202 drug trials where a placebo group was compared to patients who received neither placebo nor active drug. And it found that placebos seem to move the needle on pain, nausea, asthma, and phobias, with more inconsistent results for outcomes like smoking, dementia, depression*, obesity, hypertension, insomnia, and anxiety. (*Separate literature review on depression meds does find an effect of placebo compared with no treatment.)

“It seems like placebo taps into a family of psychological and brain processes that’s very much something we evolved for,” says Tor Wager, a University of Colorado Boulder neuroscientist who has co-authored many of the key papers on the neuroscience of placebo. “Take pain as an example. If you step on something sharp, there’s pain in your foot. Now, how should you respond to it? Well, if you are running from an attack, you don’t even want to feel that. You keep going.”

Another way to think about it: Placebos tweak our experience of symptoms, not their underlying causes.

A 2011 study elegantly illustrates this. In the experiment, asthma patients were randomly sorted into three groups: One group received an inhaler with albuterol, a drug that opens the airways. Another group got an inhaler with a placebo. A third group got “sham” acupuncture (meaning the needles were withdrawn before they touched the skin). A fourth got nothing. The study authors evaluated lung function on two metrics: self-report from the patients on their asthma symptoms, and an objective measure of lung functioning.

If you go by self-report, it looks like the placebo, albuterol, and sham acupuncture are all equally effective.

The objective measure, however, shows only the albuterol improved airflow. (FEV is a measure of lung function.)

Which isn’t to say that the self-reported improvement on placebo doesn’t matter. In many illnesses, patients would love a greater opportunity to ignore their symptoms.

“In all the objectively measurable illnesses, like cancer, even heart disease, there are components of it that are not [objectively measurable],” Kaptchuk says. And it’s those symptoms that are the prime targets to treat with placebo.

Placebo can only help symptoms that can be modulated by the mind. “There are real limits to what you can condition,” Miller says. You can’t, for example, condition the cancer-killing effects of chemotherapy. Our bodies don’t produce cancer-killing chemicals.

There’s evidence that placebos actually release opioids in the brain

Over the past 15 years, scientists have made some of their most interesting discoveries looking at how placebos have a powerful impact on the brain.

“When I first started studying placebo effects, it kind of seemed like magic — for some reason, your brain mimicked a drug response,” Wager says. “The biggest change in this field in the last 15 years is that neuroscientists are beginning to uncover the underlying neural mechanisms that create the placebo response.”

Placebos, researchers have found, actually prompt the release of opioids and other endorphins (chemicals that reduce pain) in the brain. Other findings:

• Drugs that negate the effects of opioids — such as naloxone — also counteract the placebo effect, which shows that placebos are indeed playing on the brain’s natural pain management circuitry.
• The periaqueductal gray matter, a region of the brain key for pain management, shows increased activity under placebo. Regions of the spinal cord that respond to pain show decreased activity under placebo, which suggests either the sensation of pain or our perception of it is diminished under placebo.
• Patients with Alzheimer’s disease start to show a diminished placebo response. It’s probably due to the degradation of their frontal lobes, the area of the brain that helps direct our subjective experience of the world.

Our understanding of all this is far from complete, Wager says. For one, researchers still don’t completely understand how the brain processes pain. A lot of the brain regions implicated in the placebo response also play a role in emotions. So we don’t yet know if placebo is actually reducing our sensation of pain, or just our interpretation of it. (Also, as with a lot of neuroscience studies, a brain area might “light up” in an experiment, but it’s really, really hard to know what exactly is going on.)

“So really, what we should be concluding from those studies is something like ‘placebo affects the pain you report,’” Wager says. “What does pain mean to you? That’s a decision that’s made in your brain in different circuits, and that’s essential to placebo.”

You can tell people they’re taking a sugar pill for their illness, and they’ll still feel better

Kaptchuk has studied the placebo effect for decades, and something always bothered him: deception. Placebo studies have long relied on double-blind procedures. It ensures scientific rigor but keeps patients in the dark about what they’re actually taking.

“About five years ago, I said to myself, ‘I’m really tired [of] doing research that people say is about deception and tricking people,’” he says.

So he wanted to see: Could he induce a placebo response even when he told patients they were on placebo?

His own randomized controlled trials found that giving patients open-label placebos — sugar pills that the doctors admit are sugar pills — improved symptoms of certain chronic conditions that are among the hardest for doctors to treat, including irritable bowel syndrome and lower back pain. And he wonders if chronic fatigue — a hard-to-define, hard-to-treat, but still debilitating condition — will be a good future target for this research.

“Our patients tell us it’s nuts,” he says. “The doctors think it’s nuts. And we just do it. And we’ve been getting good results.”

Kaptchuk’s work adds a few new mysteries to the placebo effect. For one, he says that the placebo effect doesn’t require patient expectations for a positive outcome to work. “All my patients are people who have been to many doctors before. They don’t have positive expectations about getting better,” he says. “They’ve been to 10 doctors already.”

Colloca has a different interpretation of his results. She says there’s a difference between belief and expectation, so while the patients may not believe the pill will work, they still unconsciously expect it to.

That’s because, she says, they still have a deep-seated conditioned memory for what it means to take a pill. They have a conditioned memory for what it means to be in the care of another person. And that memory is indeed an expectation that can kick-start the analgesic effect in the brain. They don’t have to be aware it’s happening.

Some doctors wonder if placebos can be integrated into mainstream medicine

The researchers I spoke to for this story are overall optimistic that these discoveries can be used in the clinical settings. There’s a lot of work left to do here, and certainly some of the findings are easier to implement than others. For instance, we could start with reminding doctors that they can relieve pain simply by being warm and caring to their patients.

Colloca wonders if the placebo effect can also be harnessed so that the millions living with chronic pain can feel the same therapeutic effects with a lower dosage of opioid treatments that are both ineffective and deadly.

The NIH’s Miller says it’s too soon to start prescribing placebos, or using the effect, to decrease the dosage of a drug. For one, most of these studies are short-term and conducted with healthy volunteers, not actual patients.

“There’s still lot we don’t know,” he says. Like side effects: Just as a placebo can mimic a drug, it can also mimic a side effect. “We haven’t done the kinds of studies that will indicate that you can maintain therapeutic benefit at lower side effect burden.”

More broadly, Kaptchuk says, for years researchers have seen the placebo as a hurdle to clear to produce good medicine. But placebo is not just a hurdle. “It’s basically the water that medicine swims in,” he says. “I would like to see the bottom line of my research change the art of medicine into the science of medicine.”

There's no solid evidence that people get addicted to social media — and using it could actually be beneficial

True story: I once walked headfirst into a pole on my way home from work. I can't blame the darkness (the sun had only just begun to set), and I can't blame my vision (I'd recently gotten new glasses).

from Pocket http://www.businessinsider.com/social-media-iphone-facebook-instagram-addiction-2018-3

True story: I once walked headfirst into a pole on my way home from work.

I can't blame the darkness (the sun had only just begun to set), and I can't blame my vision (I'd recently gotten new glasses). But I can blame my iPhone, whose vibration had lured me into staring at its crisp bright screen. The text I was responding to was not worth the heart-shaped bruise that I shamefully covered in makeup the next day.

Until my ridiculous injury, I had laughed at stories about the dangers of "walking while texting." I'd eye-rolled at reports of painful "iPhone neck" from leaning over tiny screens. And I'd never taken the idea of social media addiction seriously.

But that evening, I started to wonder if maybe our generation was screwed— and maybe our smartphones were to blame.

So I did some digging: I pored over scientific studies and talked to researchers who specialize in psychology, sociology, addiction, and statistics. A few experts were emphatic that social media addiction is real and should be added to the DSM IV, long considered the diagnostic bible for psychologists. Others hedged their bets and said more studies were needed.

But the conclusion I gathered was the opposite of what I've been hearing in the news. Social media and smartphones are not ruining our brains, nor will either become the downfall of a generation.

The vast majority of the large and well-designed statistical studies on smartphones and the brain actually suggest these technologies are having little to no effect on our health and well-being. And in some cases, the availability of social media and phones may be a power for good.

'The lowest quality of evidence you could give that people wouldn't laugh you out of the room'

Marcos Mesa Sam Wordley/Shutterstock.com

Most of the headlines about social media — the ones that warn us about smartphones destroying a generation,ruining our posture and mood, and eroding our brains— are simply "a projection of our own fears," Andrew Przybylski, a senior research fellow at the Oxford Internet Institute, told Business Insider.

That's because most existing studies on social media's effects suffer from the same problems that have plagued the social science field for decades.

For one thing, many of the studies are too small to carry a lot of statistical power, Przybylski said. Researchers also often go into a study with an agenda or hypothesis that they hope their study will support.

Take, for example, the claim that because teen depression and iPhone ownership have been rising at the same time, they must be connected. This is a classic example ofcorrelation, not causation: our phones are not necessarily to blame for cases of depression.

Przybylski has attempted to replicate some of the studies that suggested there's a strong tie between social media use and depression. When he used larger sets of people in a more well-controlled environment, he failed to find the same results. Instead, he's foundeither no link or a very, very small one.

"People are making expansive claims about the link between well-being and tech use, but if this was displayed on a Venn diagram, the circles would overlap one quarter of one percent," Przybylski said. "It is literally the lowest quality of evidence that you could give that people wouldn't laugh you out of the room."

Last year, Przybylski co-authored a study published in the journal Psychological Sciencein which he examined the effect of screen-time on a sample of more than 120,000 British adolescents. The researchers asked teens how much time they spent streaming, gaming, and using their smartphones and computers. After running the data through a series of statistical analyses, it became clear to Przybylski that screen-time isn't harmful for the vast majority of teens. In fact, it's sometimes helpful — especially when teens are using it for two to four hours per day.

"Overall, the evidence indicated that moderate use of digital technology is not intrinsically harmful and may be advantageous in a connected world," Przybylski wrote in the paper.

Even when it came to those positive results, however, Przybylski said the significance of the effects they observed was tiny.

"If you're a parent and you have limited resources, the question becomes: which hill are you going to die on? Where do you want to put your limited resources? Do you want to put it into making sure your kid has breakfast or gets a full night's sleep? Because for those activities the effects are three times larger than they would be for screen-time," Przybylski said.

Seeing problems everywhere

Flickr / Robert Couse-Baker

Many parents fear that using social media is universally bad for teens. They get distracted by text messages during class; they miss out on family time because they're texting at the dinner table; they scroll through Instagram instead of going to sleep.

Once you see a few examples of phone-obsessed behavior — a whole family staring silently at their phones while eating a restaurant, say — you tend to notice it more wherever you go.

This may be partially a result of the phenomenon known as confirmation bias. Essentially, you see one event that supports an idea you already have, then because you are hyper-aware of these types of activities, you find more examples that appear to confirm that idea.

It's a bit like when you begin shopping for a certain kind of car — a Honda Civic, let's say — then suddenly notice that everyone appears to be driving a Honda Civic. In reality, that model hasn't gotten more popular overnight; you're simply primed to notice them.

"A lot of the research is bound up in these problems," Przybylski said. "Our concerns or panic about a new thing" — in this case, social media — "guide how we do the research and interpret the results."

Distorted, negative viewpoints have likely influenced the research on a host of new inventions and activities throughout history.

Unfortunately, paying attention exclusively to social harms makes us blind to the ways a new technology may be help us. In the case of social media, such biases can take attention away from other more serious problems.

"It's important to think about all the things we're not talking about here. We don't talk about things like privacy, advertisements, who owns your data, and all this stuff that's actually important. So actually it serves the interest of larger companies to be debating things like screen time and usage. When you bring it all together you have a big dog and pony show," Przybylski said.

When social media may help, not harm

REUTERS/Lucas Jackson

Candice L. Odgers, a professor of psychology and social behavior at the University of California Irvine, specializes in studying new technologies and adolescent development. She told Business Insider that social media may be having some positive effects on teens and young adults, but many people are not paying attention to that research.

"The digital world hasn't created a new species of children. Many of the things that attract them to things about social media are the same things that attract them to other activities," Odgers said. "There are a lot of good things that are happening with social media use today and there's been a really negative narrative about it."

A large review of 36 studies published in the journal Adolescent Research Reviewconcluded that instead of feeling hampered by their screens, teens are chiefly using digital communication to deepen and strengthen existing in-person relationships. The authors concluded that young adults find it easier to display affection, share intimacy, and even organize events and meet-ups online.

Similarly, the authors of a 2017 review of literature on social media and screen time published by UNICEF concluded that "digital technology seems to be beneficial for children's social relationships" and that most young people are using it to "enhance their existing relationships and stay in touch with friends."

Kids who struggle to make friends in person may even use digital tools to "compensate for this and build positive relationships," they said. A small 2018 study of British teens in foster care supports that idea — it suggested that social media helped young people maintain healthy relationships with their birth parents, make new friends, and ease the transition from childhood to adulthood.

Other research, including a small 2017 study of Instagram users aged 18-55, suggests that teens also turn to platforms like Instagram as a means of exploring the world and dreaming up potential adventures — a category of people the researchers classified as "feature lovers."

"Feature lovers want to see something that's exotic or unique; they're looking at Instagram and they're thinking, 'take me to China or Alaska or some place I can't afford to go,'" T.J. Thomson, the lead author of the study, told Business Insider.

You're probably not 'addicted' to Facebook or Instagram

Tomohiro Ohsumi/Getty

The researchers behind these studies emphasized that social media and smartphones are not so much an "addiction" as a novel, attention-grabbing platform for enhancing existing activities and relationships.

In other words, social media has similar impacts on the brain as lots of other types of activity — too much or too little can be linked with negative impacts, while moderate use can have positive results.

"Claims that the brain might be hijacked or re-wired by digital technology are not supported by neuroscience evidence and should be treated with skepticism," the authors of the UNICEF review wrote.

Addiction is a complicated but serious problem that neuroscientists have yet to fully understand. It typically stems from a cache of interconnected factors that include our environment and our genes. As a result, classifying our nearly-universal reliance on digital tools as an "addiction" simply isn't fair to the people whose lives have been torn apart by things like alcoholism or drug use.

A chief characterizing factor of addictive behavior is that use of a given substance interferes with daily activity so much that people can't function normally. Studies suggest that social media, by contrast, is often used to enhance existing relationships, and does not decrease real-world interactions or cause uniform harm.

Research does indicate, however, that people who may already be predisposed to depression and anxiety could suffer more as a result of using these types of "compare-and-despair" platforms.

A series of studies published this month in the journal Information, Communication, and Society found that while people's Facebook use had no impact on their social interactions later that day, scrolling through the platform did appear to be linked with lower feelings of well-being if the person had been alone earlier in the day.

"People who use social media alone likely aren't getting their face-to-face social needs met," Michael Kearney, a co-author of the study, said in a statement. "So if they're not having their social needs met in their life outside of social media, it makes sense that looking at social media might make them feel even lonelier."

There are plenty of simple, healthy ways to address these risks without resorting to harsh measures like breaking up with your smartphone. I, for one, no longer text when I walk.

It's a small change, but my forehead is grateful.

Channeling the inevitable: Slack and the future of work

“There’s a huge degree of overlap between what executives want and what workers want,” Slack’s CEO Stewart Butterfield said at the 2018 Wharton People Analytics conference in Philadelphia.

from Pocket https://slackhq.com/channeling-the-inevitable-slack-and-the-future-of-work-50ea5154f199

“There’s a huge degree of overlap between what executives want and what workers want,” Slack’s CEO Stewart Butterfield said at the 2018 Wharton People Analytics conference in Philadelphia. Knowledge workers, in particular, share a common vision for how they’d like to work: “People want to move quickly and feel engaged,” he explained. “To operate in alignment and have the autonomy to make decisions.”

In a keynote conversation with Professor Mae McDonnell, an expert on organizational design and a professor of management at the Wharton School, Butterfield discussed how his responsibilities as a CEO have led him to explore the wider factors that often leave people feeling disaffected, disenfranchised, or alienated at work.

Everyone, he contends, is looking for the same foundations to their working life. They want to be trusted, and to be able to trust the people they work with. They would like to be respected, and work with people they respect. They want to have clarity around the goals and priorities, and to understand how the outcomes will be evaluated. To the extent these conditions are absent, they will become unhappy because, in addition to these prerequisites for healthy work, they also want to feel effective, productive, and like they are having an impact.

Tools alone won’t fix issues inherent to an organization’s culture or team dynamics, but they can be helpful to leaders in shedding light on common breakdowns and pitfalls, and they can spark ideas for how people can work together more efficiently and achieve more meaningful results.

You can watch the full session below, but here’s a look at a few key takeaways from Butterfield and McDonnell’s conversation.

Professor Mae McDonnell: Can you talk about how Slack fits in with the shifting nature of work and articulate its value?

Stewart Butterfield: The simplest articulation is that it replaces email inside your company. But there’s more to it than that. Email isn’t just a series of messages typed in boxes, stacked on top of one another.

Most of the information in your inbox is composed by machines: There are receipts from purchases, password reset links, newsletters you’ve subscribed to, notifications about new comments or updates on documents — it’s actually a window into all the work that’s happening throughout an organization. It’s where contracts are negotiated. It’s a file storage system. It serves a bunch of roles, none of which are particularly suited to the medium.

Slack is a collaboration hub across the company. Messages and conversations are organized into channels, which can be broken up by broad functional groups and projects. There can be channels for teams, projects and goals, office locations.

By their very nature, channels increase transparency — and I like to say that with a big asterisk, because transparency is often defined, in the business context, as bosses and leaders being more forthcoming. In this case, we literally define transparency as the opposite of opacity: People can actually see what’s going on in different departments and working groups in a way they couldn’t with email, because emails are addressed to individuals, or mainly received individually.

Take the process of closing a deal as an example. It’s incredibly complex and involves a lot of participants, from sales to legal to engineering. When I wanted an update on how work with Oracle was coming along, which is one of our biggest accounts, I didn’t have to ask anyone. I just went into the dedicated #accounts-oracle channel and I could see everything that’s been happening.

Channels have opened my eyes to the importance of alignment and clarity for people. Now someone in engineering who may not be involved with the account on a daily basis, but might be working on a feature that’s blocking a customer deployment, can go into a channel and get context behind requests and understand the potential impact of their actions. They’re not just getting a message into their inbox, dropped from the top.

MM: So, to riff on this idea of access to information being important for employees to learn and navigate complex situations, how does Slack mitigate the risk of information overload?

SB: I would say it attenuates the effects more than mitigates the risk. The nature of an organization is that it produces a lot of information. Depending on the organization’s size, the volume of information can increase by orders of magnitude — from 10 to 100 to 100,000 times more. But you don’t have to read all of it. It’s not being pumped into an inbox. With Slack, you have choice. There are channels you can elect to join or view as you see fit. We give people tools, like notification settings and comprehensive controls, so they manage what they need to see.

We’re also working deeply on search, not just in terms of the retrieval of documents, files, and messages that you already know exist. We also look at search in terms of searching for topics that you’re interested in and surfacing people who might be experts in those areas within the company, then pointing you towards the channels where they’re having those conversations. There’s a lot we can do by having this really large corpus of information to draw from.

To the extent that we are able to offload those capabilities that computers are so good at, and that human beings are fundamentally lousy at — like comparing a hundred million things all at once and finding things that are similar or remembering everything perfectly forever — we’re all better off.

MM: What do you think is Slack’s role in enabling corporate culture?

SB: I think Slack is a very powerful instrument for affecting the kind of change that leaders across the organization, not just executives, want to see happen. Because of the increase in transparency, the anti-pattern of management — which is “I withhold information as a means of exercising power or control in the organization” — becomes more and more difficult.

Imagine there’s something big happening: There’s an acquisition, a change in suppliers or organizational design. What you want in those kinds of cases is a higher degree of alignment, more clarity. If people have questions, you don’t want there to be a lot of uncertainty. You want people to hesitate less while taking more effective actions. So you want decision-making to be enabled at all levels and for people to feel empowered and autonomous.

In that sense, Slack is a very effective way to get people the information that they need, but it’s also an effective place to put information so that the right people and decision makers can participate.

I hope that the net impact for organizations that move from email as their primary means of communication to Slack is that, whatever the cultural goals or aims that they have, they’re easier to achieve as a result of using our product.

MM: What are some of the ways AI and machine learning will empower workers in the future versus extinguishing their jobs?

SB: There was a time when “calculator” was both a job title and a computer. Benedict Evans, an investor in the Bay Area, wrote this essay where he has a couple of stills from the 1960s movie The Apartment, starring Jack Lemmon and Shirley MacLaine.

Jack Lemmon’s character works at an insurance company, and he has an electromagnetic adding machine on his desk and a typewriter, and there are all these people pushing carts and handing him sheaves of papers. He literally reads over data, does some calculation, types up the results, then hands it off to someone else. The whole floor operates like a worksheet. And what is he? He’s a cell on a spreadsheet.

Nowadays, insurance companies probably employ just as many people, but once you give them actual spreadsheets, they can do a lot more things: Financial planning and analysis becomes a subdiscipline. You can do all this kind of sensitivity analysis with the modeling that wasn’t possible before.

Similarly, I remember when it became mandatory to start buying calculators and bringing them to math class, when before that we were focused on long division to solve complex math problems. But suddenly we could do trigonometry on our calculators and we could move up the stack in terms of the kinds of calculations that we were performing and the kind of math we were expected to do. I think we’ll see much more of that.

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