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Linda Rising on Placebos

Interview with Linda Rising by Amr Elssamadisy on Oct 27, 2009     Download:

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Summary
Linda Rising tells us about the effectiveness of placebos and the strength of our beliefs in medicine and how these same things might relate to software development. Is Agile software development just a placebo effect? Do we get better results because we expect and believe things will get better? Or is there something more to Agile?

Bio
Linda Rising has a Ph.D. from Arizona State University in the field of object-based design metrics and a background that includes university teaching and industry work. Linda is an internationally known presenter on topics related to patterns, retrospectives, agile development approaches, and the change process. Find more information about Linda at www.lindarising.org.

About the conference
Agile 2009 is an exciting international industry conference that presents the latest techniques, technologies, attitudes and first-hand experience, from both a management and development perspective, for successful Agile software development.

Good morning! This is Amr Elssamadisy with Linda Rising at the Agile 2009 Conference. Good morning Linda and thank you for coming!

Good morning. How are you? You are interviewing early today.

I am because I want to see the conference. If you don't mind, tell us, most of us know who you are, but for those who don't, can you tell us just a little bit about yourself and your interests?

I'm an independent consultant. I live in Phoenix, Arizona and I'm interested in retrospectives, the change process, Agile development of course, and patterns. And, every now and then, I will run off to some little remote corner of the world and I will, in my research find a connection back to the way we were. I've been doing that now since 2006. I started it with bonobos and chimpanzees and then moved on to 'hardwired for deception', then, last year, it was how we categorize other people. This year it's the Placebo effect.

Placebo effect? Tell us about the Placebo effect!

I was a skeptic at first because I remember seeing an episode of M.A.S.H. Do you remember the TV series M.A.S.H? It was about a shortage of morphine and all of a sudden a helicopter landed and there were a lot of incoming wounded and not enough morphine for these seriously wounded guys. What were they going to do? Somebody had the idea of pretending that they had a very powerful painkiller and they would give it out to these wounded guys and hope that, by the time the morning came there would be a shipment of morphine.

Only one of the soldiers struggled with that, everyone else immediately to sleep. Then, they began to worry "What should we do with this other soldier?". Finally, they said "We'll give him another one and we'll tell him that this is all he can have. It's very strong painkiller", so they all waited and gave him another pill and sure enough, he went right asleep. I remember seeing that and I remember thinking "Well, would you use that for real illness? Would you?". Then, a good friend of mine began to suffer from depression, this year. I talked to her husband and I said "How is she doing?" He said "Don't tell her, but the doctor has put her on a Placebo and she's doing fine!"

I thought "Doctors are seriously prescribing something they know is a sugar pill, or an antibiotic or aspirin or something that doesn't really treat the illness? Are they really doing that?" The answer is "Yes, they are!". So, it intrigued me, because there are a lot of people who think Agile has a lot of hype to it and that people who come to these conferences, just walk around. It's a very different kind of conference, isn't it? We were playing games with George last night, and I thought "How many technical conferences have people down in the corner with cowbells playing games? Just hear the excitement and the buzz, look at how many women are here! It's a very different kind of community."

And I wondered "Are they here just because they are believers? What does that mean about Agile believers?" I started looking at Placebos and sure enough, most people, at some time or another have - I guess - subscribed to something. We are hardwired to do that. We are believing kinds of animals, and in fact, until maybe 150 years ago, that's all medicine was. Some healer walked into the room, and because of your belief, you got better. That's a good thing that we have this for Agile or anything else. Now, we might think that software development is simply running from one latest hot topic to another, but perhaps it's our search for a better way, perhaps this drive to keep looking for a better way is a good thing.

I started looking at research on Placebos, I started looking at drug trials. When they test a new drug against a Placebo, they'll find that third to a half of the people under Placebo were getting better. They have to make sure that the actual drug, the real drug is at least that good in order to be effective and, in fact, what they found is that it's hard to separate the Placebo effect from the real effect, because even real drugs will have a Placebo effect that surrounds them. Then, the next thing I found was that there was a psychologist who has looked at people who are susceptible to the Placebo effect.

We have a lot of animals in the Agile community - we have pigs and chicken in Scrum. In his research, he calls believers "sheep". Then, he began to study sheep. They are a special kind of people, these believers, they are more creative, they are more innovative, they are more open to working with diverse others. They are the people, in other words, who like to live on the edge, who are open to new ideas, who like to experiment. I thought maybe that can explain some of the interesting things that go on at this conference and some of the characteristics of people who are in the Agile community - maybe they are sheep, maybe they are believers, maybe they are the ones who are innovators and open to new ideas.

What does that mean for the rest of us, are non-sheep annoying Agile?

Shall we lay down the goats? It's the sheep versus the goats? I think that all people can become sheep under certain circumstances. The thing that began to worry me was how do we know that we are not selling ourselves a bill of goods? How do we know that we're not all under on the Kool-Aide? How do we know that Agile isn't just a sugar pill? That began to seriously worry me for quite a while. Maybe we are just chasing a rainbow. Then, I stopped to realize that Agile and science are very similar.

Science is about experiments, about holding an idea for a short period of time and testing it and then examining the results of that test to find out whether or not the hypothesis holds up. That's really what Agile is about. Agile is about small experiments. I now believe that everything we do, not just software development, but our lives should be a series of small experiments. We should always be testing and we always do that with others, we bring in the goats. We really do!

We bring in every possible stakeholder, we bring in customers, we bring in users, testers work with developers. We are always examining carefully those sugar pills. Does it really work? What do you think? Are you happy with the results? That's the only thing that saves us - Agile itself. This series of small experiments. I began to feel better about the whole thing and I thought maybe that's why this is so successful. It plugs into our hardwired need to believe. A lot of us who are here are sheep and we like new innovative things and yet we are willing to bring in the goats, we are willing to experiment, we are willing to learn.

That's what makes us successful that we are willing to believe and that we are testing that belief?

Yes, that we are willing to believe and we are always testing. If you look at the way Agile conferences were and what we thought about Agile was, even a short time ago, and where we are now I have a set of slides that, in fact I'm going to deliver this morning, I'm going to give a talk. Every time I go through that set of slides, I think to myself "I created these in 1995, and I remember how it was I told the story of what Agile is about, what Scrum was about for people who were beginning, for people who were interested, who didn't know a lot and I think about how that's different. It's pretty much the same set of slides, but what I say and the stories are very different. I think we are making a lot of progress, I think we are learning.

That's great news.

Now you wonder, when you go see a doctor, "What's he giving me?"

Does it matter, if it gets results?

It doesn't matter! That's exactly right. In fact, there just was a paper about surgery. My neighbor had a form of vertebral cracks and they actually inject a cement kind of thing into your vertebra, looking for stabilization, because they have no idea why you are suffering from severe back pain. Some surgeon said "We should do some studies and we should balance this surgery against -it's called - sham surgery". They bring someone in, they make a little incision, but they don't really do anything. What they found was the sham surgery was just as effective as actually going through the very painful process of injecting patients with a cement, which impairs their mobility for the rest of their lives. The 2 groups of patients are exactly the same with regard to their efficacy, whether they were happy or not. Astounding!

It is, isn't it? The power of our beliefs!

Yes. We have a little pharmacy in our heads. All we need to do is turn that on. How powerful we really are…

You and Mark Levison are doing a workshop today.

We are doing a workshop tomorrow and we are trying to look at better ways of learning and training, based on the latest neuroscience research. I didn't know Mark Levison until last night, we met at the icebreaker. He just sent me an email, he said "I know you are interested in these weird things, and I'm interested in these weird things. Why don't we do a workshop?" So, we made a proposal together. What we are going to do is cover 5 different topics and actually we are going to use one of the techniques that we recommend, so this will be a self-referential workshop.

One of the techniques is to let the learners decide. We know we don't have time to cover the 5 topics, so we are going to let the learners decide which 3 they would like to hear. We'll actually cover 3 of them. I don't know which 3 of them. One of them is "Build on what the learner knows". Neuroscience research tells us that we all have a set of neural networks, even babies when they are born, have a set of things they already know, they already believe - since we just talked about belief.

It's much better if you build on that instead of trying to examine misbeliefs or errors and to say "It's my job as the teacher or the trainer to try to straighten out that mess. It's my job to improve you." It should be my job to build on what you already know and to start together from that point and let me do the best I can to show you a different path. That would be different for every student. That's one of the things that you can do. Another thing you can do is use all the senses.

Typically we do what we are doing now - I talk, you listen. And you are a good listener. Somebody might even reward you for that. Everybody is quiet, you are just sitting there, looking at me. That's actually the worst way to learn anything. We should be moving around, we should be I guess engaging all our senses, we should bring in smells, we should change positions. We know that exercise improves how efficient the brain is. We are going to have people moving around, trying different things, little experiments and we are also going to integrate, which is another tactic, put things together and so we are going to have people do small plays. I'm definitely a believer in plays. The whole workshop is a series of experiments. How will people like that, how will people learn in that situation and we'll see how successful we are.

 

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1. Back to top

   But we need to beat the placebo effect

   Oct 27, 2009 6:53 PM by Martin Gladdish

   I've blogged on the similarities between medical science and software development before. Unfortunately, the area where I think the medical community are ahead of us is how they measure the effectiveness (or otherwise) of a treatment against the placebo effect. Merely effecting a change, with the stated intent of it being for the better, in order to invoke the placebo effect should have positive results for the reasons Linda mentions, but the criteria for whether a process change is really worth having is whether it beats the placebo effect.
   
   This comment is in danger of over-running, so I'll put the rest as an entry on my blog. I'll leave with a parting shot of if you were to read just one book on the placebo effect and how medicine tries to work out whether they are better, make it Ben Goldacre's Bad Science.

   Reply

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   Agile needs more science, less religion

   Oct 28, 2009 6:22 AM by Craig Doremus

   I agree with Martin. Agile needs more science to back up its claims, not the 'old time religion' that appears to proliferate. In particular, we need to know what works and what doesn't in the Agile world. For instance, how much payback can you expect from TDD? Right now, it's anybody's guess.

   Reply

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   Re: Agile needs more science, less religion

   Oct 28, 2009 6:49 AM by Martin Gladdish

   I think there's at least a little good news on that front, Craig. I think it was even featured on this site a little while back, but Microsoft have tried to measure the effectiveness of TDD and have published their findings in a paper called Realizing quality improvement through test driven development: results and experiences of four industrial teams.

   Reply

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   Re: Agile needs more science, less religion

   Oct 28, 2009 7:43 AM by Amr Elssamadisy

   So Craig, when you say more science, I'm assuming you mean something like experiments, modeling, and proofs - right?
   
   How do we suggest we do that?

   Reply

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   I am a sheep

   Oct 28, 2009 8:52 AM by Ritesh Man Tamrakar

   I am believer of Placebo and Agile. It simply works. It is very interesting interview. My one question is if we have already believed something works should we be asking questions like "Does it work better than something else?" :)

   Reply

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   Greg Wilsion talk at Dev Days Toronto

   Oct 28, 2009 10:08 AM by Chris Butler

   I recently attended the Stack overflow conference Dev Days, in Toronto. There was a great speaker named Greg Wilson. He is a professor at the University of Toronto and he is doing research on how to actually bring some science into our methods. He showed some great examples of experiments already done, and he is pushing for more rigorous experimentation and a more evidence based software engineering system than we have now. I suggest seriously googling him and checking him out.
   
   The slides are here: www.slideshare.net/gvwilson/bits-of-evidence-23...
   
   and the full conference info is here: meta.stackoverflow.com/questions/27151/devdays-...

   Reply

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   more questions

   Oct 29, 2009 10:06 AM by suba bose

   It's an interesting perspective (like earlier ones with bonobos etc) but this time I failed to see the direct connection. Considering placebo as something pseudo cure real cure, which part of agile is pseudo? or whole of it? Didn't waterfall give the same placebos - or (false) beliefs? Curious here.
   
   P.S - blogged about it very briefly @ subabo.wordpress.com
   
   /suba

   Reply

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   Re: more questions

   Oct 29, 2009 10:29 AM by Amr Elssamadisy

   The thing about placebos is that they WORK. Agile is working and delivering better software.
   
   I'll be the oddball out here. Does it matter if the solution is because of belief or because of action? If the result is positive, that's all I personally care about :)

   Reply

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   Re: more questions

   Oct 29, 2009 11:50 AM by Martin Gladdish

   Blimey Amr, I'm glad you're not my doctor :)
   
   The essence of the argument is that we can make any old change, even if it's something as silly as making the room brighter, and see some improvement due to the placebo effect. So, if we are relying purely on placebo for our benefit we may as well make changes that are incredibly cheap and easy to implement. Introducing agile processes aren't incredibly cheap so, if they're no better than placebo, we may as well ignore agile and just turn more lights on!

   Reply

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    Re: Agile needs more science, less religion

    Oct 29, 2009 1:24 PM by Craig Doremus

    Amr,
    I'm talking about measuring ROI over the lifetime of the software. The research by Nachi Nagappan noted by Martin is a good start. We have many software projects that have a limited lifetime (2-3 years). TDD lowers support cost, but does the payoff justify the 15-35% percent addition to development time that Nagappan found? Both the cost (TDD) and payoff (defect-reduction) needs to be quantified in dollars and cents (or euros, etc).

    Reply

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    Re: more questions

    Nov 24, 2009 10:13 AM by Mark Levison

    Martin - I'm not so sure that we can write off the effects of Agile as a placebo. First of all its very difficult to design real experiments around a group of humans and their interactions. Who would be willing to design and fund the following test:
    -Team A will build the application using their traditional approach
    -Team B will use an Agile approach to build the same application
    
    Neither the teams nor their customers will be allowed to communicate during the development of the application. Run for 6-12 mths and study the products for quality, value delivered, ....
    
    Repeat several times over. Will you fund this effort?
    
    I think the best we will get for sometime to come is the Standish reports - look for the top 10 list of factors in predicting project success - Agile tends to expect all of them.
    
    Cheers
    Mark Levison
    The Agile Consortium

    Reply

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