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How the Placebo Effect Works · Stuff You Should Know

0:01
Speaker 1: Welcome to Stuff you should know from house Stuff Works
0:04
Speaker 1: dot com. Hey, and welcome to the podcast. I'm Josh Clark,
0:13
Speaker 1: and there's Charles W. Chuck Bryant, and there's Jerry. Jerry
0:17
Speaker 1: the placebo do sir? No, No, that was bad, Chuck. Yes.
0:25
Speaker 1: Have you ever heard of the word placebo? Do, sir? Yeah? Placebo?
0:31
Speaker 1: You know what I mean? I do. Tell everybody I
0:36
Speaker 1: shall see, No, I will please, I shall please. That's right,
0:41
Speaker 1: met ill see, We'll see about that. I shall please.
0:45
Speaker 1: That's what I meant in Latin. Yes, all right, so placebo.
0:51
Speaker 1: Everybody's heard of a placebo and very famously the placebo effect.
0:55
Speaker 1: You wonder where that comes from? The placebo effect. The
1:00
Speaker 1: word placebo um fourteenth century. It referred to hired mourners
1:06
Speaker 1: at funerals. What they would hire mourners in place of
1:10
Speaker 1: family members, and they would start their morning wailing with
1:15
Speaker 1: that mourning. But as in m O, you are with
1:17
Speaker 1: placebo domino in region vivorum, which means I shall please
1:23
Speaker 1: the Lord in the land of the living. But in
1:26
Speaker 1: that it means placebo. Uh. This article said, it carries
1:30
Speaker 1: the connotation of substitution. Weird. Yeah, that is fantastic stuff.
1:35
Speaker 1: I thought. So this is from Placebo's and Placebo Effects
1:38
Speaker 1: in Medicine Colon Historical Overview by Tisson cap Chuck Green
1:44
Speaker 1: and Legion Catchuck. That guy is high quality. Oh yeah, yeah,
1:50
Speaker 1: a lot of skeptics. He's at Harevard. Let me tell
1:54
Speaker 1: you a little bit about Ted Kapchuck. Okay, the coney
1:58
Speaker 1: Allen cap Chuck's I just raised a lot of skeptics
2:01
Speaker 1: hackles because some people see him as a huckster of
2:04
Speaker 1: fraud or everything that's wrong with placebos. These people, um
2:08
Speaker 1: would probably have a problem with us even talking seriously
2:11
Speaker 1: about the placebo effect in the first place. So I
2:14
Speaker 1: don't know that it's a really big deal that I
2:15
Speaker 1: just raised their hackles. But Ted Katchuk is a former right,
2:22
Speaker 1: let me tell you about capture. Now. He's a former
2:25
Speaker 1: acupuncturist and he apparently had some sort of epiphany one
2:31
Speaker 1: day when he was he was treating somebody and they
2:36
Speaker 1: started to feel better before he even used the acupuncture.
2:41
Speaker 1: So he started wondering, like, okay, what's going on here?
2:44
Speaker 1: And he started investigating the placebo effect, and in short
2:48
Speaker 1: order he ended up as an instructor at Harvard and
2:52
Speaker 1: became one of the leading researchers into the placebo effect,
2:56
Speaker 1: which is a really strange journey because every medical school
3:01
Speaker 1: doesn't usually hire acupuncturists. And he had like kind of
3:05
Speaker 1: a rocky road at first, like he didn't know what
3:07
Speaker 1: he was doing with clinical trials, and he got publicly
3:10
Speaker 1: called out in the New England Journal of Medicine and
3:13
Speaker 1: UM over the years, over the decades, I think this
3:15
Speaker 1: is the eighties that he really started to look into it.
3:18
Speaker 1: He um, like I said, became the foremost researcher in
3:24
Speaker 1: in coming up with quality clinical trials for trying to
3:28
Speaker 1: get to the root of what the placebo effect is
3:30
Speaker 1: and how to use it. What years was that? You
3:33
Speaker 1: know he's still doing it, but when was this? When
3:36
Speaker 1: he was started all that stuff. He got called out
3:39
Speaker 1: and I think a two thousand one issue of the
3:41
Speaker 1: New England Journal of Medicine UM basically for not using
3:45
Speaker 1: a control group in his placebo study. So you know,
3:50
Speaker 1: when you do a study, you have a placebo group
3:52
Speaker 1: which is your control group, and that basically is I'm
3:56
Speaker 1: giving you real medicine, but I'm giving Jerry a sugar pill.
4:00
Speaker 1: And in a proper study, I don't know who's getting
4:04
Speaker 1: the sugar pill and who's getting the medicine. It's called
4:06
Speaker 1: double blind. Um so in if you're studying just the
4:10
Speaker 1: placebo effect, I should be giving you a placebo and
4:14
Speaker 1: I should be giving Jerry no treatment whatsoever. To truly,
4:18
Speaker 1: I thought you needed three people, one with a real treatment,
4:20
Speaker 1: one with placebo, and one with no treatment. It's another
4:23
Speaker 1: way to do it, Okay, at the very least, though,
4:25
Speaker 1: you need the placebo group and somebody who's receiving no treatment, gotcha. Yeah, yeah,
4:30
Speaker 1: if we're skinning cats, well, if you're doing good science
4:34
Speaker 1: researching into the placebo effect. But what's ironic is is
4:38
Speaker 1: this whole double blind placebo study came about because the
4:45
Speaker 1: placebo effect was first noticed by Western practitioner by the
4:50
Speaker 1: name of Dr Henry Beecher, who in World War Two
4:53
Speaker 1: supposedly saw a nurse give a shot of sailing to
4:57
Speaker 1: a soldier because they'd run out a morphine, but the
5:01
Speaker 1: nurse told them it was morphine, and the soldier responded
5:04
Speaker 1: to this shot of saline like it was morphine, And
5:08
Speaker 1: from that Beecher was like, what is going on here?
5:10
Speaker 1: Started to investigate the placebo effect and ended up proposing
5:14
Speaker 1: the double blind placebo study to prove the efficacy of drugs.
5:19
Speaker 1: That goes back further than that, my friend, let's hear
5:21
Speaker 1: it man UH try seventy five the New Medical Dictionary,
5:27
Speaker 1: they described the placebo as a commonplace method or medicine,
5:30
Speaker 1: and then a short time later, in eighteen eleven and
5:33
Speaker 1: Quincy's lexicon uh Medicum, he defined the placebo as an
5:38
Speaker 1: epithet given to any medicine adapted more to please than
5:42
Speaker 1: to benefit the patient, like heroin. So they were on
5:46
Speaker 1: it back in the early eighteen hundreds, which is surprising. Yeah,
5:50
Speaker 1: but I mean, like that's the basis of like snake
5:52
Speaker 1: oil and hucksterism, right, Yeah, Well they called him bread
5:55
Speaker 1: pills back then because I guess it was it was
5:56
Speaker 1: probably some sort of like pill made of yeast, as
5:59
Speaker 1: my us UH and Thomas Jefferson in eighteen o seven
6:03
Speaker 1: even Uh recorded what he called the Pious Fraud, and
6:07
Speaker 1: he observed quote that one of the most successful positions
6:09
Speaker 1: I've ever known has assured me that he used more
6:12
Speaker 1: bread pills, drops of colored water, and powders of hickory
6:16
Speaker 1: ash than all other medicines put together. UM, and people
6:21
Speaker 1: treated people with bread pills. In the early eighteen hundreds,
6:23
Speaker 1: it was a thing and like they were way onto
6:25
Speaker 1: the placebo effect and and the fact that it seemed
6:29
Speaker 1: to work. Uh. And another dude named John Haygarth in
6:33
Speaker 1: the early eighteen hundreds actually started performing the first studies
6:37
Speaker 1: on placebo effect, and um, he said it went back
6:41
Speaker 1: to the renaissance idea that imagination was the major mediator
6:45
Speaker 1: between body and mind, which is starting to be proven
6:49
Speaker 1: is possibly correct. Yeah, it's pretty interesting. And in the
6:52
Speaker 1: nineties is when they started publishing papers on the placebo
6:56
Speaker 1: uh and actually doing clinical trials and um. They said.
7:01
Speaker 1: One of their points in the nineteen thirties would confidence
7:03
Speaker 1: aroused in a treatment, the encouragement afforded by a new procedure,
7:07
Speaker 1: even like just people getting treated in a new way.
7:11
Speaker 1: People would say, oh, well, this is gonna work, and
7:13
Speaker 1: it maybe he did work. And then we're up to
7:15
Speaker 1: the forties where Beacher comes along notices the placebo effect
7:19
Speaker 1: himself ultimately comes up with the double blind placebo based study.
7:24
Speaker 1: And what's ironic about that is the placebo based double
7:27
Speaker 1: blind study ultimately has split back off into the study
7:31
Speaker 1: of placebo again because there are so many trials where
7:34
Speaker 1: the placebo was more effective than the drug, even though
7:37
Speaker 1: the drug worked, but the placebo worked even better. And
7:41
Speaker 1: finally in the nine nineties, people were like, what is
7:43
Speaker 1: going on here? We need to study this thing in
7:47
Speaker 1: and of itself. Well, yeah, because one of the things
7:49
Speaker 1: I had no idea. I thought placebos were only used
7:54
Speaker 1: in studies for efficacy rates. I did not know that
7:58
Speaker 1: they are. There are doctors, always have been, and still
8:02
Speaker 1: are prescribing placebos as medicine unknowingly even though they're not
8:07
Speaker 1: supposed to. We'll get to that later. No knowingly, no
8:10
Speaker 1: unknowingly for the patient, even though they're supposed to tell
8:13
Speaker 1: the patient. Yeah, but we'll get to that towards the end.
8:15
Speaker 1: But I had no idea that they were prescribing placebos
8:18
Speaker 1: to people. Yeah, And in their defense, a lot of
8:20
Speaker 1: times doctors are carrying on a tradition where they don't
8:24
Speaker 1: have anything else to prescribe. But they can't say if
8:28
Speaker 1: they say that to their patients, the patients are going
8:30
Speaker 1: to go off and suffer. So at the very least
8:32
Speaker 1: they can use the last ditch attempt of saying psychological traitor. Yeah. Yeah,
8:38
Speaker 1: and I'm not knocking it. I just was surprised to
8:40
Speaker 1: learn that that still happens. And I'm wondering if I've
8:42
Speaker 1: ever been given a placebo. And it makes me feel
8:45
Speaker 1: dumb as a patient to say, like, yeah, man, that
8:48
Speaker 1: whatever you give me really helped. And the doctors like
8:51
Speaker 1: because it's the same thing as that prank of like
8:54
Speaker 1: giving somebody non alcoholic beer un telling the real beer
8:57
Speaker 1: and watching them make a jerk out of themselves getting
9:00
Speaker 1: or wrong. It's exactly the same thing. So let's talk
9:03
Speaker 1: about placebo. We assume that everybody knows what placebo is,
9:07
Speaker 1: but let's define it a little more clearly. The placebo effect, specifically,
9:13
Speaker 1: is the very real phenomenon that people, when given a
9:19
Speaker 1: pill or a some sort of medical intervention that feel better. Yes,
9:25
Speaker 1: they feel better, even though what they've been given is
9:28
Speaker 1: not medicine and it was not actually a real intervention. Yeah,
9:32
Speaker 1: And the placebo is the pill itself. That that is
9:36
Speaker 1: the placebo, and the effect is what you just described, right,
9:39
Speaker 1: And it doesn't have to be a pill, can be
9:41
Speaker 1: an injection, it can be fake surgery, there's true. And
9:45
Speaker 1: it doesn't even have to be uh pharmacologically inert. It
9:49
Speaker 1: can be a vitamin or like an aspirin, even though
9:53
Speaker 1: some argue that's not a true placebo. But um, sometimes
9:57
Speaker 1: that's what the doctor will give you and call it,
10:00
Speaker 1: you know, medication, But they're there. Um very often, things
10:04
Speaker 1: like a sugar pill. Yeah, like you said, pharmacologically inert
10:09
Speaker 1: um and astoundingly, depending on the size of the pill,
10:14
Speaker 1: the shape of the pill, the color of the pill,
10:16
Speaker 1: people will have different effects and responses to these things
10:20
Speaker 1: that are just sugar. Um. So there's some really strange
10:25
Speaker 1: psychological things going on here. And at first, for a
10:31
Speaker 1: long time, everybody just kind of assumed it was just psychology,
10:35
Speaker 1: that we were tricking ourselves into feeling better, or we
10:38
Speaker 1: hadn't really felt bad in the first place, and we
10:41
Speaker 1: were being tricked into not feeling bad any longer, or
10:46
Speaker 1: not thinking we were feeling bad. In any hypochondria, maybe
10:50
Speaker 1: very much. So. Yeah, Um, they this article says they've
10:54
Speaker 1: been shown to work in about thirty percent of patients,
10:56
Speaker 1: and that was actually that's based on Beacher's finding. It
10:59
Speaker 1: was like alretty, thirty five point two. Yeah, that's what
11:02
Speaker 1: he found out in nineteen fifty five. That's what they're
11:04
Speaker 1: still basing that on. Yeah, but there's been other studies
11:07
Speaker 1: that have gone back through beat your studies and said no, no, no,
11:11
Speaker 1: that's not that much. Other people have found up to
11:15
Speaker 1: respond to it, right, And basically one of the big
11:19
Speaker 1: questions is is it a psychological effect or are there extual,
11:22
Speaker 1: actual physical responses that are going on. And there's been
11:27
Speaker 1: a lot of research lately that's pretty interesting. I think,
11:30
Speaker 1: like we're saying that the the initial idea was that
11:33
Speaker 1: it was all psychological, right, Yeah, Like, uh, well, I
11:37
Speaker 1: guess we can talk about the two effects. The subject
11:40
Speaker 1: expectancy effect, which is basically, if you know the result
11:45
Speaker 1: ahead of time and the pill you're gonna take, you're
11:47
Speaker 1: gonna end up feeling that result. Right. That's what a
11:51
Speaker 1: blind study seeks to prevent, is a subject expectancy effect,
11:56
Speaker 1: and also the observer expectancy effect, which is what a
11:59
Speaker 1: double blind studies seeks to prevent. Yeah, and that's important
12:02
Speaker 1: because it's are different because it's all self reported, right,
12:05
Speaker 1: which is always a little you know, right. So the
12:08
Speaker 1: other idea, if it has a psychological basis, is that
12:11
Speaker 1: it's classical conditioning that we are raised from birth to
12:16
Speaker 1: think that if somebody gives you a pill, you're going
12:19
Speaker 1: to respond to it because it has medicine and that
12:23
Speaker 1: is not self reported. That is actually seeing physical responses. Right.
12:28
Speaker 1: And with classical conditioning established very famously by Pavlov and
12:33
Speaker 1: his dogs, right, um, you are you're having You're responding
12:41
Speaker 1: physically to a psychological stimulus. Right, So you are getting
12:46
Speaker 1: a physiological response. So classical conditioning eventually kind of came
12:51
Speaker 1: to be viewed as the more um reasonable explanation for
12:55
Speaker 1: what was going on because, uh, study after study, if
13:00
Speaker 1: the study has shown that we are having a physical
13:04
Speaker 1: reaction to these inert placebos. Yeah, one of them. In
13:07
Speaker 1: two thousand two from u C. L As Neuropsychiatric Institute,
13:11
Speaker 1: they had a couple of groups of patients and a
13:14
Speaker 1: lot of the placebo studies are uh for mental conditions. Um,
13:19
Speaker 1: not all of them, but a lot of them are
13:21
Speaker 1: in um like the clinical trials. Yeah, yeah, exactly. Um.
13:25
Speaker 1: So this one was for any depressants and they had
13:29
Speaker 1: two groups that got um experimental drugs like real drugs,
13:34
Speaker 1: and then the third was given the placebo. Uh. They
13:37
Speaker 1: spent a few weeks on these pills and monitored their
13:39
Speaker 1: brain activity with the old E G. Wonder machine and well,
13:44
Speaker 1: it's not the wonder machine. It's it's a wonder machine,
13:48
Speaker 1: not the wonder machine. Uh. And the patients on the
13:51
Speaker 1: placebo reported positive effects and showed greater increase of brain
13:55
Speaker 1: activity than those who had responded to the drug. You know,
13:59
Speaker 1: I remember or that it was, Yeah, totally undermined people's
14:04
Speaker 1: faith in antidepressants because it was on the other end
14:08
Speaker 1: of like the whole nineties where everybody was on antidepressants,
14:11
Speaker 1: and this study came out and was like people were saying, like,
14:15
Speaker 1: do these things even work? It was it was kind
14:17
Speaker 1: of taken the opposite way. Rather than wow, the placebo
14:20
Speaker 1: effect is really something, it was wow and indepressance or fraudulent. Well,
14:26
Speaker 1: I wonder what they were trying to It was a
14:28
Speaker 1: placebo study though, right, so kind of backfired or did
14:31
Speaker 1: they even care? No, I think it very much carry
14:34
Speaker 1: because there when compared to place with the whole point
14:37
Speaker 1: of a drug trial is to show that this drug
14:41
Speaker 1: is more effective than placebo, it's more effective than the imagination,
14:45
Speaker 1: and if it's not, then that means that drugs shouldn't
14:47
Speaker 1: be brought to market. Even though now the thinking is
14:51
Speaker 1: more like m that's not necessarily true. Because we're coming
14:53
Speaker 1: to understand the placebo effect can be very powerful, especially
14:58
Speaker 1: depending on the individual too. Yeah for sure. Uh. The
15:01
Speaker 1: interesting thing about that study is when the E e g.
15:04
Speaker 1: Lit up um, the activity was in different parts of
15:07
Speaker 1: the brain. Um. I think that the placebo patients said
15:11
Speaker 1: the preformal cortex was lighting up, and basically that says
15:15
Speaker 1: that the brain isn't being fooled, it's just doing something different. Yeah,
15:18
Speaker 1: they responded better to the treatment then the people who
15:24
Speaker 1: responded to the drug. So some people did respond to
15:27
Speaker 1: the drug, but different parts of their brain were activated
15:30
Speaker 1: by the drug than the people who responded well to
15:32
Speaker 1: the placebo, even though they felt better. Yeah, that's mind boggling.
15:36
Speaker 1: It is. So they had they reached the same conclusion,
15:39
Speaker 1: but using a totally different region of their brain and
15:41
Speaker 1: they actually felt better. Um. That wasn't the first study
15:45
Speaker 1: to prove that there is a physiological response to placebos
15:48
Speaker 1: or last there's a dental study from the seventies that
15:51
Speaker 1: I think was the first that showed that if you
15:54
Speaker 1: blocked endorphins, which are nature's pain relievers, you can also
16:01
Speaker 1: block the placebo effect. So the people weren't responding to
16:06
Speaker 1: the placebo like you would expect them to a pain
16:09
Speaker 1: reliever placebo because they weren't able to release their natural
16:14
Speaker 1: pain relievers. Yeah, and that's backed up I guess by
16:16
Speaker 1: this two thousand four study from the University of Michigan
16:20
Speaker 1: uh Go wolverines. They basically demonstrated that it is related
16:26
Speaker 1: to endorphins specifically. Uh, So that I guess that backs
16:30
Speaker 1: up that study because if you can block them. So
16:33
Speaker 1: here's the thing. It's not that study was related to
16:37
Speaker 1: endorphins specifically. Other studies have found that it can be
16:40
Speaker 1: related to how much a person expresses dopamine specifically. So
16:45
Speaker 1: there's like this idea that there's a genetic basis to
16:48
Speaker 1: our predisposition to UM placebos. But I think that it's
16:53
Speaker 1: depending on the drug or the effect that you're trying
16:58
Speaker 1: to induce using the placebo effects. Because think about it.
17:02
Speaker 1: If you are somebody who naturally produces more endorphins than
17:07
Speaker 1: somebody else, Uh, you're going to naturally produce more endorphins
17:13
Speaker 1: when it's UM triggered by a placebo than somebody who
17:17
Speaker 1: doesn't produce more endorphins naturally. Yeah, So there's a genetic
17:21
Speaker 1: basis to it, I guess, But I think the genetic
17:23
Speaker 1: basis is that the individual must be predisposition to be
17:26
Speaker 1: able to have that genetic response UM to the drug
17:32
Speaker 1: or the placebo and have that that um that I
17:35
Speaker 1: guess response to it. Yeah, And it's like you said,
17:38
Speaker 1: it's also personal because they found that it is even
17:42
Speaker 1: affected by a person's personal experience with past pills. The
17:47
Speaker 1: color of the pill, the shape and size of the
17:49
Speaker 1: pill will have a different reaction because the person had
17:54
Speaker 1: maybe took another little blue pill for something else. Sure,
17:57
Speaker 1: And actually blue pills in in particular, they are known
18:00
Speaker 1: to be um to have sedative effects as placebo's. Red
18:04
Speaker 1: pills are known to have stimulating and pain relieving effects
18:08
Speaker 1: as placebo. That's odd that they made by agraab blue. Yeah,
18:12
Speaker 1: like in Heavinaly marketed it as the little blue pill.
18:16
Speaker 1: Interesting sedative effect, Yes, I don't think so. So. Chok, Well,
18:21
Speaker 1: not that i'd know. Well, we've got more stuff about
18:27
Speaker 1: all this coming up. But I don't know what we're
18:29
Speaker 1: gonna talk about next. It's a grab bag right now. Yeah,
18:32
Speaker 1: but we're gonna come right back after these messages. All right,
18:39
Speaker 1: we're back, buddy, And I tell you what we're going
18:40
Speaker 1: to talk about. Something that I had never heard of,
18:43
Speaker 1: which I think is super interesting, the no sebo effect.
18:47
Speaker 1: It is super cool, and that is when well, it's
18:50
Speaker 1: there's a couple of things. That is, when you are
18:51
Speaker 1: taking a placebo and you experience maybe the effects of
18:56
Speaker 1: the pill, which is great, and the side effec of
19:00
Speaker 1: that pill that you think might be but you're supposed
19:03
Speaker 1: to have, right, you're actually experiencing side effects that aren't
19:07
Speaker 1: shouldn't be there, right, and then a sugar bill. They
19:09
Speaker 1: noticed this in clinical trials too, because when you're carrying
19:12
Speaker 1: out a clinical trial, you have to warn the patients
19:15
Speaker 1: this drug may give you these terrible side effects. And
19:19
Speaker 1: so they started noticing like people who were who were
19:22
Speaker 1: on placebo were still experiencing the side effect like physical
19:26
Speaker 1: reactions like hives and itch in things. Right, So there
19:31
Speaker 1: is a there's a negative side to placebo as well,
19:34
Speaker 1: and no cibo means I shall harm like placebo means
19:36
Speaker 1: I shall please yeah um. And they found that this
19:42
Speaker 1: is definitely backed up by the idea that it's classical conditioning.
19:45
Speaker 1: They found that people who have gone through chemotherapy UH
19:49
Speaker 1: can become nauseated when they enter a room that's painted
19:52
Speaker 1: the same color as the room where they received chemo before. Yeah,
19:56
Speaker 1: that makes sense. Yeah, so there's all sorts of ways
19:58
Speaker 1: that the no cebo effect can pop up, but it's
20:01
Speaker 1: pretty mind boggling as well. Yeah, and then no sebo
20:04
Speaker 1: can doesn't even have to be just with the placebo.
20:06
Speaker 1: You can experience side effects that aren't on the list
20:09
Speaker 1: of a real drug because of what we were talking about,
20:12
Speaker 1: because it looked like another pill you might have had before. Man,
20:16
Speaker 1: the brain powerful stuff. So going back to kat Chuk,
20:21
Speaker 1: who I'm I'm just kind of a fan of. Yeah,
20:25
Speaker 1: I think if you're into like a long form articles,
20:28
Speaker 1: which I love, go to Harvard Magazine and search for
20:33
Speaker 1: the placebo phenomenon and it's a profile of him and
20:36
Speaker 1: his work. It's really interesting stuff. But he was saying
20:41
Speaker 1: that kind of in line with the idea that like
20:44
Speaker 1: the color of the pill or the shape of the
20:45
Speaker 1: pill will have an effect, will either on the no
20:48
Speaker 1: sebo or the placebo effect. Um. He was saying that
20:52
Speaker 1: it seems like the basis of the placebo effect is
20:56
Speaker 1: what's called ritual yea, and ritual is it involves everything
21:00
Speaker 1: from like the physician's bedside manner to how expensive the
21:04
Speaker 1: patient thinks the pill is to how effective the patient
21:08
Speaker 1: thinks the pillars and um. He did a study where
21:11
Speaker 1: he carried out what was called schmaltzy um like a
21:15
Speaker 1: smalty care to where he was just lavishing attention on
21:20
Speaker 1: the patient and telling him how badly he felt that
21:24
Speaker 1: they were going through this. But this pill is really
21:28
Speaker 1: effective with your condition. And apparently not just this study,
21:32
Speaker 1: but other studies show that there's a positive correlation between
21:36
Speaker 1: the ritual and response to the placebo effect. So the
21:43
Speaker 1: more you think that this drug is expensive, that this
21:46
Speaker 1: drug is effective, that this physician cares about you, the
21:50
Speaker 1: greater of a placebo response you're going to have. Yeah,
21:54
Speaker 1: you know, I have you ever been accused of being
21:56
Speaker 1: a hypochondract by anyone? Know, it's got to be very demeaning.
22:02
Speaker 1: It is because it happened to me. And yeah, I
22:05
Speaker 1: went to the emergency room in New York, as you know,
22:07
Speaker 1: when we were up there recently for a trip. I
22:09
Speaker 1: went to the e R and uh, it was something
22:14
Speaker 1: and it was a result of it was it was
22:18
Speaker 1: throwing up in uh nausea from UM I learned from
22:23
Speaker 1: anti inflammatory pills I was taking at the time for
22:26
Speaker 1: something else I had nothing to do with being sick,
22:29
Speaker 1: and they figured that out, but they kept you know
22:32
Speaker 1: this guy, I called him Nurse Jackie. He was just
22:34
Speaker 1: like Nurse Jackie, except he was a dude. He kept
22:36
Speaker 1: coming by and treating me with things and giving me
22:38
Speaker 1: the I V. Drip and I was like, dude, I'm
22:39
Speaker 1: not feeling better and I'm not a hypochondrac in any way.
22:42
Speaker 1: I didn't go to the doctor for like eighteen years straight.
22:46
Speaker 1: And uh, I could tell he was looking at me
22:48
Speaker 1: like I got one of these guys. Yeah, And I
22:51
Speaker 1: was like, no, no, and I could tell. I could
22:53
Speaker 1: could sense it. And so he finally gave me this
22:56
Speaker 1: thing to drink that um knocked me out, woke up
23:00
Speaker 1: like twenty minutes later and felt felt better. I can't remember.
23:04
Speaker 1: It was something to gatorade now. It was like three
23:07
Speaker 1: different things. It was like a cocktail of stomach pleasing
23:10
Speaker 1: things and what's the stuff that like numbs you numb
23:14
Speaker 1: my throat and I can't remember light to can I think? Um? Yeah,
23:20
Speaker 1: it worked. I woke up and I felt better. I said,
23:22
Speaker 1: you know, I don't feel so naxious now, and they
23:24
Speaker 1: were checking me out and I reached up and I
23:25
Speaker 1: felt behind my ear for some reason, and it felt
23:29
Speaker 1: like a golf ball behind my ear and it had
23:32
Speaker 1: popped up in the last twenty minutes, and so I
23:35
Speaker 1: was literally leaving. I was like, oh, wait a minute,
23:36
Speaker 1: I got this thing behind my ear all of a sudden,
23:39
Speaker 1: and this guy looked at me like h and he
23:41
Speaker 1: called the doctor over and she was like, yeah, it's
23:43
Speaker 1: it's very swollen at your limp node. But he wasn't
23:45
Speaker 1: there for that, so he came back over. It's like,
23:47
Speaker 1: what did she say. I said, well, she said the
23:49
Speaker 1: swollen and he said that you're a hypochondriac. And I
23:52
Speaker 1: was so mad at nursed Jackie. I was like, dude,
23:55
Speaker 1: look at it. It's huge. I'm not making this up.
23:58
Speaker 1: And I started defending myself like I never go to
24:01
Speaker 1: doctors and I'm not one of those people. And he
24:03
Speaker 1: was just he was like, I was just kidding. I
24:05
Speaker 1: was just kidding, and I was just kidding. Yeah, but
24:07
Speaker 1: it made it totally made me feel like a jerk. Yeah,
24:10
Speaker 1: I mean imagine if like you, if that happened to
24:12
Speaker 1: you a lot too, I mean, well that means you're
24:14
Speaker 1: a hypocontract right. But now it definitely made me felt
24:19
Speaker 1: and I know he was kidding, but it made me
24:21
Speaker 1: feel really bad, like I'm in there just uh, what's
24:24
Speaker 1: what's the syndrome? Is that it? Yeah, we did an
24:29
Speaker 1: episode on that too. Yeah. Uh anyway, sorry about that. Yeah, well,
24:33
Speaker 1: I'm sorry that that happened to you. I mean, that
24:36
Speaker 1: is b S. But you mentioned the I V guarantee
24:40
Speaker 1: you that was just sailing, and that's a placebo in itself. No,
24:43
Speaker 1: I mean they told me that. I mean they didn't
24:45
Speaker 1: say like this is the wonder bag, but there's basically
24:49
Speaker 1: I'm no reason to give you sailing solution. Well to
24:53
Speaker 1: hydrate me, I guess if i'd been throwing up. Oh yeah, okay,
24:56
Speaker 1: but um yeah, I guess you're right though to see
24:59
Speaker 1: like something dripping into your arm, like surely that's got
25:01
Speaker 1: to be doing something. Yeah. Uh. Well, one interesting thing
25:05
Speaker 1: is back to placebo's, there have been studies that have
25:09
Speaker 1: shown that, uh, if you don't tell the patient what
25:12
Speaker 1: they're supposed to do, that they don't work as well. Yeah.
25:15
Speaker 1: They even found that with drugs that they know for
25:17
Speaker 1: a fact work, if you don't tell them it won't work. Yeah.
25:21
Speaker 1: They did a placebo based trial with a pain killer
25:26
Speaker 1: and the pain killer proved more effective than placebo. And
25:30
Speaker 1: then they did another trial with the same pain killer,
25:33
Speaker 1: didn't tell anybody what it was and it didn't work. Interesting.
25:38
Speaker 1: And then conversely, this is the one that gets me
25:41
Speaker 1: to study where they so crazy? Where you're going. They
25:45
Speaker 1: used an injection that they put into patient's jaws in
25:49
Speaker 1: the study, which me to induce pain Like that was
25:53
Speaker 1: the point. They were trying to induce pain in somebody's
25:56
Speaker 1: jaw using harmless but pain full jaw injections, and they
26:02
Speaker 1: would inject sailine into the jaw um to keep the
26:06
Speaker 1: patient's self reported pain level steady throughout the study. And
26:10
Speaker 1: then they used another injection and gave them sline but
26:14
Speaker 1: told them this was a pain reliever, and everybody's pain
26:18
Speaker 1: across the board dropped as a result in the study.
26:23
Speaker 1: Unbelievable placebo effect. I could just sit around and rattle
26:26
Speaker 1: off studies all day. It's pretty interesting. What do you
26:29
Speaker 1: think about obacalp Yeah, it seems kids are done. You
26:34
Speaker 1: could just call it placebo anyway, I think it's unnecessary. Well,
26:37
Speaker 1: obacalp is placebo spelled backwards obviously, and that in two
26:41
Speaker 1: thousand eight was I guess sort of invented or not
26:45
Speaker 1: invented but coined and packaged by a mother I think
26:49
Speaker 1: Australian named jin Boutner. She Australian, I don't know. I
26:54
Speaker 1: think so is that an Australian last name? And then
26:57
Speaker 1: I don't think there's such a thing. Um, And so
27:00
Speaker 1: that's basically Placebo's for kids. It's marketed. You can you
27:04
Speaker 1: can buy a bottle of obacalp and it's for when
27:06
Speaker 1: your kid isn't feeling good. But um, you but you
27:11
Speaker 1: know your kids not sick, that kind of thing, and
27:13
Speaker 1: so you give the kid the pill and it makes
27:15
Speaker 1: them feel better. And some people have problems with this
27:17
Speaker 1: and say you're teaching your child that you get relief
27:21
Speaker 1: from pills only when they're you know, I don't necessarily
27:24
Speaker 1: need to be taking pills all the time. And proponents say,
27:28
Speaker 1: you know what, it's it's the same thing as putting
27:29
Speaker 1: a bandage or kissing a boo boo. It's like you said,
27:33
Speaker 1: these are dumb little kids. Well, I remember growing up
27:36
Speaker 1: with the children's aspirin, the orange aspirin. I'm pretty sure
27:40
Speaker 1: those were just sugar pills. You think I had a
27:42
Speaker 1: whole bottle of them, and I was fine, but those
27:45
Speaker 1: are vitamins. It was children's aspirin. Oh I think they
27:48
Speaker 1: were orange flavored. Yeah, I totally remember those. Yeah, I
27:52
Speaker 1: think those are probably place I remember the taste, like
27:56
Speaker 1: I can still sense that they're good, the whole bottle
27:59
Speaker 1: of them once because I was a little fat kid,
28:02
Speaker 1: you didn't eat and get sick sugar pills. I have
28:05
Speaker 1: I think so, because I even remember I was old
28:07
Speaker 1: enough thinking like I probably shouldn't have eaten that whole
28:09
Speaker 1: bottle of those things because it's medicine, and watched it
28:12
Speaker 1: down with the sky and I was right and that
28:15
Speaker 1: was fine. Afterwards, Well, they do have legit baby aspert
28:18
Speaker 1: now though, they I'm starting to doubt everything, so starting
28:25
Speaker 1: to talk about doubt. There are plenty of criticisms of
28:28
Speaker 1: all this, and we'll talk about him right after this.
28:41
Speaker 1: So Chuck, I'm a big time into the placebo effect.
28:45
Speaker 1: Your big time into the placebo effect. There are people
28:48
Speaker 1: who are not that's true. There Uh, it raises plenty
28:52
Speaker 1: of skepticism, which again is one of the reasons why
28:54
Speaker 1: my hat is off to Ted Katchuk because he has
28:57
Speaker 1: responded to the criticism. He's adjusted his methodolog g he's
29:00
Speaker 1: doing really good science in the investigation of the placebo effect.
29:04
Speaker 1: I like that guy. Still, skeptics say, there are a
29:08
Speaker 1: lot of things that you can use to explain away
29:11
Speaker 1: the placebo effect. For example, it's possible the person was
29:15
Speaker 1: actually a hypochondriac, they weren't actually sick in the first place. Yeah,
29:20
Speaker 1: It's possible that some people get better with no treatment.
29:24
Speaker 1: It's possible that some diseases do treat themselves, just get
29:29
Speaker 1: better over the course of time. And if if you
29:32
Speaker 1: overlay a placebo effect or a placebo and and you
29:36
Speaker 1: put that over the same course of time, it's gonna
29:39
Speaker 1: look like it was the placebo that did it, when
29:41
Speaker 1: really it's just heal itself. Yeah, which is why they
29:44
Speaker 1: critics call for studies where there is one UH group
29:48
Speaker 1: that has not given any medication whatsoever exactly, which makes sense.
29:52
Speaker 1: So UM. One of the other criticisms, though, is that
29:57
Speaker 1: if a doctor is is saying and there are, like
30:00
Speaker 1: you said, plenty of doctors who do this, UM. There
30:03
Speaker 1: there were studies that found that UM. A two thousand
30:06
Speaker 1: seven study from the University of Chicago found doctors surveyed
30:11
Speaker 1: in the Chicago area had prescribed placebos before at some
30:15
Speaker 1: point during their career. In two thousand and eight, they
30:18
Speaker 1: did a little more robust when six hundred doctors all
30:20
Speaker 1: across the US and half of them said that they
30:23
Speaker 1: had prescribed placebos. So this is like, this is still
30:27
Speaker 1: going on the thing. It's pretty widespread, and the criticism
30:30
Speaker 1: is well, that means doctors are lying to their patients.
30:33
Speaker 1: They're using deception to practice medicine, and that's unethical. So
30:38
Speaker 1: the A m A came out with it's a guideline
30:41
Speaker 1: that's kind of flies in the face of the placebo
30:43
Speaker 1: effector of the idea that if you give somebody a
30:45
Speaker 1: placebo and tell them it's a placebo, that it shouldn't work,
30:49
Speaker 1: which is not necessarily true. Yeah, in two thousand six,
30:52
Speaker 1: the AMY came out and said, uh, quote, physicians may
30:56
Speaker 1: use placebos for diagnosis or treatment only if they patient
31:00
Speaker 1: is informed and agrees to it. To me, that means
31:03
Speaker 1: it's not a placebo. I mean I guess it is,
31:06
Speaker 1: but if you know it is, I don't get it. Like,
31:09
Speaker 1: what's the point of a doctor coming in and saying,
31:11
Speaker 1: I'm going to give you the sugar pill? Would would
31:14
Speaker 1: you like a prescription for sugar pills, and you say, yes,
31:16
Speaker 1: I would. Supposedly, there are um studies that show the
31:21
Speaker 1: placebo effect is still works sometimes, but the across the board,
31:28
Speaker 1: pretty much everyone believes that if the placebo effect is
31:31
Speaker 1: a real thing, the cats out of the bag. It
31:33
Speaker 1: is part of the imagination, and that you do kind
31:36
Speaker 1: of have to fool the person into thinking that it's
31:38
Speaker 1: a real thing. That expectation coupled with imagination provides the
31:43
Speaker 1: placebo effect. Yeah, and this article points out to we're
31:46
Speaker 1: not just saying these doctors are lying liars um. Apparently,
31:51
Speaker 1: one one tech that a doctor can take is to say, uh,
31:55
Speaker 1: I have something that I think can help, but I
31:59
Speaker 1: don't know exactly know what the deal is with it
32:01
Speaker 1: or how it works, but i'll give it to you
32:03
Speaker 1: if you want to try it. And you know how
32:05
Speaker 1: people are a lot of people are like, sure, I'll
32:07
Speaker 1: try anything. Right Exactly, that's not really deception because if
32:11
Speaker 1: the doctors are prescribing a placebo he or she obviously
32:14
Speaker 1: does believe in the placebo effects, so here she does
32:17
Speaker 1: think it could work but doesn't know how, or if
32:20
Speaker 1: it only really does work in of the population, then
32:24
Speaker 1: you've got a seventy chance of striking out anyway with
32:27
Speaker 1: this course of treatment. Uh so you're back to where
32:31
Speaker 1: he started to begin with. Yeah, and again it's got
32:33
Speaker 1: that falls into what's the point category? Now again, we
32:36
Speaker 1: should say that a lot of physicians who do prescribe
32:39
Speaker 1: placebos aren't just doing it to toy with their patients.
32:42
Speaker 1: They're doing because they think that their patient will suffer
32:46
Speaker 1: more without it, or they just don't have anything that
32:51
Speaker 1: could be used to address the patient's problem, like they
32:54
Speaker 1: can't find anything medically wrong with the patient, but just
32:58
Speaker 1: saying that the patient's not going to help. So here's
33:00
Speaker 1: a sugar pill. UM. The other tech that a doctor
33:03
Speaker 1: can take to chuck is um to say, hey, new patient,
33:07
Speaker 1: welcome to my practice. Let me tell you about the
33:10
Speaker 1: placebo effect. And in the course of me treating you,
33:14
Speaker 1: sometime during your lifetime, I may find that a placebo
33:17
Speaker 1: will be the best thing to use. Are you okay
33:19
Speaker 1: with me doing that to you at some point possibly
33:23
Speaker 1: basically like signing up for my own personal U long
33:26
Speaker 1: term study kind of as a doctor. But wouldn't you
33:29
Speaker 1: from that point on be like you just gave me
33:31
Speaker 1: the placeboy, it's a placebo. I know it's a placebo.
33:34
Speaker 1: I wouldn't know which way was up, Like, I don't
33:36
Speaker 1: know how to feel. That's the better worse side effects? None, yep.
33:42
Speaker 1: And the other tech doctors can take is to knock
33:45
Speaker 1: off early and go hit the golf course, which they
33:47
Speaker 1: do that one a lot on TV. That's a that's
33:50
Speaker 1: a that's such an old bit trope. It's like, yeah,
33:53
Speaker 1: cops in their doughnuts? Is that doctors in golf? I
33:56
Speaker 1: think that was pretty accurate. I mean in Caddyshack, the
33:58
Speaker 1: doctor was Dr Beeper. He was the one who just
34:03
Speaker 1: got mad all the time, right now. That was Judge Smailes.
34:06
Speaker 1: Dr Beeper was he was just one of the guys,
34:10
Speaker 1: one of the foursome, okay that I think he played.
34:15
Speaker 1: Was it Buck Henry? Was he the doctor? No? I can't,
34:19
Speaker 1: I can. I can picture the guy. It's Buck Henry, right,
34:24
Speaker 1: I don't think so we'll figure this out offline. How
34:27
Speaker 1: about that? Yeah? All right? If you want to know
34:29
Speaker 1: more about the placebo effect, and believe us there is
34:32
Speaker 1: plenty more to know about it, you can type those
34:34
Speaker 1: two words in the search part how stuff works dot
34:36
Speaker 1: com and uh, since I said that, it's time for
34:40
Speaker 1: a listener mail. I'm gonna call this Australian last name.
34:45
Speaker 1: This is, he says, dear Josh, Chuck and Jerry and
34:49
Speaker 1: anyone else I should think, And I think we never
34:52
Speaker 1: mentioned other people that support us. Didn't we already talk
34:55
Speaker 1: about in Australian last name? Yeah, that was the joke. Okay,
34:59
Speaker 1: let's call the call back, gotcha. I just felt like
35:03
Speaker 1: this listener mail, though, made me realize that we don't
35:05
Speaker 1: think other folks a lot besides Jerry and like Noelan Matt.
35:08
Speaker 1: But um, let's do that noway. Like Rebecca h Rebecca
35:14
Speaker 1: is uh, what's her official title? I don't even know
35:16
Speaker 1: what titles are around producer web producer maybe yeah, I
35:20
Speaker 1: mean she handles our website. It makes everything look great.
35:24
Speaker 1: And Sherry, even though we do our own social media,
35:26
Speaker 1: Sherry does social media for how stuff works. And she
35:29
Speaker 1: throws to us a lot, throws to us and helps
35:30
Speaker 1: us out a lot. And Joe, our buddy, Joe is
35:33
Speaker 1: a huge help um, and that's kind of the crack staff.
35:37
Speaker 1: I mean, we're answering our own emails and we're doing
35:41
Speaker 1: a lot of our own stuff, but it doesn't mean
35:43
Speaker 1: we don't have help. You know what I'm saying. We
35:45
Speaker 1: have tons of help, so you know, I just want
35:46
Speaker 1: to say thanks to this. It's very nice if you
35:48
Speaker 1: chuck thanks everybody. I figured six years and seven years
35:51
Speaker 1: and we might as well shout out some of our help.
35:53
Speaker 1: Uh So this from Alex and he said to thank
35:55
Speaker 1: anyone else he doesn't know about. And he's from Perth,
35:58
Speaker 1: Western Australia, which is nothing like Eastern Australia. I'm a
36:03
Speaker 1: nineteen year old aspiring electrician trapped in the depths of
36:06
Speaker 1: Western Australia's mining downturn due to layoffs in the mining sector.
36:10
Speaker 1: Have been unable to find an apprenticeship and I would
36:13
Speaker 1: have lost hope if it weren't for you guys. I
36:15
Speaker 1: was just after New Year's It was just after New
36:17
Speaker 1: Year's January six when I came across the magical production
36:22
Speaker 1: called Stuff You Should Know um As. At the time
36:25
Speaker 1: of this writing, it is May tent uh and I
36:28
Speaker 1: have finished the epic adventure of six hundred episodes plus.
36:33
Speaker 1: That's in a very short time, my friend. It's been
36:36
Speaker 1: an amazing journey and I want to thank you for
36:38
Speaker 1: pulling me through the hard days of resume writing and
36:41
Speaker 1: delivering long days of waiting. Uh Previously we're mind numbing,
36:44
Speaker 1: but have since been filled with interesting, insightful, and overall
36:47
Speaker 1: incredible enjoyable content. My favorites gene patents, lobotomies, and the
36:52
Speaker 1: masterfully dictated Halloween episodes. We like those two. Those are
36:57
Speaker 1: some of my favorites. Christmas. I think it's the best
37:00
Speaker 1: uh so que the exist existential crisis. After um, you
37:03
Speaker 1: guys forming such an integral part of my life over
37:06
Speaker 1: the past five months, I don't know I'm going to
37:08
Speaker 1: acclimate myself to just to a week. Um. And we
37:12
Speaker 1: hear that a lot from people who mainline the show. Yeah,
37:14
Speaker 1: there's like a withdrawal period. Yeah, and I've done that
37:18
Speaker 1: with TV shows, you know. I do that for sure.
37:22
Speaker 1: You mainline it and then you're like, well I need it. Yeah. Um.
37:26
Speaker 1: I would just like to sincerely say thank you to
37:28
Speaker 1: both of you and Jerry and anyone else for pulling
37:30
Speaker 1: me through these times, and hope the future contains a
37:32
Speaker 1: stable job for myself, more content for yourselves to pass
37:35
Speaker 1: on to the stuff you should know, Army, and an
37:37
Speaker 1: ever growing fan base that you can both woo with
37:39
Speaker 1: your dulcet tones. And then lightening information. Yours faithfully, That
37:43
Speaker 1: is Alex gettings from Peth. Thanks Alec, Alex, Yeah, yeah,
37:48
Speaker 1: thank you very much. Will you get a job buddy,
37:51
Speaker 1: Yeah for sure. If you're in Perthon you're looking for
37:53
Speaker 1: an electrician, contact Alex. He's shockingly good. Nice sit there.
38:00
Speaker 1: We're ending on that one. If you want to get
38:02
Speaker 1: in touch with us, you can tweet to us at
38:05
Speaker 1: s y s K podcast. You can join us on
38:07
Speaker 1: Facebook dot com, slash stuff you Should Know. You can
38:09
Speaker 1: send us an email to Stuff Podcast at how stuff
38:12
Speaker 1: works dot com, and as I always join us at
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Speaker 1: at home on the web, Stuff you Should Know dot com.
38:22
Speaker 1: For more on this and thousands of other topics, is
38:25
Speaker 1: that how stuff Works dot com