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SYSK Selects: How the Placebo Effect Works · Stuff You Should Know

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