WEBVTT - The Shocking Power of the Placebo Effect! 0:00:03.760 --> 0:00:04.720 Now Really. 0:00:06.720 --> 0:00:11.440 Really Real Hello, and welcome to Really Know Really, with 0:00:11.560 --> 0:00:14.680 Jason Alexander and Peter Tilden, who note that subscribing to 0:00:14.720 --> 0:00:18.120 our show has improved the health of our subscribers, or 0:00:18.280 --> 0:00:20.759 at least it seems that way, because as much as 0:00:20.840 --> 0:00:23.200 we'd love you to subscribe, it might just be a 0:00:23.239 --> 0:00:24.759 case of the placebo effect. 0:00:25.800 --> 0:00:27.880 A recent YouTube video shows. 0:00:27.640 --> 0:00:31.880 College freshmen acting obviously intoxicated after drinking what they were 0:00:31.880 --> 0:00:36.400 told were several beers, but the beers were completely non alcoholic, 0:00:36.520 --> 0:00:39.440 hence the placebo effect, which refers to a fake treatment 0:00:39.479 --> 0:00:42.199 of ailments by administering sugar pills in place of an 0:00:42.240 --> 0:00:46.320 actual medication that is nonetheless successful. So how does it 0:00:46.360 --> 0:00:49.240 work and how can it be so powerful and defective? 0:00:49.479 --> 0:00:52.000 To answer that and other questions, we sought out the 0:00:52.000 --> 0:00:56.320 world's foremost expert on placebos, doctor Luana Coloca, And what 0:00:56.400 --> 0:00:59.880 we found out is a prescription for a fascinating episode 0:01:00.280 --> 0:01:02.120 or a viable substitute anyway. 0:01:02.360 --> 0:01:04.520 And now here are two guys who are almost as 0:01:04.520 --> 0:01:06.640 good as the real thing, Jason and Peter. 0:01:08.440 --> 0:01:11.559 There is a product that Jerry Seinfeld does a great 0:01:11.640 --> 0:01:14.880 routine about that actually is a good pick me up 0:01:14.920 --> 0:01:19.759 for me, is the five hour energy shot works? I 0:01:19.800 --> 0:01:26.119 find it works. As Jerry said, why five hours five 0:01:26.160 --> 0:01:29.600 hours of energy? You need an hour, two hours, four hours, 0:01:29.920 --> 0:01:34.960 six or eight hours? Who needs five hours? They probably 0:01:34.959 --> 0:01:38.319 did research that said, oh people, people will like the title. 0:01:38.200 --> 0:01:40.959 Five five hours, five. 0:01:40.240 --> 0:01:42.440 Hours, seven hour energy drinking. I don't have, Yeah, I 0:01:42.480 --> 0:01:43.560 don't doing anything that long. 0:01:43.760 --> 0:01:44.839 Six hours hard to say. 0:01:45.040 --> 0:01:48.920 Two hours, you know, one hour, two hours you barely 0:01:48.920 --> 0:01:53.080 get through late. I'm just thinking if they told me 0:01:53.120 --> 0:01:55.600 it was a five hour energy shot, and I drank 0:01:55.640 --> 0:01:58.840 it and it was grape juice, but I go. 0:02:00.320 --> 0:02:03.240 Well, and that discussed. Today's episode is about the power 0:02:03.280 --> 0:02:08.359 of nothing right placebo effect, which basically started. I should 0:02:08.400 --> 0:02:12.680 mention that it's being recognized as powerful enough that the 0:02:12.680 --> 0:02:17.160 American Medical Association considers it ethical to use placebos to 0:02:17.280 --> 0:02:19.839 enhance healing on their own. I was trying to find 0:02:19.880 --> 0:02:23.280 something to denote how powerful this can be. So a 0:02:23.320 --> 0:02:25.440 twenty six year old man was taken to an emergency 0:02:25.520 --> 0:02:28.560 room after arguing with his girlfriend. He attempted suicide by 0:02:28.560 --> 0:02:31.679 swallowing twenty nine capsules of an experimental drug that he 0:02:31.720 --> 0:02:35.240 obtained from a clinical trial that he was testing on antidepressants. 0:02:35.240 --> 0:02:39.000 When he arrived at the hospital, he was sluggish, shaking, sweating, 0:02:39.040 --> 0:02:42.120 had rapid breathing. His blood pressure was extremely low eighty 0:02:42.160 --> 0:02:46.600 over forty, and his pulse was one ten doctors who 0:02:46.639 --> 0:02:49.600 are finally successful at raising his blood pressure. Over the 0:02:49.639 --> 0:02:51.840 course of four hours, they injected him with six leaders 0:02:51.880 --> 0:02:55.520 of saline solution. His blood pressure increased to one hundred 0:02:55.560 --> 0:02:57.280 and over sixty two, which is at the lower end 0:02:57.320 --> 0:03:00.560 of the normal range, but his pulse remained high. On six. 0:03:01.200 --> 0:03:04.880 What finally cured the patient wasn't anything the hospital emergency 0:03:04.960 --> 0:03:07.440 room staffed it. Instead, a doctor from the clinical trial 0:03:07.520 --> 0:03:10.200 arrived at the hospital. He told the patient that those 0:03:10.240 --> 0:03:13.960 antidepressant tolls weren't antidepressants because he had been randomized into 0:03:14.000 --> 0:03:17.440 the control arm of the trial, he had overdosed on placebos. 0:03:18.000 --> 0:03:21.040 Within fifteen minutes, the patient's blood pressure stabilized at one 0:03:21.120 --> 0:03:23.720 twenty six over eighty and his heart rate dropped to 0:03:23.760 --> 0:03:26.760 a perfectly normal eighty beats per minute, which shows you 0:03:26.880 --> 0:03:31.320 the power of thinking you've taken something that he can 0:03:31.360 --> 0:03:37.440 actually physically manifest itself. An overdose of placebo. The guy 0:03:37.480 --> 0:03:39.360 thought he was going to die, and it actually took 0:03:39.440 --> 0:03:40.760 yeah pretty pretty amazing. 0:03:40.800 --> 0:03:43.480 So that's that's a power that cut in all directions, 0:03:43.520 --> 0:03:48.120 Like if I if I want to tell myself that 0:03:48.160 --> 0:03:52.080 the chocolate cake I ate was really just a placebo, 0:03:53.000 --> 0:03:58.520 will I not Will my insulin level not spike? Will 0:03:58.600 --> 0:04:01.640 my beltline not expand? 0:04:03.960 --> 0:04:06.120 But the placebo effect, And they're also said there's a 0:04:06.160 --> 0:04:09.200 no cebo effect, which is the opposite, which is about 0:04:09.240 --> 0:04:10.600 believing that something's bad for you. 0:04:11.080 --> 0:04:12.920 Well, I have a question for our guess because I 0:04:13.760 --> 0:04:16.880 was once in a desperate situation given a drug that 0:04:17.080 --> 0:04:18.760 was the only thing that solved it. But I want 0:04:18.760 --> 0:04:22.400 to know if it could have been solved with because 0:04:22.400 --> 0:04:25.120 it is a pain management thing, and that is an 0:04:25.160 --> 0:04:28.400 area that pusedly. Placebos have had a great deal of efficacy. 0:04:28.760 --> 0:04:31.599 And by the way, seventeen ninety nine is the beginning 0:04:31.640 --> 0:04:34.240 when a British physician named John Hagar set out the 0:04:34.320 --> 0:04:39.039 test this quack remedy. It was expensive metal rods named 0:04:39.120 --> 0:04:42.760 perkinstractors that purported to draw disease in the body, and 0:04:42.800 --> 0:04:46.320 he pitted the metal rods against wooden rods that looked 0:04:46.320 --> 0:04:50.760 the same. Four or five patients with rheumatism reported that 0:04:50.839 --> 0:04:52.280 the pain improved. 0:04:51.880 --> 0:04:57.240 Well, that is supposedly the science behind natural healers or 0:04:57.279 --> 0:04:58.720 shamanistic healers, and a. 0:04:58.640 --> 0:04:59.240 Lot of it is. 0:04:59.520 --> 0:05:02.120 You know, there was one one thing I read in 0:05:02.160 --> 0:05:05.760 the research you sent me that said, left alone nothing, 0:05:05.839 --> 0:05:06.600 you don't do anything. 0:05:07.760 --> 0:05:09.760 Three out of five times people just get better. 0:05:09.839 --> 0:05:13.839 Nature takes nature. So if you if you say, oh, oh, 0:05:13.880 --> 0:05:14.560 I'm making. 0:05:14.320 --> 0:05:17.760 You better, I'm making gaha making you better. 0:05:19.200 --> 0:05:22.599 Along with natural feeling, the mind goes, oh, I do 0:05:22.720 --> 0:05:23.040 you know what? 0:05:23.120 --> 0:05:24.080 I feel a little better? 0:05:24.120 --> 0:05:27.640 And that that that is you know, I say what 0:05:27.760 --> 0:05:32.640 acupuncture may be or acupressure or reiki or shaman is. 0:05:32.600 --> 0:05:35.760 The minerals that you take forever. But man, I say something, 0:05:36.040 --> 0:05:38.160 I feel a little better. Whatever you did, what I 0:05:38.200 --> 0:05:39.520 just did to you, I feel a lot of that. 0:05:39.720 --> 0:05:44.520 That's the ancient practice of BS. 0:05:45.520 --> 0:05:50.160 But it is fascinating how the mind, the mind actually 0:05:50.320 --> 0:05:51.400 can heal itself. 0:05:51.800 --> 0:05:55.520 So we went out and found a placebo expert. 0:05:56.120 --> 0:05:57.760 Yeah, why wouldn't we do that? 0:05:57.800 --> 0:05:59.960 Why wouldn't we Why wouldn't we could stop in this? 0:06:00.400 --> 0:06:02.599 Why would they agree come on our show? 0:06:02.720 --> 0:06:05.000 Hey, we have said every episode I. 0:06:04.960 --> 0:06:05.960 Know we have with us today. 0:06:06.000 --> 0:06:10.039 Doctor Lewana Coloca is an empowered distinguished professor at the 0:06:10.120 --> 0:06:13.599 University of Maryland and the director of the Placebo Beyond 0:06:13.760 --> 0:06:16.920 Opinions Center, which I need to find out more about. 0:06:17.800 --> 0:06:21.800 It's at NIH funded, internationally recognized expert. Doctor Klocha and 0:06:21.839 --> 0:06:26.080 her team research human pain modulation in patients suffering from 0:06:26.200 --> 0:06:30.200 chronic pain, hoping to deepen understanding of placebo and no 0:06:30.360 --> 0:06:32.680 Cibo effects, which is what we've been talking about. She 0:06:32.760 --> 0:06:35.360 has an MD, a PhD in neuroscience, a master's degree 0:06:35.400 --> 0:06:39.560 in neuron Oh my god, she's done postdoctoral training at 0:06:39.560 --> 0:06:42.280 the Brain Imaging Center in Stockholm, Sweden. And it is 0:06:42.320 --> 0:06:45.880 a pleasure to welcome you, to really know, really, doctor 0:06:45.960 --> 0:06:46.720 Lewana Kaloka. 0:06:46.800 --> 0:06:49.080 Nice to see you, Thank you very much. 0:06:50.040 --> 0:06:51.760 So I wanted to just alert you the fact that 0:06:51.800 --> 0:06:54.000 I just told a story that I thought was one 0:06:54.000 --> 0:06:56.120 of the better examples of the guy who overdosed when 0:06:56.120 --> 0:06:58.960 placebo went to the hospital and because he took all 0:06:59.000 --> 0:07:02.320 the antidepressants and his blood pressure, everything responded as if 0:07:02.320 --> 0:07:05.440 he had overdosed until the doctor said you were in 0:07:05.520 --> 0:07:09.240 the placebo group, and then within fifteen minutes to adjust it. 0:07:09.279 --> 0:07:11.800 And that kind of is the most dumb down way, 0:07:11.880 --> 0:07:14.400 easiest way to show the power of the brain that 0:07:14.480 --> 0:07:18.520 the brain believes something, it can actually create physiological response 0:07:19.080 --> 0:07:21.880 to something that's not happening, which is insane. 0:07:22.400 --> 0:07:25.880 The brain is very powerful and still one of the 0:07:26.000 --> 0:07:31.240 organs will know less. So we truly excited to use 0:07:31.240 --> 0:07:33.960 plusy boats as a tool to understand how the brain 0:07:34.360 --> 0:07:36.160 can influence body responses. 0:07:36.440 --> 0:07:40.080 Was there a particular bit of research or an event 0:07:40.200 --> 0:07:43.240 that because you really this is like part of your 0:07:43.240 --> 0:07:46.480 full time work in research, was there something that just 0:07:46.560 --> 0:07:48.520 made you go, oh, I just want to know more 0:07:48.560 --> 0:07:49.960 about this placebo thing. 0:07:50.640 --> 0:07:55.440 Actually there is. I was a fresh PhD student and 0:07:55.760 --> 0:07:59.440 I had to finish my medical degree since a few 0:07:59.480 --> 0:08:04.520 months and I started starting plasive effects with Parkinson patients 0:08:05.000 --> 0:08:09.760 receiving a very complex surgical procedure that we call diffibent stimulation. 0:08:10.880 --> 0:08:14.000 I was very skeptical. I even told my. 0:08:14.000 --> 0:08:19.600 Mentor I wanted to do science that really matters, and 0:08:19.880 --> 0:08:23.840 I didn't feel like Placibo is exactly that in those 0:08:23.840 --> 0:08:29.640 science until I was in the interpretative room and we 0:08:29.720 --> 0:08:35.319 started recording neurons from a patient with only local ants teacher, 0:08:35.440 --> 0:08:38.800 so it was collaborating with pass and so on, and 0:08:38.840 --> 0:08:44.480 then we gave a Placibo that was subercutaneous injection of 0:08:44.679 --> 0:08:46.920 the fake doose of dopamine. 0:08:46.960 --> 0:08:50.440 Actually it was just a selling solution, and we started 0:08:50.440 --> 0:08:55.760 recording and the spike of the neurons decreased as if 0:08:56.600 --> 0:09:02.240 we had given the active treatment. They add apomorphine, which 0:09:02.320 --> 0:09:03.199 is shocking. 0:09:04.640 --> 0:09:05.440 It was shocking. 0:09:05.840 --> 0:09:09.280 So you're saying instead of dopamine, you gave it fake dopamine. 0:09:09.640 --> 0:09:10.199 Exactly. 0:09:10.880 --> 0:09:14.240 The patients heard better, they said, oh, I feel better, 0:09:14.840 --> 0:09:19.600 might remor disappear. A neurologist enter into the room to 0:09:19.679 --> 0:09:24.280 assess the rigidity and was also decreased. The most important 0:09:24.360 --> 0:09:28.520 for me as neurophysiologist, I was on the left side 0:09:28.679 --> 0:09:32.560 before the equipment. See the spike of the neurons, and 0:09:32.600 --> 0:09:37.880 the spike become flower and as if we had given 0:09:38.000 --> 0:09:39.040 the active treatment. 0:09:39.480 --> 0:09:42.840 So it wasn't just the patient's experience. 0:09:43.040 --> 0:09:48.040 You could actually see that the body was responding neurologically 0:09:48.080 --> 0:09:49.520 as if it had received. 0:09:49.120 --> 0:09:49.600 The real thing. 0:09:50.320 --> 0:09:53.679 I love that you say that, because as a NEUROSCIENTI 0:09:54.240 --> 0:09:57.920 I want something changing in the brain for me as 0:09:58.000 --> 0:10:01.920 much as as physician opinion of a patient. The release 0:10:02.000 --> 0:10:07.720 of I want something true, you know, so objective, and 0:10:08.200 --> 0:10:13.640 that objective sign was the reduction of the spike and 0:10:13.720 --> 0:10:18.560 the neuronal activity as if the patient had receive an 0:10:18.600 --> 0:10:22.480 active treatment. So for me, when we go wine all 0:10:22.559 --> 0:10:26.719 the results, the clinical evidence and the objective evidence, but 0:10:26.880 --> 0:10:29.240 me pujective evidence it's real. 0:10:29.840 --> 0:10:33.080 So you mentioned something in that example that I that 0:10:33.160 --> 0:10:36.720 I want to ask about. Years ago, I started getting 0:10:36.800 --> 0:10:39.880 kidney stones and the first time I got one, I 0:10:39.960 --> 0:10:43.040 was I was on a set and I was being 0:10:43.040 --> 0:10:47.280 treated with vicodin. I it wasn't working, and eventually I 0:10:47.360 --> 0:10:51.040 was rushed to the hospital. Now, I have never in 0:10:51.080 --> 0:10:53.960 my life prior to this moment, had morphine. 0:10:54.480 --> 0:10:57.400 But vicodin wasn't helping. Nothing was helping this pain. 0:10:57.920 --> 0:11:01.199 All of a sudden, they gave me morphine and instantaneously 0:11:01.400 --> 0:11:05.400 my pain disappeared. My question to you is if they 0:11:05.400 --> 0:11:10.120 had just told me I was getting morphine, would I 0:11:10.160 --> 0:11:13.240 have had the pain reduction? Even though I don't know 0:11:13.280 --> 0:11:14.560 what morphine feels like. 0:11:16.679 --> 0:11:19.920 Some patients respond very well even if they never had 0:11:19.960 --> 0:11:25.920 the experience. Some other patients may not. But the Blasibo 0:11:26.000 --> 0:11:30.760 research started with beech Air that was an anesthesiologist working 0:11:30.960 --> 0:11:36.040 with saltiers in Sicily during the Second World WARLD and 0:11:36.280 --> 0:11:40.440 it odd soldiers this is morphine your pain will be released, 0:11:41.000 --> 0:11:45.079 and the observe that some patients were able to manage 0:11:45.120 --> 0:11:49.200 their pain, do not feel pain, whether some patients do 0:11:49.320 --> 0:11:52.280 not do that, and that is one of the main 0:11:52.320 --> 0:11:55.560 line of research in my lab currently. We are interested 0:11:55.679 --> 0:11:58.719 to know where this lucky one and those people a 0:11:58.800 --> 0:12:00.000 little bit less if. 0:12:00.040 --> 0:12:02.160 People, yeah, well you also did you did the thing 0:12:02.160 --> 0:12:04.280 that was fascinating to me where I know you did 0:12:04.280 --> 0:12:06.760 the pain experiment where you would show a red light 0:12:06.880 --> 0:12:09.200 when you when you hit people with a certain voltage, 0:12:09.520 --> 0:12:11.839 and a green light when it was low. And after 0:12:11.880 --> 0:12:14.640 a while you started messing with it and doing the 0:12:14.679 --> 0:12:17.320 high voltage but showing them green, and they didn't feel 0:12:17.360 --> 0:12:19.880 the pain that they had registered that they felt when 0:12:19.880 --> 0:12:22.000 it was a red light. So the mind was told 0:12:22.040 --> 0:12:25.240 to associate low with green and it adjusted. 0:12:26.120 --> 0:12:31.120 We observe the fifty five percentage of people responding to that. 0:12:31.760 --> 0:12:35.040 It's a huge number. We don't even get this proportion 0:12:35.160 --> 0:12:39.160 of responder when we run a try and or pharmacological 0:12:39.200 --> 0:12:44.600 treatment of paint. Five is a very large proportion and 0:12:45.160 --> 0:12:50.800 it may explain why many trials for pain, chronic acute 0:12:50.840 --> 0:12:57.120 pain pain because the placebo response is so relevant. That's 0:12:57.280 --> 0:13:00.880 somehow creating what we would call it sell effects. It 0:13:01.160 --> 0:13:03.800 masks the effects of the active treatment. 0:13:04.160 --> 0:13:08.360 If the results are so good, do doctors ethically can 0:13:08.440 --> 0:13:09.920 they prescribe a placebo. 0:13:10.640 --> 0:13:14.800 We call this open labeled placibo, telling patients we give 0:13:14.880 --> 0:13:19.360 you placypo And over the last you know, five seven years, 0:13:19.400 --> 0:13:24.000 several labs have published that even placibo and telling patients 0:13:24.040 --> 0:13:30.120 they're taking placibo improve different kind of pain disorders, no 0:13:30.320 --> 0:13:38.000 back pain as their tritis, irritable bowel syndrome related the pain. 0:13:38.840 --> 0:13:43.240 And we felt too bad to let them go without anything. 0:13:44.080 --> 0:13:48.280 So what do we start doing was telling a patient, look, 0:13:48.400 --> 0:13:53.200 that is how you respond in this cant while we 0:13:53.280 --> 0:13:57.640 were running this brain imaging experiment, and we offer you 0:13:57.720 --> 0:14:03.400 the possibility to continue to benefit in another way. The 0:14:03.480 --> 0:14:08.160 only way we have to give you placimbol. And you 0:14:08.320 --> 0:14:12.120 understand this are placibo that you will bring home and 0:14:12.200 --> 0:14:15.559 you will take for forty five days. So we start 0:14:15.720 --> 0:14:21.480 doing that. The results are amazing. Their clinical pain decrease 0:14:21.720 --> 0:14:28.440 when they receive open label placibo, and they understood, they 0:14:28.560 --> 0:14:33.760 verbalized get it. They still respond that's that is not 0:14:34.000 --> 0:14:38.040 one day, you know. 0:14:36.480 --> 0:14:38.440 So you're sending a home with forty five days of 0:14:38.480 --> 0:14:41.720 sugar pills and their pain is still gone, even though 0:14:41.720 --> 0:14:45.240 I know that it's sugar pills. Is it is it? 0:14:45.320 --> 0:14:47.560 Is there a guess? Is it the attention they're getting? 0:14:47.600 --> 0:14:49.040 Is it the treatment that they're getting. 0:14:49.400 --> 0:14:52.760 We have several control groups and still they receive the 0:14:52.800 --> 0:14:57.200 attention because we were monitoring people without we call no 0:14:57.480 --> 0:15:01.200 LP without any placibo. So the people that is the 0:15:01.320 --> 0:15:06.040 more were, you know, monitoring daily the information and the 0:15:06.120 --> 0:15:11.200 interaction with my team, they didn't improve. So there must 0:15:11.400 --> 0:15:17.040 be something in the action of choosing to take up 0:15:17.080 --> 0:15:25.480 placbo that trigger probably again this endogenous mechanism more healing. 0:15:26.320 --> 0:15:29.240 After Could has anyone tried or do you do you 0:15:29.520 --> 0:15:32.880 speculate that this could work the other way? So, for instance, 0:15:33.360 --> 0:15:36.560 if you have a patient who is now addicted to 0:15:36.640 --> 0:15:44.480 an opioid, is there has anyone tried a placebo opioid 0:15:44.720 --> 0:15:49.080 to sort of get them off opioids where their mind 0:15:49.160 --> 0:15:51.800 is thinking, well, I'm still getting this thing, but in 0:15:51.800 --> 0:15:52.560 fact they are not. 0:15:53.960 --> 0:15:54.360 This is. 0:16:04.560 --> 0:16:09.920 Has anyone tried a placebo opioid to sort of get 0:16:09.960 --> 0:16:13.280 them off opioids where their mind is thinking, well, I'm 0:16:13.320 --> 0:16:15.960 still getting listening, but in fact they are not. 0:16:17.360 --> 0:16:20.960 This is brilliant and it should be the next line 0:16:20.960 --> 0:16:25.080 of research to try to use placebo to taper the 0:16:25.160 --> 0:16:30.080 opioids or help those people. So today we don't have 0:16:30.160 --> 0:16:35.160 any trial begin done with open label placibo, and it 0:16:35.320 --> 0:16:39.760 is still an open question. And the challenge has been 0:16:39.840 --> 0:16:43.520 and the offer this podcast will help to be contacted 0:16:43.680 --> 0:16:47.680 from many patients who use opioids to manage their pain. 0:16:48.200 --> 0:16:53.320 The challenge is to enroll patients who use oois and 0:16:53.600 --> 0:16:59.320 that has been the you know, difficulties so far, but 0:17:00.240 --> 0:17:03.840 we do want to do that. We do to enroll 0:17:03.920 --> 0:17:08.120 patients to work with us because this is literally an alliance, 0:17:08.160 --> 0:17:11.480 a partnership where we want to see how the brain 0:17:11.680 --> 0:17:16.280 can play a or in helping managing given situations that 0:17:16.359 --> 0:17:17.440 are very difficult. 0:17:17.880 --> 0:17:20.520 Does this have to do also, because again there's a 0:17:20.600 --> 0:17:23.520 novel effect, which is if you're negative and you believe 0:17:23.560 --> 0:17:25.399 it's not going to work. Does this have to do 0:17:25.480 --> 0:17:27.280 with a level of I mean there are different levels 0:17:27.320 --> 0:17:30.880 of positiveness in people and dourness and sadness and depression 0:17:31.520 --> 0:17:35.200 that other people are more apt because they're more positive, 0:17:35.320 --> 0:17:36.520 they're more hopeful. 0:17:37.600 --> 0:17:37.800 Yes. 0:17:38.040 --> 0:17:43.480 Absolutely, What do we consistently see is that those people 0:17:43.520 --> 0:17:49.840 who tended to be distress fearful tend to have lower 0:17:49.880 --> 0:17:56.360 expectations of benefit, and often they also have lower plasive effects. 0:17:56.400 --> 0:18:02.199 But what is interesting is that place ebo somehow, or 0:18:02.560 --> 0:18:06.000 even in people without any of we see people that. 0:18:06.119 --> 0:18:09.600 We ask you know, how much do you wish to improve? 0:18:09.920 --> 0:18:10.320 As well? 0:18:10.400 --> 0:18:14.200 Letter everything? I have zero, there is nothing that can 0:18:14.240 --> 0:18:17.200 help me. Well, when we do this rhet the green 0:18:17.960 --> 0:18:24.320 exposure to reduction of pain, we can observe plasive effects 0:18:24.359 --> 0:18:28.280 even in hopeless people, people who don't believe, people who 0:18:28.359 --> 0:18:32.520 don't have anymore desire a drive to. 0:18:32.560 --> 0:18:36.159 Improve our people are doctors right now writing prescriptions for 0:18:36.560 --> 0:18:37.600 policles for people. 0:18:39.640 --> 0:18:42.240 No, I don't think so not yet, So I. 0:18:42.160 --> 0:18:44.640 Can't go to the CBS yet. 0:18:45.720 --> 0:18:46.600 I'm generic. 0:18:49.040 --> 0:18:52.919 Some of my colleagues hope that that will be the 0:18:52.960 --> 0:18:56.920 next step that at least in the States, we're not there. 0:18:57.800 --> 0:19:02.320 You can't prescribe about as. 0:19:01.880 --> 0:19:03.879 There is something that I have done for years that 0:19:03.960 --> 0:19:08.360 I discovered I could do and it has been very 0:19:08.359 --> 0:19:09.000 helpful to me. 0:19:09.080 --> 0:19:10.720 So I don't get migraines. 0:19:10.280 --> 0:19:12.520 But you know, like anybody, I get a headache now 0:19:12.520 --> 0:19:14.640 and then if I take a pain reliever it's great. 0:19:14.760 --> 0:19:16.560 It knocks my headache out, but there are times when 0:19:16.600 --> 0:19:19.280 I don't have it nearby. So I have been able 0:19:19.359 --> 0:19:25.040 to mentally change the sensation of pain to a sensation 0:19:25.160 --> 0:19:31.439 of pressure. And when it's pressure it it doesn't. I 0:19:31.520 --> 0:19:33.560 just say to myself, Okay, where does it hurt. Okay, 0:19:33.600 --> 0:19:36.320 it hurts right there. So don't think of it as 0:19:36.359 --> 0:19:40.720 like this throbbing, radiating thing that's irritating your nerves. Think 0:19:40.760 --> 0:19:44.560 of it as literally someone is pushing from the inside, 0:19:44.560 --> 0:19:47.479 like a massage from the inside. It's just pushing on 0:19:47.520 --> 0:19:49.560 that spot and what you're feeling is the tenderness of 0:19:49.600 --> 0:19:50.040 the spot. 0:19:50.400 --> 0:19:51.480 And by doing that. 0:19:52.880 --> 0:19:56.720 Emotionally, I don't go oh something, you know, it's like 0:19:56.800 --> 0:20:00.280 when you Sometimes it can actually take the headache away. 0:20:01.160 --> 0:20:03.800 What it can certainly do is keep me at a 0:20:03.800 --> 0:20:06.000 place where I'm very comfortable until I can get to 0:20:06.080 --> 0:20:07.960 a place where I can lie down on a massage 0:20:07.960 --> 0:20:10.280 ball or get to a pain reliever. 0:20:11.040 --> 0:20:15.919 The experience is shed is so important because in chronic 0:20:16.000 --> 0:20:19.119 pain patient or those who have even acute pain, this 0:20:19.280 --> 0:20:23.520 scene can be amplified by the level of attention with pain. 0:20:24.240 --> 0:20:28.080 So when you describe the lack of ability to have 0:20:28.280 --> 0:20:31.160 the drug. You know, the logos of control. You want 0:20:31.240 --> 0:20:34.120 to be in control, so you say, okay, in one hour, 0:20:34.200 --> 0:20:36.920 I will be home. I can lie down and I 0:20:37.040 --> 0:20:41.560 feel better. And many times we take up and kill 0:20:41.760 --> 0:20:47.560 immediately because we want Somehow, this feeling of pen reduction 0:20:48.400 --> 0:20:52.600 and the response also can occur quite fast, even before 0:20:53.480 --> 0:20:58.080 you know we metabolized to that medication. Feeling that how 0:20:58.160 --> 0:21:02.040 the placebo component is power fully. You know, many time 0:21:02.240 --> 0:21:07.199 we experience an lgsmmediately after taking appeal. That is a 0:21:07.240 --> 0:21:12.240 ready deplasible component. Also, it is interesting that we panic 0:21:12.440 --> 0:21:16.560 when we don't have access to a bankiller. Unfortunately, for 0:21:16.720 --> 0:21:22.440 many patients this sort of ability to tackle the inner 0:21:25.080 --> 0:21:30.639 mechanism of descending modulation of a pain become a very 0:21:31.400 --> 0:21:35.760 unusual or difficult because they never tried or they never 0:21:35.840 --> 0:21:39.719 were told of, and so the action of them is 0:21:39.880 --> 0:21:43.600 taking appill immediately and then if the first doesn't work, 0:21:44.000 --> 0:21:47.679 taking two or three or four and then escalating to 0:21:47.760 --> 0:21:54.320 the next more powerful pain medication that mechanism can create. 0:21:54.880 --> 0:21:59.920 You know, this sort of need of escalating and multitaire 0:22:00.160 --> 0:22:03.560 be and so on. That is why I still believe 0:22:03.680 --> 0:22:07.440 that even treatments that may work by virtual of placbo 0:22:07.520 --> 0:22:12.280 mechans so important as long as they empower a patient 0:22:13.160 --> 0:22:18.560 to be able to harness what I love to call informacy. 0:22:18.880 --> 0:22:19.560 We all have that. 0:22:21.359 --> 0:22:24.200 Has anyone this is good? This is my last question, 0:22:24.320 --> 0:22:27.000 because you're gonna all judge me. I don't want to 0:22:27.040 --> 0:22:29.119 judge you anyway, because I don't want to be judged. 0:22:29.400 --> 0:22:33.000 So we've been talking about Placibo's primarily for pain management. 0:22:34.680 --> 0:22:38.960 For a patient that would have to take viagra, mm hmm, 0:22:39.800 --> 0:22:43.600 if you give them a placebo viagra, do they get 0:22:43.640 --> 0:22:44.640 the desired effect? 0:22:46.119 --> 0:22:48.080 Probably they will. 0:22:48.680 --> 0:22:51.880 I mean, has anyone to your knowledge as anyone, don't 0:22:52.000 --> 0:22:54.840 don't research on that because I also think I have 0:22:54.920 --> 0:22:58.800 to assume a large part of that result is psychological. 0:23:00.640 --> 0:23:04.480 Absolutely, there are studies showed that side the effects of 0:23:04.760 --> 0:23:10.760 treatment for prostate cancer that actually, you know, delifless the 0:23:10.760 --> 0:23:16.600 physician described have reduction of a libido and sexual dysfunction. 0:23:17.160 --> 0:23:20.800 So those patients who are alect about the side effects 0:23:20.840 --> 0:23:26.280 of cancer related the therabists tended to experience a larger 0:23:26.320 --> 0:23:30.600 amounts of side effects for dysfunction compared to those patients 0:23:30.640 --> 0:23:34.720 who were taught in a different way or even not 0:23:34.960 --> 0:23:42.080 told about the side effects related to sexual functions. So 0:23:42.160 --> 0:23:47.720 they're literally the mind somehow influence in both the positive 0:23:47.760 --> 0:23:51.359 and negative way, and the azybol the bar between of 0:23:51.440 --> 0:23:57.400 the placebo works in a more you know, effective way. 0:23:57.480 --> 0:24:00.000 I mean when we need that. If someone tells us 0:24:00.040 --> 0:24:04.040 you will experience the science of defense, this will become self 0:24:04.080 --> 0:24:06.160 profit most all the time. 0:24:07.119 --> 0:24:09.800 Belief is the oldest medicine known command. So thank you, 0:24:09.960 --> 0:24:12.320 thank you very much for coming on, and work faster 0:24:12.440 --> 0:24:12.840 and harder. 0:24:12.880 --> 0:24:15.919 Would you please or at least believe you believe you are. 0:24:16.000 --> 0:24:17.840 Yes, we believe you are and that will that will 0:24:17.840 --> 0:24:21.239 help Jason, And thank you for coming on. 0:24:21.560 --> 0:24:23.080 Thank you doctically. 0:24:22.480 --> 0:24:24.680 Appreciate your work than you you. 0:24:34.119 --> 0:24:36.240 Just inside you may you may need to placey of 0:24:36.400 --> 0:24:39.800 us for the for for little j Why. 0:24:39.760 --> 0:24:43.520 Can't I can I not be spec with it? Why 0:24:43.560 --> 0:24:45.120 do you know what I see? 0:24:45.160 --> 0:24:48.080