WEBVTT - How the Placebo Effect Works 0:00:01.080 --> 0:00:04.520 Welcome to Stuff you should know from house Stuff Works 0:00:04.519 --> 0:00:13.160 dot com. Hey, and welcome to the podcast. I'm Josh Clark, 0:00:13.200 --> 0:00:17.200 and there's Charles W. Chuck Bryant, and there's Jerry. Jerry 0:00:17.880 --> 0:00:25.560 the placebo do sir? No, No, that was bad, Chuck. Yes. 0:00:25.880 --> 0:00:31.320 Have you ever heard of the word placebo? Do, sir? Yeah? Placebo? 0:00:31.680 --> 0:00:36.159 You know what I mean? I do. Tell everybody I 0:00:36.280 --> 0:00:41.159 shall see, No, I will please, I shall please. That's right, 0:00:41.159 --> 0:00:45.120 met ill see, We'll see about that. I shall please. 0:00:45.280 --> 0:00:50.600 That's what I meant in Latin. Yes, all right, so placebo. 0:00:51.520 --> 0:00:55.560 Everybody's heard of a placebo and very famously the placebo effect. 0:00:55.840 --> 0:01:00.040 You wonder where that comes from? The placebo effect. The 0:01:00.040 --> 0:01:06.040 word placebo um fourteenth century. It referred to hired mourners 0:01:06.080 --> 0:01:10.360 at funerals. What they would hire mourners in place of 0:01:10.400 --> 0:01:14.000 family members, and they would start their morning wailing with 0:01:15.000 --> 0:01:17.720 that mourning. But as in m O, you are with 0:01:17.840 --> 0:01:23.119 placebo domino in region vivorum, which means I shall please 0:01:23.160 --> 0:01:26.600 the Lord in the land of the living. But in 0:01:26.720 --> 0:01:30.240 that it means placebo. Uh. This article said, it carries 0:01:30.280 --> 0:01:35.920 the connotation of substitution. Weird. Yeah, that is fantastic stuff. 0:01:35.959 --> 0:01:38.560 I thought. So this is from Placebo's and Placebo Effects 0:01:38.560 --> 0:01:44.600 in Medicine Colon Historical Overview by Tisson cap Chuck Green 0:01:44.880 --> 0:01:50.639 and Legion Catchuck. That guy is high quality. Oh yeah, yeah, 0:01:50.680 --> 0:01:54.720 a lot of skeptics. He's at Harevard. Let me tell 0:01:54.760 --> 0:01:58.160 you a little bit about Ted Kapchuck. Okay, the coney 0:01:58.200 --> 0:02:01.320 Allen cap Chuck's I just raised a lot of skeptics 0:02:01.360 --> 0:02:04.160 hackles because some people see him as a huckster of 0:02:04.240 --> 0:02:08.040 fraud or everything that's wrong with placebos. These people, um 0:02:08.200 --> 0:02:11.480 would probably have a problem with us even talking seriously 0:02:11.480 --> 0:02:14.200 about the placebo effect in the first place. So I 0:02:14.200 --> 0:02:15.800 don't know that it's a really big deal that I 0:02:15.840 --> 0:02:22.079 just raised their hackles. But Ted Katchuk is a former right, 0:02:22.720 --> 0:02:25.160 let me tell you about capture. Now. He's a former 0:02:25.200 --> 0:02:31.440 acupuncturist and he apparently had some sort of epiphany one 0:02:31.520 --> 0:02:36.880 day when he was he was treating somebody and they 0:02:36.960 --> 0:02:40.400 started to feel better before he even used the acupuncture. 0:02:41.000 --> 0:02:44.160 So he started wondering, like, okay, what's going on here? 0:02:44.160 --> 0:02:48.240 And he started investigating the placebo effect, and in short 0:02:48.360 --> 0:02:52.160 order he ended up as an instructor at Harvard and 0:02:52.240 --> 0:02:56.040 became one of the leading researchers into the placebo effect, 0:02:56.639 --> 0:03:01.040 which is a really strange journey because every medical school 0:03:01.280 --> 0:03:05.800 doesn't usually hire acupuncturists. And he had like kind of 0:03:05.800 --> 0:03:07.560 a rocky road at first, like he didn't know what 0:03:07.600 --> 0:03:10.440 he was doing with clinical trials, and he got publicly 0:03:10.440 --> 0:03:12.760 called out in the New England Journal of Medicine and 0:03:13.200 --> 0:03:15.480 UM over the years, over the decades, I think this 0:03:15.639 --> 0:03:18.320 is the eighties that he really started to look into it. 0:03:18.720 --> 0:03:24.200 He um, like I said, became the foremost researcher in 0:03:24.200 --> 0:03:28.280 in coming up with quality clinical trials for trying to 0:03:28.280 --> 0:03:30.680 get to the root of what the placebo effect is 0:03:30.720 --> 0:03:33.120 and how to use it. What years was that? You 0:03:33.120 --> 0:03:36.280 know he's still doing it, but when was this? When 0:03:36.280 --> 0:03:39.320 he was started all that stuff. He got called out 0:03:39.360 --> 0:03:41.760 and I think a two thousand one issue of the 0:03:41.760 --> 0:03:45.200 New England Journal of Medicine UM basically for not using 0:03:45.720 --> 0:03:50.000 a control group in his placebo study. So you know, 0:03:50.040 --> 0:03:52.640 when you do a study, you have a placebo group 0:03:52.760 --> 0:03:56.280 which is your control group, and that basically is I'm 0:03:56.320 --> 0:03:59.960 giving you real medicine, but I'm giving Jerry a sugar pill. 0:04:00.760 --> 0:04:04.080 And in a proper study, I don't know who's getting 0:04:04.080 --> 0:04:06.200 the sugar pill and who's getting the medicine. It's called 0:04:06.200 --> 0:04:10.680 double blind. Um so in if you're studying just the 0:04:10.680 --> 0:04:14.400 placebo effect, I should be giving you a placebo and 0:04:14.400 --> 0:04:17.880 I should be giving Jerry no treatment whatsoever. To truly, 0:04:18.200 --> 0:04:20.679 I thought you needed three people, one with a real treatment, 0:04:20.680 --> 0:04:23.400 one with placebo, and one with no treatment. It's another 0:04:23.440 --> 0:04:25.440 way to do it, Okay, at the very least, though, 0:04:25.600 --> 0:04:30.560 you need the placebo group and somebody who's receiving no treatment, gotcha. Yeah, yeah, 0:04:30.680 --> 0:04:33.799 if we're skinning cats, well, if you're doing good science 0:04:34.000 --> 0:04:38.599 researching into the placebo effect. But what's ironic is is 0:04:38.680 --> 0:04:45.120 this whole double blind placebo study came about because the 0:04:45.160 --> 0:04:50.280 placebo effect was first noticed by Western practitioner by the 0:04:50.360 --> 0:04:53.239 name of Dr Henry Beecher, who in World War Two 0:04:53.640 --> 0:04:57.919 supposedly saw a nurse give a shot of sailing to 0:04:57.960 --> 0:05:01.200 a soldier because they'd run out a morphine, but the 0:05:01.279 --> 0:05:04.400 nurse told them it was morphine, and the soldier responded 0:05:04.440 --> 0:05:07.920 to this shot of saline like it was morphine, And 0:05:08.000 --> 0:05:10.480 from that Beecher was like, what is going on here? 0:05:10.520 --> 0:05:14.080 Started to investigate the placebo effect and ended up proposing 0:05:14.120 --> 0:05:18.520 the double blind placebo study to prove the efficacy of drugs. 0:05:19.200 --> 0:05:21.760 That goes back further than that, my friend, let's hear 0:05:21.760 --> 0:05:27.560 it man UH try seventy five the New Medical Dictionary, 0:05:27.760 --> 0:05:30.839 they described the placebo as a commonplace method or medicine, 0:05:30.960 --> 0:05:33.320 and then a short time later, in eighteen eleven and 0:05:33.400 --> 0:05:38.719 Quincy's lexicon uh Medicum, he defined the placebo as an 0:05:38.760 --> 0:05:42.880 epithet given to any medicine adapted more to please than 0:05:42.960 --> 0:05:45.960 to benefit the patient, like heroin. So they were on 0:05:46.040 --> 0:05:50.240 it back in the early eighteen hundreds, which is surprising. Yeah, 0:05:50.320 --> 0:05:52.200 but I mean, like that's the basis of like snake 0:05:52.240 --> 0:05:55.000 oil and hucksterism, right, Yeah, Well they called him bread 0:05:55.000 --> 0:05:56.840 pills back then because I guess it was it was 0:05:56.880 --> 0:05:59.599 probably some sort of like pill made of yeast, as 0:05:59.720 --> 0:06:03.200 my us UH and Thomas Jefferson in eighteen o seven 0:06:03.240 --> 0:06:07.039 even Uh recorded what he called the Pious Fraud, and 0:06:07.040 --> 0:06:09.680 he observed quote that one of the most successful positions 0:06:09.680 --> 0:06:12.520 I've ever known has assured me that he used more 0:06:12.560 --> 0:06:16.240 bread pills, drops of colored water, and powders of hickory 0:06:16.279 --> 0:06:21.159 ash than all other medicines put together. UM, and people 0:06:21.160 --> 0:06:23.400 treated people with bread pills. In the early eighteen hundreds, 0:06:23.400 --> 0:06:25.280 it was a thing and like they were way onto 0:06:25.360 --> 0:06:28.960 the placebo effect and and the fact that it seemed 0:06:29.000 --> 0:06:33.640 to work. Uh. And another dude named John Haygarth in 0:06:33.640 --> 0:06:37.400 the early eighteen hundreds actually started performing the first studies 0:06:37.400 --> 0:06:41.600 on placebo effect, and um, he said it went back 0:06:41.600 --> 0:06:45.880 to the renaissance idea that imagination was the major mediator 0:06:45.880 --> 0:06:49.520 between body and mind, which is starting to be proven 0:06:49.640 --> 0:06:52.160 is possibly correct. Yeah, it's pretty interesting. And in the 0:06:52.240 --> 0:06:55.760 nineties is when they started publishing papers on the placebo 0:06:56.040 --> 0:07:01.000 uh and actually doing clinical trials and um. They said. 0:07:01.040 --> 0:07:03.240 One of their points in the nineteen thirties would confidence 0:07:03.279 --> 0:07:07.760 aroused in a treatment, the encouragement afforded by a new procedure, 0:07:07.920 --> 0:07:10.800 even like just people getting treated in a new way. 0:07:11.480 --> 0:07:13.800 People would say, oh, well, this is gonna work, and 0:07:13.840 --> 0:07:15.880 it maybe he did work. And then we're up to 0:07:15.920 --> 0:07:19.840 the forties where Beacher comes along notices the placebo effect 0:07:19.880 --> 0:07:23.640 himself ultimately comes up with the double blind placebo based study. 0:07:24.200 --> 0:07:27.280 And what's ironic about that is the placebo based double 0:07:27.320 --> 0:07:31.120 blind study ultimately has split back off into the study 0:07:31.120 --> 0:07:34.840 of placebo again because there are so many trials where 0:07:34.840 --> 0:07:37.360 the placebo was more effective than the drug, even though 0:07:37.360 --> 0:07:41.080 the drug worked, but the placebo worked even better. And 0:07:41.200 --> 0:07:43.800 finally in the nine nineties, people were like, what is 0:07:43.880 --> 0:07:47.120 going on here? We need to study this thing in 0:07:47.160 --> 0:07:49.520 and of itself. Well, yeah, because one of the things 0:07:49.640 --> 0:07:54.440 I had no idea. I thought placebos were only used 0:07:54.560 --> 0:07:58.520 in studies for efficacy rates. I did not know that 0:07:58.600 --> 0:08:02.160 they are. There are doctors, always have been, and still 0:08:02.200 --> 0:08:07.360 are prescribing placebos as medicine unknowingly even though they're not 0:08:07.400 --> 0:08:10.680 supposed to. We'll get to that later. No knowingly, no 0:08:10.840 --> 0:08:13.800 unknowingly for the patient, even though they're supposed to tell 0:08:13.800 --> 0:08:15.920 the patient. Yeah, but we'll get to that towards the end. 0:08:15.960 --> 0:08:18.560 But I had no idea that they were prescribing placebos 0:08:18.560 --> 0:08:20.800 to people. Yeah, And in their defense, a lot of 0:08:20.840 --> 0:08:24.400 times doctors are carrying on a tradition where they don't 0:08:24.400 --> 0:08:28.720 have anything else to prescribe. But they can't say if 0:08:28.760 --> 0:08:30.800 they say that to their patients, the patients are going 0:08:30.800 --> 0:08:32.800 to go off and suffer. So at the very least 0:08:32.840 --> 0:08:38.160 they can use the last ditch attempt of saying psychological traitor. Yeah. Yeah, 0:08:38.200 --> 0:08:40.240 and I'm not knocking it. I just was surprised to 0:08:40.320 --> 0:08:42.280 learn that that still happens. And I'm wondering if I've 0:08:42.320 --> 0:08:45.640 ever been given a placebo. And it makes me feel 0:08:45.720 --> 0:08:48.360 dumb as a patient to say, like, yeah, man, that 0:08:48.440 --> 0:08:50.360 whatever you give me really helped. And the doctors like 0:08:51.559 --> 0:08:53.959 because it's the same thing as that prank of like 0:08:54.440 --> 0:08:57.440 giving somebody non alcoholic beer un telling the real beer 0:08:57.480 --> 0:08:59.839 and watching them make a jerk out of themselves getting 0:09:00.040 --> 0:09:03.440 or wrong. It's exactly the same thing. So let's talk 0:09:03.440 --> 0:09:07.080 about placebo. We assume that everybody knows what placebo is, 0:09:07.120 --> 0:09:12.480 but let's define it a little more clearly. The placebo effect, specifically, 0:09:13.400 --> 0:09:18.920 is the very real phenomenon that people, when given a 0:09:19.000 --> 0:09:25.360 pill or a some sort of medical intervention that feel better. Yes, 0:09:25.440 --> 0:09:28.120 they feel better, even though what they've been given is 0:09:28.200 --> 0:09:32.400 not medicine and it was not actually a real intervention. Yeah, 0:09:32.400 --> 0:09:36.320 And the placebo is the pill itself. That that is 0:09:36.559 --> 0:09:39.960 the placebo, and the effect is what you just described, right, 0:09:39.960 --> 0:09:41.200 And it doesn't have to be a pill, can be 0:09:41.200 --> 0:09:45.560 an injection, it can be fake surgery, there's true. And 0:09:45.559 --> 0:09:49.520 it doesn't even have to be uh pharmacologically inert. It 0:09:49.600 --> 0:09:53.520 can be a vitamin or like an aspirin, even though 0:09:53.760 --> 0:09:57.480 some argue that's not a true placebo. But um, sometimes 0:09:57.480 --> 0:10:00.360 that's what the doctor will give you and call it, 0:10:00.600 --> 0:10:04.840 you know, medication, But they're there. Um very often, things 0:10:04.840 --> 0:10:09.040 like a sugar pill. Yeah, like you said, pharmacologically inert 0:10:09.480 --> 0:10:14.240 um and astoundingly, depending on the size of the pill, 0:10:14.360 --> 0:10:16.200 the shape of the pill, the color of the pill, 0:10:16.960 --> 0:10:20.760 people will have different effects and responses to these things 0:10:20.800 --> 0:10:25.360 that are just sugar. Um. So there's some really strange 0:10:25.840 --> 0:10:31.120 psychological things going on here. And at first, for a 0:10:31.160 --> 0:10:35.160 long time, everybody just kind of assumed it was just psychology, 0:10:35.200 --> 0:10:38.679 that we were tricking ourselves into feeling better, or we 0:10:38.760 --> 0:10:41.880 hadn't really felt bad in the first place, and we 0:10:41.880 --> 0:10:46.040 were being tricked into not feeling bad any longer, or 0:10:46.120 --> 0:10:49.840 not thinking we were feeling bad. In any hypochondria, maybe 0:10:50.040 --> 0:10:54.120 very much. So. Yeah, Um, they this article says they've 0:10:54.120 --> 0:10:56.160 been shown to work in about thirty percent of patients, 0:10:56.840 --> 0:10:59.480 and that was actually that's based on Beacher's finding. It 0:10:59.559 --> 0:11:02.240 was like alretty, thirty five point two. Yeah, that's what 0:11:02.320 --> 0:11:04.240 he found out in nineteen fifty five. That's what they're 0:11:04.240 --> 0:11:07.560 still basing that on. Yeah, but there's been other studies 0:11:07.600 --> 0:11:11.360 that have gone back through beat your studies and said no, no, no, 0:11:11.600 --> 0:11:14.319 that's not that much. Other people have found up to 0:11:15.559 --> 0:11:19.120 respond to it, right, And basically one of the big 0:11:19.200 --> 0:11:22.720 questions is is it a psychological effect or are there extual, 0:11:22.920 --> 0:11:27.040 actual physical responses that are going on. And there's been 0:11:27.040 --> 0:11:29.600 a lot of research lately that's pretty interesting. I think, 0:11:30.800 --> 0:11:33.360 like we're saying that the the initial idea was that 0:11:33.440 --> 0:11:37.559 it was all psychological, right, Yeah, Like, uh, well, I 0:11:37.600 --> 0:11:40.440 guess we can talk about the two effects. The subject 0:11:40.480 --> 0:11:45.559 expectancy effect, which is basically, if you know the result 0:11:45.600 --> 0:11:47.080 ahead of time and the pill you're gonna take, you're 0:11:47.080 --> 0:11:51.240 gonna end up feeling that result. Right. That's what a 0:11:51.280 --> 0:11:55.920 blind study seeks to prevent, is a subject expectancy effect, 0:11:56.240 --> 0:11:59.240 and also the observer expectancy effect, which is what a 0:11:59.360 --> 0:12:02.160 double blind studies seeks to prevent. Yeah, and that's important 0:12:02.160 --> 0:12:05.480 because it's are different because it's all self reported, right, 0:12:05.679 --> 0:12:08.880 which is always a little you know, right. So the 0:12:08.960 --> 0:12:11.880 other idea, if it has a psychological basis, is that 0:12:11.920 --> 0:12:15.520 it's classical conditioning that we are raised from birth to 0:12:16.120 --> 0:12:19.760 think that if somebody gives you a pill, you're going 0:12:19.840 --> 0:12:23.400 to respond to it because it has medicine and that 0:12:23.559 --> 0:12:27.959 is not self reported. That is actually seeing physical responses. Right. 0:12:28.200 --> 0:12:33.640 And with classical conditioning established very famously by Pavlov and 0:12:33.720 --> 0:12:40.400 his dogs, right, um, you are you're having You're responding 0:12:41.240 --> 0:12:46.800 physically to a psychological stimulus. Right, So you are getting 0:12:46.800 --> 0:12:51.040 a physiological response. So classical conditioning eventually kind of came 0:12:51.080 --> 0:12:55.360 to be viewed as the more um reasonable explanation for 0:12:55.440 --> 0:13:00.000 what was going on because, uh, study after study, if 0:13:00.000 --> 0:13:04.040 the study has shown that we are having a physical 0:13:04.080 --> 0:13:07.880 reaction to these inert placebos. Yeah, one of them. In 0:13:07.920 --> 0:13:11.239 two thousand two from u C. L As Neuropsychiatric Institute, 0:13:11.520 --> 0:13:14.360 they had a couple of groups of patients and a 0:13:14.400 --> 0:13:19.400 lot of the placebo studies are uh for mental conditions. Um, 0:13:19.440 --> 0:13:20.880 not all of them, but a lot of them are 0:13:21.360 --> 0:13:25.880 in um like the clinical trials. Yeah, yeah, exactly. Um. 0:13:25.960 --> 0:13:29.400 So this one was for any depressants and they had 0:13:29.400 --> 0:13:34.440 two groups that got um experimental drugs like real drugs, 0:13:34.760 --> 0:13:37.320 and then the third was given the placebo. Uh. They 0:13:37.360 --> 0:13:39.800 spent a few weeks on these pills and monitored their 0:13:39.840 --> 0:13:44.800 brain activity with the old E G. Wonder machine and well, 0:13:44.800 --> 0:13:48.240 it's not the wonder machine. It's it's a wonder machine, 0:13:48.280 --> 0:13:51.440 not the wonder machine. Uh. And the patients on the 0:13:51.440 --> 0:13:55.040 placebo reported positive effects and showed greater increase of brain 0:13:55.040 --> 0:13:59.440 activity than those who had responded to the drug. You know, 0:13:59.520 --> 0:14:04.760 I remember or that it was, Yeah, totally undermined people's 0:14:04.760 --> 0:14:08.000 faith in antidepressants because it was on the other end 0:14:08.040 --> 0:14:11.560 of like the whole nineties where everybody was on antidepressants, 0:14:11.600 --> 0:14:15.360 and this study came out and was like people were saying, like, 0:14:15.400 --> 0:14:17.959 do these things even work? It was it was kind 0:14:17.960 --> 0:14:20.680 of taken the opposite way. Rather than wow, the placebo 0:14:20.720 --> 0:14:26.120 effect is really something, it was wow and indepressance or fraudulent. Well, 0:14:26.160 --> 0:14:28.360 I wonder what they were trying to It was a 0:14:28.360 --> 0:14:31.320 placebo study though, right, so kind of backfired or did 0:14:31.360 --> 0:14:34.080 they even care? No, I think it very much carry 0:14:34.120 --> 0:14:37.320 because there when compared to place with the whole point 0:14:37.520 --> 0:14:41.200 of a drug trial is to show that this drug 0:14:41.240 --> 0:14:44.359 is more effective than placebo, it's more effective than the imagination, 0:14:45.280 --> 0:14:47.840 and if it's not, then that means that drugs shouldn't 0:14:47.840 --> 0:14:51.040 be brought to market. Even though now the thinking is 0:14:51.080 --> 0:14:53.880 more like m that's not necessarily true. Because we're coming 0:14:53.920 --> 0:14:58.160 to understand the placebo effect can be very powerful, especially 0:14:58.240 --> 0:15:01.840 depending on the individual too. Yeah for sure. Uh. The 0:15:01.920 --> 0:15:04.160 interesting thing about that study is when the E e g. 0:15:04.400 --> 0:15:07.120 Lit up um, the activity was in different parts of 0:15:07.120 --> 0:15:11.160 the brain. Um. I think that the placebo patients said 0:15:11.160 --> 0:15:15.000 the preformal cortex was lighting up, and basically that says 0:15:15.040 --> 0:15:18.840 that the brain isn't being fooled, it's just doing something different. Yeah, 0:15:18.880 --> 0:15:23.720 they responded better to the treatment then the people who 0:15:24.160 --> 0:15:27.680 responded to the drug. So some people did respond to 0:15:27.680 --> 0:15:30.240 the drug, but different parts of their brain were activated 0:15:30.240 --> 0:15:32.320 by the drug than the people who responded well to 0:15:32.360 --> 0:15:36.240 the placebo, even though they felt better. Yeah, that's mind boggling. 0:15:36.320 --> 0:15:38.880 It is. So they had they reached the same conclusion, 0:15:39.120 --> 0:15:41.120 but using a totally different region of their brain and 0:15:41.120 --> 0:15:45.120 they actually felt better. Um. That wasn't the first study 0:15:45.120 --> 0:15:48.560 to prove that there is a physiological response to placebos 0:15:48.800 --> 0:15:51.840 or last there's a dental study from the seventies that 0:15:51.880 --> 0:15:54.600 I think was the first that showed that if you 0:15:54.680 --> 0:16:01.040 blocked endorphins, which are nature's pain relievers, you can also 0:16:01.120 --> 0:16:06.120 block the placebo effect. So the people weren't responding to 0:16:06.120 --> 0:16:09.080 the placebo like you would expect them to a pain 0:16:09.160 --> 0:16:14.280 reliever placebo because they weren't able to release their natural 0:16:14.320 --> 0:16:16.840 pain relievers. Yeah, and that's backed up I guess by 0:16:16.880 --> 0:16:20.000 this two thousand four study from the University of Michigan 0:16:20.880 --> 0:16:26.840 uh Go wolverines. They basically demonstrated that it is related 0:16:26.880 --> 0:16:30.560 to endorphins specifically. Uh, So that I guess that backs 0:16:30.640 --> 0:16:33.440 up that study because if you can block them. So 0:16:33.480 --> 0:16:36.920 here's the thing. It's not that study was related to 0:16:37.080 --> 0:16:40.440 endorphins specifically. Other studies have found that it can be 0:16:40.480 --> 0:16:45.160 related to how much a person expresses dopamine specifically. So 0:16:45.400 --> 0:16:48.040 there's like this idea that there's a genetic basis to 0:16:48.080 --> 0:16:53.480 our predisposition to UM placebos. But I think that it's 0:16:53.560 --> 0:16:58.800 depending on the drug or the effect that you're trying 0:16:58.840 --> 0:17:01.800 to induce using the placebo effects. Because think about it. 0:17:02.640 --> 0:17:07.160 If you are somebody who naturally produces more endorphins than 0:17:07.240 --> 0:17:13.320 somebody else, Uh, you're going to naturally produce more endorphins 0:17:13.320 --> 0:17:17.040 when it's UM triggered by a placebo than somebody who 0:17:17.080 --> 0:17:21.200 doesn't produce more endorphins naturally. Yeah, So there's a genetic 0:17:21.240 --> 0:17:23.160 basis to it, I guess, But I think the genetic 0:17:23.160 --> 0:17:26.520 basis is that the individual must be predisposition to be 0:17:26.640 --> 0:17:32.000 able to have that genetic response UM to the drug 0:17:32.160 --> 0:17:35.879 or the placebo and have that that um that I 0:17:35.880 --> 0:17:38.640 guess response to it. Yeah, And it's like you said, 0:17:38.680 --> 0:17:42.680 it's also personal because they found that it is even 0:17:42.720 --> 0:17:47.639 affected by a person's personal experience with past pills. The 0:17:47.680 --> 0:17:49.840 color of the pill, the shape and size of the 0:17:49.840 --> 0:17:53.960 pill will have a different reaction because the person had 0:17:54.000 --> 0:17:57.560 maybe took another little blue pill for something else. Sure, 0:17:57.680 --> 0:18:00.760 And actually blue pills in in particular, they are known 0:18:00.800 --> 0:18:04.640 to be um to have sedative effects as placebo's. Red 0:18:04.680 --> 0:18:08.160 pills are known to have stimulating and pain relieving effects 0:18:08.440 --> 0:18:12.440 as placebo. That's odd that they made by agraab blue. Yeah, 0:18:12.640 --> 0:18:16.040 like in Heavinaly marketed it as the little blue pill. 0:18:16.840 --> 0:18:21.400 Interesting sedative effect, Yes, I don't think so. So. Chok, Well, 0:18:21.720 --> 0:18:27.160 not that i'd know. Well, we've got more stuff about 0:18:27.160 --> 0:18:29.120 all this coming up. But I don't know what we're 0:18:29.119 --> 0:18:32.240 gonna talk about next. It's a grab bag right now. Yeah, 0:18:32.560 --> 0:18:39.080 but we're gonna come right back after these messages. All right, 0:18:39.320 --> 0:18:40.879 we're back, buddy, And I tell you what we're going 0:18:40.920 --> 0:18:43.160 to talk about. Something that I had never heard of, 0:18:43.160 --> 0:18:46.760 which I think is super interesting, the no sebo effect. 0:18:47.560 --> 0:18:49.960 It is super cool, and that is when well, it's 0:18:50.119 --> 0:18:51.800 there's a couple of things. That is, when you are 0:18:51.840 --> 0:18:56.840 taking a placebo and you experience maybe the effects of 0:18:56.840 --> 0:19:00.439 the pill, which is great, and the side effec of 0:19:00.440 --> 0:19:03.920 that pill that you think might be but you're supposed 0:19:03.960 --> 0:19:06.840 to have, right, you're actually experiencing side effects that aren't 0:19:07.160 --> 0:19:09.399 shouldn't be there, right, and then a sugar bill. They 0:19:09.440 --> 0:19:12.520 noticed this in clinical trials too, because when you're carrying 0:19:12.560 --> 0:19:14.760 out a clinical trial, you have to warn the patients 0:19:15.400 --> 0:19:19.320 this drug may give you these terrible side effects. And 0:19:19.359 --> 0:19:22.240 so they started noticing like people who were who were 0:19:22.240 --> 0:19:26.080 on placebo were still experiencing the side effect like physical 0:19:26.119 --> 0:19:31.240 reactions like hives and itch in things. Right, So there 0:19:31.320 --> 0:19:34.120 is a there's a negative side to placebo as well, 0:19:34.119 --> 0:19:36.760 and no cibo means I shall harm like placebo means 0:19:36.800 --> 0:19:42.160 I shall please yeah um. And they found that this 0:19:42.240 --> 0:19:45.560 is definitely backed up by the idea that it's classical conditioning. 0:19:45.920 --> 0:19:49.560 They found that people who have gone through chemotherapy UH 0:19:49.840 --> 0:19:52.840 can become nauseated when they enter a room that's painted 0:19:52.880 --> 0:19:56.120 the same color as the room where they received chemo before. Yeah, 0:19:56.200 --> 0:19:58.840 that makes sense. Yeah, so there's all sorts of ways 0:19:58.880 --> 0:20:01.080 that the no cebo effect can pop up, but it's 0:20:01.200 --> 0:20:04.200 pretty mind boggling as well. Yeah, and then no sebo 0:20:04.320 --> 0:20:06.639 can doesn't even have to be just with the placebo. 0:20:06.720 --> 0:20:09.680 You can experience side effects that aren't on the list 0:20:09.720 --> 0:20:12.520 of a real drug because of what we were talking about, 0:20:12.560 --> 0:20:16.080 because it looked like another pill you might have had before. Man, 0:20:16.160 --> 0:20:20.959 the brain powerful stuff. So going back to kat Chuk, 0:20:21.280 --> 0:20:24.880 who I'm I'm just kind of a fan of. Yeah, 0:20:25.480 --> 0:20:28.840 I think if you're into like a long form articles, 0:20:28.960 --> 0:20:33.600 which I love, go to Harvard Magazine and search for 0:20:33.800 --> 0:20:36.439 the placebo phenomenon and it's a profile of him and 0:20:36.520 --> 0:20:40.479 his work. It's really interesting stuff. But he was saying 0:20:41.000 --> 0:20:44.280 that kind of in line with the idea that like 0:20:44.320 --> 0:20:45.760 the color of the pill or the shape of the 0:20:45.760 --> 0:20:48.200 pill will have an effect, will either on the no 0:20:48.359 --> 0:20:51.960 sebo or the placebo effect. Um. He was saying that 0:20:52.400 --> 0:20:56.000 it seems like the basis of the placebo effect is 0:20:56.359 --> 0:21:00.320 what's called ritual yea, and ritual is it involves everything 0:21:00.400 --> 0:21:04.360 from like the physician's bedside manner to how expensive the 0:21:04.400 --> 0:21:08.240 patient thinks the pill is to how effective the patient 0:21:08.280 --> 0:21:11.560 thinks the pillars and um. He did a study where 0:21:11.800 --> 0:21:15.480 he carried out what was called schmaltzy um like a 0:21:15.520 --> 0:21:20.520 smalty care to where he was just lavishing attention on 0:21:20.600 --> 0:21:24.159 the patient and telling him how badly he felt that 0:21:24.200 --> 0:21:28.280 they were going through this. But this pill is really 0:21:28.320 --> 0:21:32.879 effective with your condition. And apparently not just this study, 0:21:32.880 --> 0:21:36.320 but other studies show that there's a positive correlation between 0:21:36.760 --> 0:21:43.080 the ritual and response to the placebo effect. So the 0:21:43.160 --> 0:21:46.000 more you think that this drug is expensive, that this 0:21:46.080 --> 0:21:50.359 drug is effective, that this physician cares about you, the 0:21:50.600 --> 0:21:54.360 greater of a placebo response you're going to have. Yeah, 0:21:54.600 --> 0:21:56.639 you know, I have you ever been accused of being 0:21:56.640 --> 0:22:00.520 a hypochondract by anyone? Know, it's got to be very demeaning. 0:22:02.119 --> 0:22:05.480 It is because it happened to me. And yeah, I 0:22:05.480 --> 0:22:07.199 went to the emergency room in New York, as you know, 0:22:07.760 --> 0:22:09.879 when we were up there recently for a trip. I 0:22:09.920 --> 0:22:14.240 went to the e R and uh, it was something 0:22:14.320 --> 0:22:17.399 and it was a result of it was it was 0:22:18.760 --> 0:22:23.359 throwing up in uh nausea from UM I learned from 0:22:23.760 --> 0:22:26.679 anti inflammatory pills I was taking at the time for 0:22:26.800 --> 0:22:28.440 something else I had nothing to do with being sick, 0:22:29.119 --> 0:22:32.480 and they figured that out, but they kept you know 0:22:32.560 --> 0:22:34.320 this guy, I called him Nurse Jackie. He was just 0:22:34.320 --> 0:22:36.720 like Nurse Jackie, except he was a dude. He kept 0:22:36.720 --> 0:22:38.520 coming by and treating me with things and giving me 0:22:38.520 --> 0:22:39.840 the I V. Drip and I was like, dude, I'm 0:22:39.840 --> 0:22:42.840 not feeling better and I'm not a hypochondrac in any way. 0:22:42.880 --> 0:22:45.879 I didn't go to the doctor for like eighteen years straight. 0:22:46.320 --> 0:22:48.600 And uh, I could tell he was looking at me 0:22:48.640 --> 0:22:51.919 like I got one of these guys. Yeah, And I 0:22:51.960 --> 0:22:53.680 was like, no, no, and I could tell. I could 0:22:53.880 --> 0:22:56.439 could sense it. And so he finally gave me this 0:22:56.760 --> 0:23:00.359 thing to drink that um knocked me out, woke up 0:23:00.359 --> 0:23:04.920 like twenty minutes later and felt felt better. I can't remember. 0:23:04.960 --> 0:23:07.720 It was something to gatorade now. It was like three 0:23:07.720 --> 0:23:10.640 different things. It was like a cocktail of stomach pleasing 0:23:10.680 --> 0:23:14.200 things and what's the stuff that like numbs you numb 0:23:14.280 --> 0:23:20.480 my throat and I can't remember light to can I think? Um? Yeah, 0:23:20.520 --> 0:23:22.040 it worked. I woke up and I felt better. I said, 0:23:22.160 --> 0:23:24.360 you know, I don't feel so naxious now, and they 0:23:24.359 --> 0:23:25.840 were checking me out and I reached up and I 0:23:25.880 --> 0:23:29.640 felt behind my ear for some reason, and it felt 0:23:29.640 --> 0:23:32.239 like a golf ball behind my ear and it had 0:23:32.840 --> 0:23:35.119 popped up in the last twenty minutes, and so I 0:23:35.160 --> 0:23:36.520 was literally leaving. I was like, oh, wait a minute, 0:23:36.560 --> 0:23:38.440 I got this thing behind my ear all of a sudden, 0:23:39.000 --> 0:23:41.359 and this guy looked at me like h and he 0:23:41.440 --> 0:23:43.320 called the doctor over and she was like, yeah, it's 0:23:43.400 --> 0:23:45.880 it's very swollen at your limp node. But he wasn't 0:23:45.880 --> 0:23:47.639 there for that, so he came back over. It's like, 0:23:47.840 --> 0:23:49.399 what did she say. I said, well, she said the 0:23:49.440 --> 0:23:52.399 swollen and he said that you're a hypochondriac. And I 0:23:52.440 --> 0:23:55.320 was so mad at nursed Jackie. I was like, dude, 0:23:55.960 --> 0:23:58.560 look at it. It's huge. I'm not making this up. 0:23:58.600 --> 0:24:00.960 And I started defending myself like I never go to 0:24:01.040 --> 0:24:03.640 doctors and I'm not one of those people. And he 0:24:03.680 --> 0:24:05.119 was just he was like, I was just kidding. I 0:24:05.119 --> 0:24:07.119 was just kidding, and I was just kidding. Yeah, but 0:24:07.160 --> 0:24:10.120 it made it totally made me feel like a jerk. Yeah, 0:24:10.560 --> 0:24:12.720 I mean imagine if like you, if that happened to 0:24:12.760 --> 0:24:14.919