1 00:00:00,040 --> 00:00:04,000 Speaker 1: M Hey everybody, it's me Josh, and for this week's 2 00:00:04,120 --> 00:00:07,560 Speaker 1: S Y s K Select, I've chosen an episode on Placebos. 3 00:00:08,160 --> 00:00:11,760 Speaker 1: It's an episode chock full of facts of the podcast, 4 00:00:12,240 --> 00:00:14,520 Speaker 1: and yet Chuck comes out with one of the all 5 00:00:14,560 --> 00:00:17,840 Speaker 1: time greats right out of the gate. But don't stop listening. 6 00:00:17,880 --> 00:00:21,440 Speaker 1: Then the whole episode is amazingly wonderful, which is why 7 00:00:21,480 --> 00:00:26,520 Speaker 1: I chose it. So enjoy it. Welcome to Stuff you 8 00:00:26,560 --> 00:00:35,640 Speaker 1: should know, a production of I Heart Radios How Stuff Works. Hey, 9 00:00:35,680 --> 00:00:38,000 Speaker 1: and welcome to the podcast. I'm Josh Clark, and there's 10 00:00:38,040 --> 00:00:43,320 Speaker 1: Charles W. Chuck Bryant, and there's Jerry Jerry place cebo, 11 00:00:43,560 --> 00:00:50,440 Speaker 1: do sir? No? No, that was bad, Chuck. Yes. Have 12 00:00:50,560 --> 00:00:55,800 Speaker 1: you ever heard of the word placebo? Do sir? Yeah? Placebo? 13 00:00:56,160 --> 00:01:00,640 Speaker 1: You know what I mean. I'll tell every buddy, I 14 00:01:00,760 --> 00:01:05,360 Speaker 1: shall see, No, I will please, I shall please. That's 15 00:01:05,360 --> 00:01:08,600 Speaker 1: what I meant. I shall see. We'll see about that. 16 00:01:08,920 --> 00:01:14,000 Speaker 1: I shall please. That's what I meant in Latin. Yes, right, 17 00:01:14,160 --> 00:01:18,840 Speaker 1: so placebo. Everybody's heard of a placebo, and very famously 18 00:01:18,920 --> 00:01:22,800 Speaker 1: the placebo effect. Do you wonder where that comes from? 19 00:01:22,920 --> 00:01:28,480 Speaker 1: The placebo effect? The word placebo um fourteenth century. It 20 00:01:28,680 --> 00:01:33,559 Speaker 1: referred to hired mourners at funerals. What they would hire 21 00:01:33,640 --> 00:01:37,319 Speaker 1: mourners in place of family members, and they would start 22 00:01:37,360 --> 00:01:41,120 Speaker 1: their morning wailing with that mourning. But as in m O, 23 00:01:41,200 --> 00:01:47,000 Speaker 1: you are with placebo domino in region vivorum, which means 24 00:01:47,040 --> 00:01:48,880 Speaker 1: I shall please the Lord in the land of the living. 25 00:01:50,320 --> 00:01:54,200 Speaker 1: But in that it means placebo. Uh this article, so 26 00:01:54,360 --> 00:01:59,040 Speaker 1: it carries the connotation of substitution. Weird. Yeah, that is 27 00:01:59,120 --> 00:02:02,200 Speaker 1: fantastic stuff, I thought. So this is from placebos and 28 00:02:02,200 --> 00:02:08,239 Speaker 1: placebo effects in Medicine. Colon Historical Overview by Tisson cap 29 00:02:08,320 --> 00:02:15,120 Speaker 1: Chuck Green and Legion Catchuck. That guy is high quality. Yeah, 30 00:02:15,160 --> 00:02:18,960 Speaker 1: a lot of skeptics Catchuck, Catchuck. He's at Harvard. Let 31 00:02:18,960 --> 00:02:22,280 Speaker 1: me tell you a little bit about Ted Kapchuck the 32 00:02:22,360 --> 00:02:25,040 Speaker 1: coney Allen cap Chuck's I just raised a lot of 33 00:02:25,200 --> 00:02:28,520 Speaker 1: skeptics hackles because some people see him as a huckster 34 00:02:28,600 --> 00:02:31,720 Speaker 1: of fraud or everything that's wrong with placebos. These people, 35 00:02:32,360 --> 00:02:35,520 Speaker 1: um would probably have a problem with us even talking 36 00:02:35,520 --> 00:02:38,520 Speaker 1: seriously about the placebo effect in the first place. So 37 00:02:38,600 --> 00:02:40,160 Speaker 1: I don't know that it's a really big deal that 38 00:02:40,200 --> 00:02:44,360 Speaker 1: I just raised their hackles. But Ted Catchuk is a 39 00:02:44,480 --> 00:02:47,639 Speaker 1: former owes me fifty bucks. Right, let me tell you 40 00:02:47,680 --> 00:02:53,160 Speaker 1: about Catchuck. Now. He's a former acupuncturist, and he apparently 41 00:02:53,280 --> 00:02:57,120 Speaker 1: had some sort of um epiphany one day when he 42 00:02:57,320 --> 00:03:02,280 Speaker 1: was he was treating somebody and they started to feel 43 00:03:02,320 --> 00:03:07,600 Speaker 1: better before he even used the acupuncture. So he started wondering, like, okay, 44 00:03:07,639 --> 00:03:10,800 Speaker 1: what's going on here? And he started investigating the placebo effect, 45 00:03:11,160 --> 00:03:15,239 Speaker 1: and in short order he ended up as an instructor 46 00:03:15,320 --> 00:03:19,200 Speaker 1: at Harvard and became one of the leading researchers into 47 00:03:19,280 --> 00:03:24,040 Speaker 1: the placebo effect, which is a really strange journey because 48 00:03:24,280 --> 00:03:29,839 Speaker 1: Harvard Medical School doesn't usually hire acupuncturists. And he had 49 00:03:29,880 --> 00:03:31,520 Speaker 1: like kind of a rocky road at first, like he 50 00:03:31,520 --> 00:03:33,840 Speaker 1: didn't know what he was doing with clinical trials, and 51 00:03:34,080 --> 00:03:36,400 Speaker 1: he got publicly called out in the New England Journal 52 00:03:36,400 --> 00:03:39,640 Speaker 1: of Medicine and UM over the years, over the decades, 53 00:03:39,680 --> 00:03:42,040 Speaker 1: I think this is the eighties that he really started 54 00:03:42,080 --> 00:03:45,560 Speaker 1: to look into it. He um, like I said, became 55 00:03:45,680 --> 00:03:51,200 Speaker 1: the foremost researcher in in coming up with quality clinical 56 00:03:51,240 --> 00:03:53,920 Speaker 1: trials for trying to get to the root of what 57 00:03:53,960 --> 00:03:56,240 Speaker 1: the placebo effect is and how to use it. What 58 00:03:56,400 --> 00:03:59,880 Speaker 1: years was that, you know, he's still doing it. But 59 00:04:00,000 --> 00:04:02,600 Speaker 1: when was this? When he was started all that stuff, 60 00:04:02,960 --> 00:04:05,080 Speaker 1: he got called out and I think a two thousand 61 00:04:05,120 --> 00:04:08,280 Speaker 1: one issue of the New England Journal of Medicine, UM, 62 00:04:08,320 --> 00:04:13,560 Speaker 1: basically for not using a control group in his placebo study. 63 00:04:13,800 --> 00:04:16,120 Speaker 1: So you know, when you do a study, you have 64 00:04:16,160 --> 00:04:19,440 Speaker 1: a placebo group which is your control group, and that 65 00:04:19,600 --> 00:04:22,960 Speaker 1: basically is I'm giving you real medicine, but I'm giving 66 00:04:23,080 --> 00:04:27,520 Speaker 1: Jerry a sugar pill. And in a proper study, I 67 00:04:27,560 --> 00:04:29,679 Speaker 1: don't know who's getting the sugar pill and who's getting 68 00:04:29,680 --> 00:04:34,000 Speaker 1: the medicine. It's called double blind, right, um. So you know, 69 00:04:34,080 --> 00:04:37,520 Speaker 1: if you're studying just the placebo effect, I should be 70 00:04:37,560 --> 00:04:40,120 Speaker 1: giving you a placebo and I should be giving Jerry 71 00:04:40,120 --> 00:04:43,839 Speaker 1: no treatment whatsoever. To truly, I thought you needed three people, 72 00:04:43,920 --> 00:04:46,200 Speaker 1: one with a real treatment, one with placebo, and one 73 00:04:46,240 --> 00:04:48,799 Speaker 1: with no treatment. It's another way to do it, Okay, 74 00:04:48,839 --> 00:04:51,400 Speaker 1: at the very least, though, you need the placebo group 75 00:04:51,480 --> 00:04:55,000 Speaker 1: and somebody who's receiving no treatment. Gotcha, you see. Yeah, yeah, 76 00:04:55,120 --> 00:04:58,279 Speaker 1: if we're skinning cats, well, if you're doing good science 77 00:04:58,440 --> 00:05:03,240 Speaker 1: researching into the placebo. But what's ironic is is this 78 00:05:03,279 --> 00:05:10,159 Speaker 1: whole double blind placebo study came about because the placebo 79 00:05:10,200 --> 00:05:14,960 Speaker 1: effect was first noticed by Western practitioner by the name 80 00:05:15,000 --> 00:05:18,800 Speaker 1: of Dr Henry Beecher, who in World War Two supposedly 81 00:05:19,760 --> 00:05:22,520 Speaker 1: saw a nurse give a shot of sailine to a 82 00:05:22,560 --> 00:05:26,000 Speaker 1: soldier because they'd run out of morphine. But the nurse 83 00:05:26,080 --> 00:05:29,000 Speaker 1: told them it was morphine, and the soldier responded to 84 00:05:29,080 --> 00:05:32,760 Speaker 1: this shot of sailine like it was morphine, And from 85 00:05:32,760 --> 00:05:35,320 Speaker 1: that Beecher was like, what is going on here, started 86 00:05:35,360 --> 00:05:38,640 Speaker 1: to investigate the placebo effect and ended up proposing the 87 00:05:38,680 --> 00:05:43,000 Speaker 1: double blind placebo study to prove the efficacy of drugs. 88 00:05:43,680 --> 00:05:46,240 Speaker 1: It goes back further than that, my friend, let's hear 89 00:05:46,240 --> 00:05:52,040 Speaker 1: it man uh try sev five the New Medical Dictionary, 90 00:05:52,240 --> 00:05:55,320 Speaker 1: they described the placebo as a commonplace method or medicine, 91 00:05:55,440 --> 00:05:57,760 Speaker 1: and then a short time later, in eighteen eleven and 92 00:05:57,880 --> 00:06:03,200 Speaker 1: Quincy's lexicon uh Medicum, he defined the placebo as an 93 00:06:03,200 --> 00:06:07,360 Speaker 1: epithet given to any medicine adapted more to please than 94 00:06:07,400 --> 00:06:10,440 Speaker 1: to benefit the patient, like heroin. So they were on 95 00:06:10,520 --> 00:06:14,720 Speaker 1: it back in the early eighteen hundreds, which is surprising. Yeah, 96 00:06:14,760 --> 00:06:16,679 Speaker 1: but I mean, like that's the basis of like snake 97 00:06:16,720 --> 00:06:19,440 Speaker 1: oil and hucksterism, right, Yeah, Well, they called him bread 98 00:06:19,480 --> 00:06:21,320 Speaker 1: pills back then, because I guess it was. It was 99 00:06:21,320 --> 00:06:24,080 Speaker 1: probably some sort of like pill made of yeast. As 100 00:06:24,240 --> 00:06:27,680 Speaker 1: my guests UH and Thomas Jefferson in eighteen o seven 101 00:06:27,720 --> 00:06:31,560 Speaker 1: even recorded what he called the Pious Fraud, and he 102 00:06:31,640 --> 00:06:34,320 Speaker 1: observed quote that one of the most successful positions I've 103 00:06:34,320 --> 00:06:37,720 Speaker 1: ever known has assured me that he used more bread pills, 104 00:06:38,080 --> 00:06:41,200 Speaker 1: drops of colored water, and powders of hickory ash than 105 00:06:41,279 --> 00:06:46,200 Speaker 1: all other medicines put together. Um. And people treated people 106 00:06:46,200 --> 00:06:48,039 Speaker 1: with bread pills in the early eighteen hundreds. It was 107 00:06:48,040 --> 00:06:50,400 Speaker 1: a thing, and like they were way onto the placebo 108 00:06:50,440 --> 00:06:53,760 Speaker 1: effect and and the fact that it seemed to work. 109 00:06:54,560 --> 00:06:58,440 Speaker 1: UH and another dude named John Haygarth in the early 110 00:06:58,520 --> 00:07:01,960 Speaker 1: eighteen hundreds UH actually started performing the first studies on 111 00:07:02,000 --> 00:07:06,159 Speaker 1: placebo's effect and UM, he said it went back to 112 00:07:06,160 --> 00:07:10,680 Speaker 1: the Renaissance idea that imagination was the major mediator between 113 00:07:10,680 --> 00:07:14,200 Speaker 1: body and mind, which is starting to be proven is 114 00:07:14,200 --> 00:07:17,400 Speaker 1: possibly correct. Yeah, it's pretty interesting. And in the nineties 115 00:07:17,480 --> 00:07:20,560 Speaker 1: is when they started publishing papers on the placebo U 116 00:07:20,720 --> 00:07:25,600 Speaker 1: and actually doing clinical trials and UM. They said one 117 00:07:25,640 --> 00:07:28,240 Speaker 1: of their points in the nineteen thirties would confidence aroused 118 00:07:28,240 --> 00:07:32,240 Speaker 1: in a treatment, the encouragement afforded by a new procedure, 119 00:07:32,400 --> 00:07:35,280 Speaker 1: even like just people getting treated in a new way. 120 00:07:35,960 --> 00:07:38,240 Speaker 1: People would say, oh, well, this is gonna work, and 121 00:07:38,320 --> 00:07:40,360 Speaker 1: it maybe he did work. And then we're up to 122 00:07:40,400 --> 00:07:44,320 Speaker 1: the forties where Beacher comes along notices the placebo effect 123 00:07:44,360 --> 00:07:48,120 Speaker 1: himself ultimately comes up with the double blind placebo based study. 124 00:07:48,680 --> 00:07:51,760 Speaker 1: And what's ironic about that is the placebo based double 125 00:07:51,800 --> 00:07:55,600 Speaker 1: blind study ultimately has split back off into the study 126 00:07:55,600 --> 00:07:59,080 Speaker 1: of placebo again. Yeah, because there are so many trials 127 00:07:59,080 --> 00:08:01,680 Speaker 1: where the placebo was more effective than the drug, even 128 00:08:01,680 --> 00:08:04,840 Speaker 1: though the drug worked, but the placebo worked even better. 129 00:08:05,480 --> 00:08:08,280 Speaker 1: And finally in the nine people were like, what is 130 00:08:08,320 --> 00:08:11,600 Speaker 1: going on here? We need to study this thing in 131 00:08:11,640 --> 00:08:14,000 Speaker 1: and of itself. Well, yeah, because one of the things 132 00:08:14,080 --> 00:08:18,880 Speaker 1: I had no idea. I thought placebos were only used 133 00:08:19,040 --> 00:08:23,000 Speaker 1: in studies for efficacy rates. I did not know that 134 00:08:23,040 --> 00:08:26,640 Speaker 1: they are. There are doctors, always have been, and still 135 00:08:26,640 --> 00:08:31,840 Speaker 1: are prescribing placebos as medicine unknowingly even though they're not 136 00:08:31,880 --> 00:08:35,160 Speaker 1: supposed to. We'll get to that later. No knowingly, no 137 00:08:35,280 --> 00:08:38,280 Speaker 1: unknowingly for the patient, even though they're supposed to tell 138 00:08:38,280 --> 00:08:40,360 Speaker 1: the patient. Yeah, but we'll get to that towards the end, 139 00:08:40,440 --> 00:08:43,040 Speaker 1: but I had no idea that they were prescribing placebos 140 00:08:43,040 --> 00:08:45,280 Speaker 1: to people. Yeah, And in their defense, a lot of 141 00:08:45,280 --> 00:08:48,880 Speaker 1: times doctors are carrying on a tradition where they don't 142 00:08:48,880 --> 00:08:53,199 Speaker 1: have anything else to prescribe. But they can't say if 143 00:08:53,240 --> 00:08:55,240 Speaker 1: they say that to their patients, their patients is going 144 00:08:55,280 --> 00:08:57,240 Speaker 1: to go off and suffer. So at the very least 145 00:08:57,280 --> 00:09:02,600 Speaker 1: they can use the last ditch attempt of saying psychological trickery. Yeah, yeah, 146 00:09:02,640 --> 00:09:04,679 Speaker 1: And I'm not knocking to I just was surprised to 147 00:09:04,760 --> 00:09:06,760 Speaker 1: learn that that still happens. And I'm wondering if I've 148 00:09:06,760 --> 00:09:10,120 Speaker 1: ever been given a placebo. And it makes me feel 149 00:09:10,160 --> 00:09:12,839 Speaker 1: dumb as a patient to say, like, yeah, man, that 150 00:09:12,920 --> 00:09:14,840 Speaker 1: whatever you give me really helped. And the doctors like 151 00:09:16,040 --> 00:09:18,439 Speaker 1: because it's the same thing as that prank of like 152 00:09:18,920 --> 00:09:21,680 Speaker 1: giving somebody non alcoholic beer and telling it's a real 153 00:09:21,720 --> 00:09:24,079 Speaker 1: beer and watching them make a jerk out of themselves 154 00:09:24,080 --> 00:09:27,880 Speaker 1: getting drunk. It's exactly the same thing. So let's talk 155 00:09:27,920 --> 00:09:31,560 Speaker 1: about placebo. We assume that everybody knows what placebo is, 156 00:09:31,600 --> 00:09:36,960 Speaker 1: but let's define it a little more clearly. The placebo effect, specifically, 157 00:09:37,880 --> 00:09:43,400 Speaker 1: is the very real phenomenon that people when given a 158 00:09:43,480 --> 00:09:49,840 Speaker 1: pill or a some sort of medical intervention, that feel better. Yes, 159 00:09:49,880 --> 00:09:52,600 Speaker 1: they feel better, even though what they've been given is 160 00:09:52,679 --> 00:09:56,840 Speaker 1: not medicine and is was not actually a real intervention. Yeah. 161 00:09:56,880 --> 00:10:00,800 Speaker 1: And the placebo is the pill itself. That that that is 162 00:10:01,040 --> 00:10:04,400 Speaker 1: the placebo, and the effect is what you just described, right, 163 00:10:04,400 --> 00:10:05,600 Speaker 1: And it doesn't have to be a pill. It can 164 00:10:05,600 --> 00:10:09,920 Speaker 1: be an injection, it can be fake surgery, there's true. 165 00:10:09,920 --> 00:10:13,800 Speaker 1: And it doesn't even have to be uh, pharmacologically inert 166 00:10:13,920 --> 00:10:17,760 Speaker 1: It can be a vitamin or like an aspirin, even 167 00:10:17,760 --> 00:10:21,480 Speaker 1: though some argue that's not a true placebo. But um, 168 00:10:21,520 --> 00:10:24,240 Speaker 1: sometimes that's what the doctor will give you, uh and 169 00:10:24,440 --> 00:10:28,680 Speaker 1: call it, you know, medication. But there there um very 170 00:10:28,720 --> 00:10:32,160 Speaker 1: often things like a sugar pill. Yeah, like you said, 171 00:10:32,200 --> 00:10:38,320 Speaker 1: pharmacologically inert um. And astoundingly, depending on the size of 172 00:10:38,360 --> 00:10:40,319 Speaker 1: the pill, the shape of the pill, the color of 173 00:10:40,360 --> 00:10:44,640 Speaker 1: the pill, people will have different effects and responses to 174 00:10:44,720 --> 00:10:48,640 Speaker 1: these things that are just sugar. Um. So there's some 175 00:10:48,760 --> 00:10:54,600 Speaker 1: really strange psychological things going on here. And at first, 176 00:10:55,320 --> 00:10:58,160 Speaker 1: for a long time, everybody just kind of assumed it 177 00:10:58,200 --> 00:11:02,000 Speaker 1: was just psychology, that we we're tricking ourselves into feeling better, 178 00:11:02,440 --> 00:11:05,400 Speaker 1: or we hadn't really felt bad in the first place, 179 00:11:06,080 --> 00:11:10,240 Speaker 1: and we were being tricked into not feeling bad any longer, 180 00:11:10,400 --> 00:11:12,600 Speaker 1: or not thinking we were feeling bad any like an 181 00:11:12,600 --> 00:11:17,480 Speaker 1: offshoot of hypochondria, maybe very much. So. Yeah, um, they 182 00:11:17,679 --> 00:11:19,520 Speaker 1: this article says they've been shown to work in about 183 00:11:19,520 --> 00:11:22,880 Speaker 1: thirty percent of patients, and that was actually that's based 184 00:11:22,880 --> 00:11:26,360 Speaker 1: on Beacher's finding. It was like thirty thirty five point two. Yeah, 185 00:11:26,440 --> 00:11:28,720 Speaker 1: that's what he found out in nine that's what they're 186 00:11:28,720 --> 00:11:32,040 Speaker 1: still basing that on. Yeah, but there's been other studies 187 00:11:32,080 --> 00:11:35,920 Speaker 1: that have gone back through Beacher's studies and said, no, no, no, 188 00:11:36,040 --> 00:11:38,800 Speaker 1: that's not that much. Other people have found up to 189 00:11:38,880 --> 00:11:43,439 Speaker 1: six respond to it, right, And basically one of the 190 00:11:43,480 --> 00:11:46,640 Speaker 1: big questions is is it a psychological effect or are 191 00:11:46,679 --> 00:11:51,079 Speaker 1: there excell actual physical responses that are going on. And 192 00:11:51,160 --> 00:11:53,760 Speaker 1: there's been a lot of research lately that's pretty interesting, 193 00:11:53,760 --> 00:11:56,520 Speaker 1: I think. Right. So, like we were saying that the 194 00:11:56,520 --> 00:12:01,920 Speaker 1: the initial idea was that it was all psychological, right, yeah, Like, uh, well, 195 00:12:01,960 --> 00:12:04,360 Speaker 1: I guess we can talk about the two effects. The 196 00:12:04,400 --> 00:12:09,679 Speaker 1: subject expectancy effect, which is basically, if you know the 197 00:12:09,720 --> 00:12:11,400 Speaker 1: result ahead of time and the pill you're gonna take, 198 00:12:11,400 --> 00:12:15,400 Speaker 1: you're gonna end up feeling that result, right. So that's 199 00:12:15,400 --> 00:12:18,520 Speaker 1: what a blind study seeks to prevent, is a subject 200 00:12:18,640 --> 00:12:23,400 Speaker 1: expectancy effect and also the observer expectancy effect, which is 201 00:12:23,400 --> 00:12:26,000 Speaker 1: what a double blind study seeks to prevent. Yeah, and 202 00:12:26,040 --> 00:12:29,920 Speaker 1: that's important because it's are different because it's all self reported, right, 203 00:12:30,120 --> 00:12:33,319 Speaker 1: which is always a little you know, right. So the 204 00:12:33,360 --> 00:12:36,280 Speaker 1: other idea, if it has a psychological basis, is that 205 00:12:36,360 --> 00:12:39,960 Speaker 1: it's classical conditioning. That we are raised from birth to 206 00:12:40,559 --> 00:12:44,199 Speaker 1: think that if somebody gives you a pill, you're going 207 00:12:44,280 --> 00:12:47,760 Speaker 1: to respond to it because it has medicine. Yeah, and 208 00:12:47,760 --> 00:12:52,360 Speaker 1: that is not self reported. That is actually seeing physical responses, right. 209 00:12:52,640 --> 00:12:58,079 Speaker 1: And with classical conditioning established very famously by Pavlov and 210 00:12:58,160 --> 00:13:04,800 Speaker 1: his dogs, right, um, you are you're having you're responding 211 00:13:05,679 --> 00:13:10,880 Speaker 1: physically to a psychological stimulus, right, so you you are 212 00:13:10,920 --> 00:13:15,280 Speaker 1: getting a physiological response. So classical conditioning eventually kind of 213 00:13:15,320 --> 00:13:19,679 Speaker 1: came to be viewed as the more um reasonable explanation 214 00:13:19,720 --> 00:13:24,320 Speaker 1: for what was going on, because, uh, study after study 215 00:13:24,320 --> 00:13:28,440 Speaker 1: after study has shown that we are having a physical 216 00:13:28,520 --> 00:13:32,320 Speaker 1: reaction to these inert placebos. Yeah, one of them in 217 00:13:32,360 --> 00:13:35,680 Speaker 1: two thousand two from U. C. L As Neuropsychiatric Institute. 218 00:13:35,960 --> 00:13:38,800 Speaker 1: They had a couple of groups of patients and a 219 00:13:38,800 --> 00:13:43,840 Speaker 1: lot of the placebo studies are uh for mental conditions. Um, 220 00:13:43,880 --> 00:13:45,319 Speaker 1: not all of them, but a lot of them are 221 00:13:45,559 --> 00:13:50,319 Speaker 1: or in UM like the clinical trials. Yeah, yeah, exactly. UM. 222 00:13:50,400 --> 00:13:53,840 Speaker 1: So this one was for any depressants, and they had 223 00:13:53,840 --> 00:13:58,880 Speaker 1: two groups that got UM experimental drugs like real drugs, 224 00:13:59,200 --> 00:14:01,760 Speaker 1: and then the third was given the placebo. Uh. They 225 00:14:01,760 --> 00:14:04,240 Speaker 1: spent a few weeks on these pills and monitored their 226 00:14:04,280 --> 00:14:08,840 Speaker 1: brain activity with the old E. G. Wonder machine and 227 00:14:09,000 --> 00:14:11,559 Speaker 1: well it's not the Wonder machine, the Mrs Wonder, it's 228 00:14:11,600 --> 00:14:15,080 Speaker 1: it's a wonder machine, not the Wonder machine. Uh. And 229 00:14:15,160 --> 00:14:18,480 Speaker 1: the patients on the placebo reported positive effects and showed 230 00:14:18,520 --> 00:14:22,160 Speaker 1: greater increase of brain activity than those who had responded 231 00:14:22,200 --> 00:14:25,920 Speaker 1: to the drug. You know, I remember that it was 232 00:14:26,120 --> 00:14:31,240 Speaker 1: the study. Yeah, totally undermined people's faith in antidepressants because 233 00:14:31,280 --> 00:14:33,440 Speaker 1: it was on the other end of like the whole 234 00:14:33,560 --> 00:14:37,200 Speaker 1: nineties where everybody was on antidepressants and wasn't This study 235 00:14:37,280 --> 00:14:39,880 Speaker 1: came out and was like people were saying, like, do 236 00:14:39,960 --> 00:14:42,480 Speaker 1: these things even work? It was it was kind of 237 00:14:42,520 --> 00:14:45,520 Speaker 1: taken the opposite way rather than Wow, the placebo effect 238 00:14:45,560 --> 00:14:49,000 Speaker 1: is really something. It was wow and it depressence, right, fraudulent, 239 00:14:49,320 --> 00:14:51,720 Speaker 1: right right? Right? Well, I wonder what they were trying 240 00:14:51,760 --> 00:14:54,520 Speaker 1: to It was a placebo study though, right, so it 241 00:14:54,560 --> 00:14:57,120 Speaker 1: kind of backfired or did they even care? No, I 242 00:14:57,160 --> 00:15:00,640 Speaker 1: think it very much cared because there when compared to 243 00:15:00,640 --> 00:15:03,800 Speaker 1: place with the whole point of a drug trial is 244 00:15:03,840 --> 00:15:07,000 Speaker 1: to show that this drug is more effective than placebo. 245 00:15:07,080 --> 00:15:10,280 Speaker 1: It's more effective than the imagination, right right, And if 246 00:15:10,320 --> 00:15:12,560 Speaker 1: it's not, then that means that drugs shouldn't be brought 247 00:15:12,600 --> 00:15:16,240 Speaker 1: to market. Even though now the thinking is more like, hmm, 248 00:15:16,480 --> 00:15:19,320 Speaker 1: that's not necessarily true, because we're coming to understand the 249 00:15:19,360 --> 00:15:23,400 Speaker 1: placebo effect can be very powerful, especially depending on the 250 00:15:23,400 --> 00:15:27,160 Speaker 1: individual too. Yeah, for sure. Uh. The interesting thing about 251 00:15:27,200 --> 00:15:29,960 Speaker 1: that study is when the E E G. Lit up um, 252 00:15:30,000 --> 00:15:33,160 Speaker 1: the activity was in different parts of the brain. Um 253 00:15:33,200 --> 00:15:36,160 Speaker 1: that I think that the placebo patients said the preformal 254 00:15:36,200 --> 00:15:39,680 Speaker 1: cortex was lighting up, and basically that says that the 255 00:15:39,680 --> 00:15:43,280 Speaker 1: brain isn't being fooled, it's just doing something different. Yeah, 256 00:15:43,320 --> 00:15:48,160 Speaker 1: they responded better to the treatment then the people who 257 00:15:48,600 --> 00:15:52,120 Speaker 1: responded to the drug. So some people did respond to 258 00:15:52,120 --> 00:15:54,680 Speaker 1: the drug, but different parts of their brain were activated 259 00:15:54,680 --> 00:15:56,760 Speaker 1: by the drug than the people who responded well to 260 00:15:56,800 --> 00:15:59,880 Speaker 1: the placebos, right, even though they felt better. Yeah, that's 261 00:16:00,000 --> 00:16:02,480 Speaker 1: mind boggling. It is. So they had they reached the 262 00:16:02,520 --> 00:16:05,480 Speaker 1: same conclusion but using a totally different regions of their brain, 263 00:16:05,480 --> 00:16:09,200 Speaker 1: and they actually felt better. Um. That wasn't the first 264 00:16:09,200 --> 00:16:12,240 Speaker 1: study to prove that there is a physiological response to 265 00:16:12,280 --> 00:16:16,160 Speaker 1: placebos or last there's a dental study from the seventies 266 00:16:16,200 --> 00:16:18,920 Speaker 1: that I think was the first that showed that if 267 00:16:18,960 --> 00:16:25,040 Speaker 1: you blocked endorphins, which are nature's pain relievers, uh, you 268 00:16:25,080 --> 00:16:29,880 Speaker 1: can also block the placebo effect. So the people weren't 269 00:16:29,920 --> 00:16:32,400 Speaker 1: responding to the placebo like you would expect them to 270 00:16:32,760 --> 00:16:38,000 Speaker 1: a pain reliever placebo because they weren't able to release 271 00:16:38,080 --> 00:16:40,880 Speaker 1: their natural pain relievers. Yeah, and that's backed up I 272 00:16:40,880 --> 00:16:43,920 Speaker 1: guess by this two thousand four study from the University 273 00:16:43,920 --> 00:16:50,600 Speaker 1: of Michigan, uh Go wolverines. They basically demonstrated that it 274 00:16:50,680 --> 00:16:54,680 Speaker 1: is related to endorphins specifically. Uh So that I guess 275 00:16:54,680 --> 00:16:57,640 Speaker 1: that backs up that study because if you can block them. 276 00:16:57,720 --> 00:17:01,200 Speaker 1: So here's the thing. It's not that study was related 277 00:17:01,240 --> 00:17:04,720 Speaker 1: to endorphins specifically. Other studies have found that it can 278 00:17:04,760 --> 00:17:08,840 Speaker 1: be related to how much a person expresses dopamine specifically. 279 00:17:09,359 --> 00:17:12,400 Speaker 1: So there's like this idea that there's a genetic basis 280 00:17:12,400 --> 00:17:17,600 Speaker 1: to our predisposition to UM placebos. But I think that 281 00:17:17,720 --> 00:17:23,000 Speaker 1: it's depending on the drug or the effect that you're 282 00:17:23,000 --> 00:17:26,199 Speaker 1: trying to induce using the placebo effect, because think about it, 283 00:17:27,080 --> 00:17:31,600 Speaker 1: if you are somebody who naturally produces more endorphins than 284 00:17:31,640 --> 00:17:37,760 Speaker 1: somebody else, Uh, you're going to naturally produce more endorphins 285 00:17:37,760 --> 00:17:41,480 Speaker 1: when it's UM triggered by a placebo than somebody who 286 00:17:41,520 --> 00:17:46,000 Speaker 1: doesn't produce more endorphins naturally. So there's a genetic basis 287 00:17:46,080 --> 00:17:48,000 Speaker 1: to it, I guess. But I think the genetic basis 288 00:17:48,080 --> 00:17:51,399 Speaker 1: is that the individual must be predisposition to be able 289 00:17:51,440 --> 00:17:56,679 Speaker 1: to have that genetic response UM to the drug or 290 00:17:56,680 --> 00:18:01,159 Speaker 1: the placebo and have that that UM I guess response 291 00:18:01,240 --> 00:18:03,600 Speaker 1: to it. Yeah, And it's like you said, it's also 292 00:18:03,720 --> 00:18:08,040 Speaker 1: personal because they found that it is even affected by 293 00:18:08,080 --> 00:18:12,560 Speaker 1: a person's personal experience with past pills. The color of 294 00:18:12,600 --> 00:18:15,520 Speaker 1: the pill, the shape and size of the bill will 295 00:18:15,880 --> 00:18:19,000 Speaker 1: have a different reaction because the person had maybe took 296 00:18:19,520 --> 00:18:22,640 Speaker 1: another little blue pill for something else. Sure, and actually 297 00:18:22,680 --> 00:18:26,280 Speaker 1: blue pills in in particular are known to be um 298 00:18:26,280 --> 00:18:29,600 Speaker 1: to have sedative effects as place Ebo's red pills are 299 00:18:29,640 --> 00:18:33,600 Speaker 1: known to have stimulating and pain relieving effects as placebo. 300 00:18:33,760 --> 00:18:38,000 Speaker 1: That's odd that they made viagrab blue. Yeah, like inhabitedly 301 00:18:38,240 --> 00:18:43,280 Speaker 1: marketed it as the little blue pill. Interesting sedative effect, Yes, 302 00:18:43,400 --> 00:18:49,679 Speaker 1: I don't think so, so, Chuck, Well, not that i'd know. Well, 303 00:18:49,440 --> 00:18:53,000 Speaker 1: we've got more stuff about all this coming up. I 304 00:18:53,040 --> 00:18:54,640 Speaker 1: don't know what we're going to talk about next. It's 305 00:18:54,680 --> 00:19:16,720 Speaker 1: a grab bag right now. We're back, buddy, and I 306 00:19:16,760 --> 00:19:18,720 Speaker 1: tell you what we're going to talk about. Something that 307 00:19:18,760 --> 00:19:21,120 Speaker 1: I had never heard of, which I think is super interesting, 308 00:19:21,920 --> 00:19:25,080 Speaker 1: the no sebo effect. It is super cool. And that 309 00:19:25,240 --> 00:19:27,520 Speaker 1: is when well, it's a there's a couple of things. 310 00:19:27,560 --> 00:19:30,080 Speaker 1: That is, when you are taking a placebo and you 311 00:19:30,240 --> 00:19:34,400 Speaker 1: experience maybe the effects of the pill, which is great, 312 00:19:34,840 --> 00:19:38,080 Speaker 1: and the side effects of that pill that you think 313 00:19:38,480 --> 00:19:41,800 Speaker 1: might be but you're supposed to have, right, you're actually 314 00:19:41,800 --> 00:19:44,720 Speaker 1: experiencing side effects that aren't shouldn't be there, right, And 315 00:19:45,000 --> 00:19:47,680 Speaker 1: it's a sugar pill. They noticed this in clinical trials too, 316 00:19:47,800 --> 00:19:50,159 Speaker 1: because when you're carrying out a clinical trial, you have 317 00:19:50,200 --> 00:19:53,400 Speaker 1: to warn the patients, Yeah, this drug may give you 318 00:19:53,560 --> 00:19:57,040 Speaker 1: these terrible side effects, and so they started noticing like 319 00:19:57,160 --> 00:20:01,400 Speaker 1: people who were who were on placebo, we're still experiencing 320 00:20:01,400 --> 00:20:05,959 Speaker 1: the side effect like physical reactions like hives and itching 321 00:20:06,119 --> 00:20:09,360 Speaker 1: in things. Right, so there is a there's a negative 322 00:20:09,400 --> 00:20:11,520 Speaker 1: side to placebo as well, and no sebo means I 323 00:20:11,560 --> 00:20:16,280 Speaker 1: shall harm like placebo means I shall please. Yeah, yeah um. 324 00:20:16,359 --> 00:20:19,679 Speaker 1: And they found that and this is definitely backed up 325 00:20:19,680 --> 00:20:22,919 Speaker 1: by the idea that it's classical conditioning. They found that 326 00:20:23,040 --> 00:20:27,800 Speaker 1: people who have gone through chemotherapy can become nauseated when 327 00:20:27,840 --> 00:20:30,119 Speaker 1: they enter a room that's painted the same color as 328 00:20:30,160 --> 00:20:33,600 Speaker 1: the room where they receive chemo before. Yeah, that makes sense. Yeah, 329 00:20:33,680 --> 00:20:36,080 Speaker 1: So there's all sorts of ways that the no sebo 330 00:20:36,119 --> 00:20:39,920 Speaker 1: effect can pop up, but it's pretty mind boggling as well. Yeah, 331 00:20:39,920 --> 00:20:42,159 Speaker 1: and then no seabow can doesn't even have to be 332 00:20:42,240 --> 00:20:45,359 Speaker 1: just with the placebo. You can experience side effects that 333 00:20:45,400 --> 00:20:48,080 Speaker 1: aren't on the list of a real drug because of 334 00:20:48,119 --> 00:20:50,280 Speaker 1: what we were talking about, because it looked like another 335 00:20:50,320 --> 00:20:55,520 Speaker 1: pill you might have had before. Man, the brain powerful stuff. So, 336 00:20:56,119 --> 00:20:58,840 Speaker 1: going back to Kapchuk, whom I'm just kind of a 337 00:20:58,840 --> 00:21:03,560 Speaker 1: fan of, Yeah, I think if you're into like a 338 00:21:03,680 --> 00:21:08,920 Speaker 1: long form articles, which I love. Go to Harvard Magazine 339 00:21:09,200 --> 00:21:12,520 Speaker 1: and search for the placebo phenomenon and it's a profile 340 00:21:12,520 --> 00:21:16,159 Speaker 1: at him and his work. It's really interesting stuff. But 341 00:21:16,240 --> 00:21:20,040 Speaker 1: he was saying that kind of in line with the 342 00:21:20,080 --> 00:21:21,800 Speaker 1: idea that like the color of the pill or the 343 00:21:21,800 --> 00:21:24,320 Speaker 1: shape of the pill will have an effect, won't either 344 00:21:24,400 --> 00:21:27,840 Speaker 1: on the no sebo or the placebo effect. Um. He 345 00:21:27,880 --> 00:21:30,639 Speaker 1: was saying that it seems like the basis of the 346 00:21:30,680 --> 00:21:35,919 Speaker 1: placebo effect is what's called ritual, and ritual is it 347 00:21:35,960 --> 00:21:39,760 Speaker 1: involves everything from like the physician's bedside manner, to how 348 00:21:39,800 --> 00:21:44,119 Speaker 1: expensive the patient thinks the pill is, to how effective 349 00:21:44,240 --> 00:21:47,320 Speaker 1: the patient thinks the pillows and um. He did a 350 00:21:47,359 --> 00:21:51,399 Speaker 1: study where he carried out what was called schmaltzy um, 351 00:21:51,720 --> 00:21:56,199 Speaker 1: like a schmalty care to where he was just lavishing 352 00:21:56,240 --> 00:22:00,240 Speaker 1: attention on the patient and telling him how bad he 353 00:22:00,320 --> 00:22:03,520 Speaker 1: felt that they were going through this, but this pill 354 00:22:04,000 --> 00:22:08,840 Speaker 1: is really effective with your condition. And apparently not just 355 00:22:08,920 --> 00:22:11,360 Speaker 1: this study, but other studies show that there's a positive 356 00:22:11,359 --> 00:22:18,960 Speaker 1: correlation between the ritual yeah and response to the placebo effect. 357 00:22:19,320 --> 00:22:22,040 Speaker 1: So the more you think that this drug is expensive, 358 00:22:22,240 --> 00:22:25,880 Speaker 1: that this drug is effective, that this physician cares about you, 359 00:22:26,720 --> 00:22:30,880 Speaker 1: the greater of a placebo response you're going to have. Yeah, 360 00:22:31,080 --> 00:22:33,119 Speaker 1: you know, I have you ever been accused of being 361 00:22:33,119 --> 00:22:37,000 Speaker 1: a hypochondract by anyone? Know, it's kind to be very demeaning. 362 00:22:38,640 --> 00:22:41,880 Speaker 1: It is because it happened to me. Oh yeah, Yeah. 363 00:22:41,920 --> 00:22:43,439 Speaker 1: I went to the emergency room in New York, as 364 00:22:43,480 --> 00:22:45,920 Speaker 1: you know, when we were up there recently for our trip. 365 00:22:46,280 --> 00:22:50,160 Speaker 1: I went to the e R and uh something, it 366 00:22:50,240 --> 00:22:53,600 Speaker 1: was something and it was a result of it was 367 00:22:53,640 --> 00:22:59,199 Speaker 1: it was throwing up in uh nausea from UM I 368 00:22:59,280 --> 00:23:02,359 Speaker 1: learned from anti inflammatory pills I was taking at the 369 00:23:02,400 --> 00:23:04,480 Speaker 1: time for something else. I had nothing to do with 370 00:23:04,520 --> 00:23:08,639 Speaker 1: being sick, and they figured that out, but they kept. 371 00:23:08,800 --> 00:23:10,560 Speaker 1: You know, this guy, I called him Nurse Jackie. He 372 00:23:10,600 --> 00:23:12,359 Speaker 1: was just like Nurse Jackie exap. He was a dude. 373 00:23:12,760 --> 00:23:14,680 Speaker 1: He kept coming by and treating me with things and 374 00:23:14,680 --> 00:23:16,160 Speaker 1: giving me the I V. Drip And I was like, dude, 375 00:23:16,160 --> 00:23:18,920 Speaker 1: I'm not feeling better and I'm not a hypochondric in 376 00:23:18,960 --> 00:23:20,840 Speaker 1: any way. I didn't go to the doctor for like 377 00:23:21,080 --> 00:23:24,560 Speaker 1: eighteen years straight. And uh, I could tell he was 378 00:23:24,560 --> 00:23:28,200 Speaker 1: looking at me like I got one of these guys. Yeah, 379 00:23:28,200 --> 00:23:29,800 Speaker 1: And I was like no, no, And I could tell 380 00:23:29,840 --> 00:23:32,640 Speaker 1: I could could sense it, and so he finally gave 381 00:23:32,680 --> 00:23:36,120 Speaker 1: me this thing to drink that um knocked me out. 382 00:23:36,240 --> 00:23:38,680 Speaker 1: I woke up like twenty minutes later and felt felt better. 383 00:23:39,320 --> 00:23:42,359 Speaker 1: What was it, I can't remember. It was something to 384 00:23:42,560 --> 00:23:45,040 Speaker 1: gata now. It was like three different things. It was 385 00:23:45,040 --> 00:23:48,480 Speaker 1: like a cocktail of stomach pleasing things and what's the 386 00:23:48,520 --> 00:23:52,960 Speaker 1: stuff that like numbs? You numb my throat? And I 387 00:23:52,960 --> 00:23:56,000 Speaker 1: can't remember light to cane, I think um and it 388 00:23:56,040 --> 00:23:57,840 Speaker 1: worked with Yeah, it worked. I woke up and I 389 00:23:57,880 --> 00:23:59,280 Speaker 1: felt better. I said, you know, I don't feel so 390 00:23:59,359 --> 00:24:01,760 Speaker 1: nauseous now, and they were checking me out and I 391 00:24:01,760 --> 00:24:05,439 Speaker 1: reached up and I felt behind my ear for some reason, 392 00:24:05,480 --> 00:24:07,640 Speaker 1: and it felt like a golf ball behind my ear. 393 00:24:08,160 --> 00:24:11,399 Speaker 1: And it popped up in the last twenty minutes, and 394 00:24:11,400 --> 00:24:12,720 Speaker 1: so I was literally leaving. I was like, oh, wait 395 00:24:12,720 --> 00:24:14,280 Speaker 1: a minute, I got this thing behind my ear all 396 00:24:14,320 --> 00:24:16,679 Speaker 1: of a sudden, and this guy looked at me like 397 00:24:16,960 --> 00:24:19,560 Speaker 1: h and he called the doctor over and she was like, yeah, 398 00:24:19,640 --> 00:24:22,080 Speaker 1: it's it's very swollen at your lymph node. But he 399 00:24:22,119 --> 00:24:24,280 Speaker 1: wasn't there for that, so he came back over. He's like, hey, 400 00:24:24,320 --> 00:24:25,879 Speaker 1: what did she say? I said, well, she said the 401 00:24:25,920 --> 00:24:28,879 Speaker 1: swollen and he said that you're a hypochondriac. And I 402 00:24:28,920 --> 00:24:31,800 Speaker 1: was so mad. It nursed Jackie. I was like, dude, 403 00:24:32,440 --> 00:24:35,040 Speaker 1: look at it. It's huge. I'm not making this up. 404 00:24:35,080 --> 00:24:37,439 Speaker 1: And I started defending myself like I never go to 405 00:24:37,520 --> 00:24:40,120 Speaker 1: doctors and I'm not one of those people. And he 406 00:24:40,160 --> 00:24:41,600 Speaker 1: was just he was like, I was just kidding. I 407 00:24:41,600 --> 00:24:43,600 Speaker 1: was just kidding, and I was just kidding. Yeah, but 408 00:24:43,640 --> 00:24:46,600 Speaker 1: it made it totally made me feel like a jerk. Yeah, 409 00:24:47,000 --> 00:24:49,200 Speaker 1: I mean imagine if like you, if that happened to 410 00:24:49,240 --> 00:24:51,239 Speaker 1: you a lot too. I mean that's all that means, 411 00:24:51,280 --> 00:24:55,439 Speaker 1: you're a hypochondriact. But now it definitely made me felt 412 00:24:56,160 --> 00:24:57,600 Speaker 1: and I know he was kidding, but it made me 413 00:24:57,600 --> 00:25:01,240 Speaker 1: feel really bad, like I'm in there just uh, what's 414 00:25:01,280 --> 00:25:05,359 Speaker 1: what's the syndrome? Lynch? Is that it? Yeah? We did 415 00:25:05,440 --> 00:25:08,720 Speaker 1: want an episode on that too. Yeah, uh, anyway, sorry 416 00:25:08,720 --> 00:25:12,000 Speaker 1: about that. Yeah, well I'm sorry that that happened to you. Thanks. 417 00:25:12,400 --> 00:25:14,800 Speaker 1: I mean that is b s. But you mentioned the 418 00:25:14,840 --> 00:25:18,160 Speaker 1: I V guarantee you that was just sailing, and that's 419 00:25:18,560 --> 00:25:21,240 Speaker 1: a placebo in itself. No, I mean they told me that. 420 00:25:21,800 --> 00:25:23,439 Speaker 1: I mean they didn't say like that this is the 421 00:25:23,480 --> 00:25:27,560 Speaker 1: wonder bag, right, But there's basically, I'm no reason to 422 00:25:27,760 --> 00:25:30,760 Speaker 1: give you sailine solution well to hydrate me. I guess 423 00:25:30,760 --> 00:25:34,520 Speaker 1: if i'd been throwing up. Oh yeah, okay, but um yeah, 424 00:25:34,560 --> 00:25:36,480 Speaker 1: I guess you're right though, to see like something dripping 425 00:25:36,520 --> 00:25:40,960 Speaker 1: into your arm, like, surely that's got to be doing something. Yeah. Uh. Well, 426 00:25:41,160 --> 00:25:45,320 Speaker 1: one interesting thing is back to placebo's there have been 427 00:25:45,359 --> 00:25:48,320 Speaker 1: studies that have shown that, uh, if you don't tell 428 00:25:48,320 --> 00:25:50,840 Speaker 1: the patient what they're supposed to do, that they don't 429 00:25:50,840 --> 00:25:53,080 Speaker 1: work as well. Yeah. They even found that with drugs 430 00:25:53,119 --> 00:25:56,240 Speaker 1: that they know for a fact work. Yeah, if you 431 00:25:56,240 --> 00:25:58,639 Speaker 1: don't tell them, it won't work. Yeah. They did a 432 00:25:58,760 --> 00:26:03,399 Speaker 1: placebo based trial with a pain killer and the pain 433 00:26:03,480 --> 00:26:08,160 Speaker 1: killer proved more effective than placebo. And then they did 434 00:26:08,200 --> 00:26:11,120 Speaker 1: another trial with the same pain killer, didn't tell anybody 435 00:26:11,160 --> 00:26:15,960 Speaker 1: what it was and it didn't work. Interesting. And then conversely, 436 00:26:16,200 --> 00:26:19,119 Speaker 1: this is the one that gets me, the study where 437 00:26:19,359 --> 00:26:24,359 Speaker 1: they so crazy. They used an injection that they put 438 00:26:24,440 --> 00:26:28,520 Speaker 1: into patient's jaws in the study, which is mean to 439 00:26:28,640 --> 00:26:31,240 Speaker 1: induce pain, Like that was the point. They were trying 440 00:26:31,280 --> 00:26:36,680 Speaker 1: to induce pain in somebody's jaw using harmless but painful 441 00:26:37,000 --> 00:26:40,960 Speaker 1: jaw injections, and they would inject sailine into the jaw 442 00:26:41,520 --> 00:26:45,399 Speaker 1: um to keep the patient's self reported pain level steady 443 00:26:45,560 --> 00:26:49,520 Speaker 1: throughout the study. And then they used another injection and 444 00:26:49,560 --> 00:26:52,760 Speaker 1: gave them sailine but told them this was a pain reliever, 445 00:26:53,359 --> 00:26:57,880 Speaker 1: and everybody's pain across the board dropped as a result 446 00:26:57,880 --> 00:27:02,280 Speaker 1: in the study. Unbelievable placebo effect. I could just sit 447 00:27:02,320 --> 00:27:05,440 Speaker 1: around and rattle off studies all day. It's pretty interesting. 448 00:27:05,480 --> 00:27:10,360 Speaker 1: What do you think about obacalp. Yeah, it seems kids 449 00:27:10,359 --> 00:27:12,359 Speaker 1: are done. You kid just call it placebo anyway, I 450 00:27:12,440 --> 00:27:16,600 Speaker 1: think it's unnecessary. Well, Obacalp is placebo spelled backwards obviously, 451 00:27:16,720 --> 00:27:20,520 Speaker 1: and that in two thousand and eight was I guess, 452 00:27:20,560 --> 00:27:23,840 Speaker 1: sort of invented or not invented, but coined and packaged 453 00:27:24,400 --> 00:27:30,560 Speaker 1: by a mother I think Australian named jin Boutner. She Australian. 454 00:27:30,840 --> 00:27:32,879 Speaker 1: I don't know. I think so is that an Australian 455 00:27:32,960 --> 00:27:34,840 Speaker 1: last name? And then I don't think there's such a 456 00:27:34,880 --> 00:27:40,000 Speaker 1: thing um, And so that's basically Placebo's for kids. It's marketed. 457 00:27:40,040 --> 00:27:42,520 Speaker 1: You can you can buy a bottle of obacalp, and 458 00:27:42,560 --> 00:27:46,760 Speaker 1: it's for when your kid isn't feeling good. But um, 459 00:27:46,840 --> 00:27:48,960 Speaker 1: you but you know, your kids not sick, that kind 460 00:27:48,960 --> 00:27:51,360 Speaker 1: of thing, and so you give the kid the pill 461 00:27:51,359 --> 00:27:53,240 Speaker 1: and it makes them feel better. And some people have 462 00:27:53,320 --> 00:27:56,359 Speaker 1: problems with this and say, you're teaching your child that 463 00:27:57,200 --> 00:28:00,240 Speaker 1: you get relief from pills only when they're you know, 464 00:28:00,359 --> 00:28:02,600 Speaker 1: I don't necessarily need to be taking pills all the time. 465 00:28:03,160 --> 00:28:05,720 Speaker 1: And proponents say, you know what, it's it's the same 466 00:28:05,760 --> 00:28:08,639 Speaker 1: thing as putting a bandage or kissing a boo boo. 467 00:28:08,920 --> 00:28:11,880 Speaker 1: It's like you said, these are dumb little kids. Well, 468 00:28:11,880 --> 00:28:15,520 Speaker 1: I remember growing up with the children's aspirin, the orange aspirin. 469 00:28:16,200 --> 00:28:18,320 Speaker 1: I'm pretty sure those were just sugar pills. You think. 470 00:28:18,480 --> 00:28:20,560 Speaker 1: I ate a whole bottle of them when I was fine, 471 00:28:21,600 --> 00:28:24,679 Speaker 1: But those were vitamins. It was children's aspirin. Oh, I 472 00:28:24,680 --> 00:28:28,560 Speaker 1: think they were orange flavored. Yeah, I totally remember those. Yeah, 473 00:28:28,600 --> 00:28:32,919 Speaker 1: I think those were probably a placeba. I remember the taste, 474 00:28:32,960 --> 00:28:34,560 Speaker 1: like I can still sense that they were good, a 475 00:28:35,440 --> 00:28:37,000 Speaker 1: whole bottle of them once. Because I was a little 476 00:28:37,040 --> 00:28:40,960 Speaker 1: fat kid. You didn't eat and get sick those sugar pills. 477 00:28:41,040 --> 00:28:43,840 Speaker 1: I have I think so, because I even remember I 478 00:28:43,840 --> 00:28:45,960 Speaker 1: was old enough thinking like I probably shouldn't have eaten 479 00:28:46,000 --> 00:28:48,800 Speaker 1: that whole bottle of those things because it's medicine, and 480 00:28:48,800 --> 00:28:50,640 Speaker 1: watched it down with the sky and I was right 481 00:28:51,080 --> 00:28:54,440 Speaker 1: and that was fine. Afterwards, Well, they do have legit 482 00:28:54,480 --> 00:29:00,239 Speaker 1: baby aspirin now though they I'm starting to doubt every thing, 483 00:29:00,880 --> 00:29:04,440 Speaker 1: so start to talk about doubt. There are plenty of 484 00:29:04,480 --> 00:29:07,360 Speaker 1: criticisms of all this, and we'll talk about him right 485 00:29:07,360 --> 00:29:25,760 Speaker 1: after this. So Chuck, I'm a big time into the 486 00:29:25,800 --> 00:29:28,240 Speaker 1: placebo effect. I can tell your big time into the 487 00:29:28,240 --> 00:29:32,440 Speaker 1: placebo effect. There are people who are not that's true. 488 00:29:32,680 --> 00:29:35,920 Speaker 1: There Uh. It raises plenty of skepticism, which again is 489 00:29:35,960 --> 00:29:37,560 Speaker 1: one of the reasons why my hat is off to 490 00:29:37,600 --> 00:29:41,080 Speaker 1: Ted Katchuk, because he has responded to the criticism. He's 491 00:29:41,120 --> 00:29:44,640 Speaker 1: adjusted his methodology. He's doing really good science in the 492 00:29:44,680 --> 00:29:48,400 Speaker 1: investigation of the placebo effect. I like that guy. Still, 493 00:29:48,840 --> 00:29:51,480 Speaker 1: skeptics say, there are a lot of things that you 494 00:29:51,520 --> 00:29:55,840 Speaker 1: can use to explain away the placebo effect. For example, 495 00:29:56,200 --> 00:29:59,880 Speaker 1: it's possible the person was actually a hypochondriac. They were 496 00:30:00,000 --> 00:30:03,120 Speaker 1: and actually sick in the first place. Yeah, it's possible 497 00:30:03,160 --> 00:30:07,360 Speaker 1: that some people get better with no treatment. Yeah, it's 498 00:30:07,400 --> 00:30:12,120 Speaker 1: possible that some diseases do treat themselves just get better. 499 00:30:12,640 --> 00:30:15,680 Speaker 1: Over the course of time. And if if you overlay 500 00:30:15,760 --> 00:30:19,480 Speaker 1: a placebo effect or placebo and and you put that 501 00:30:19,560 --> 00:30:21,840 Speaker 1: over the same course of time, it's gonna look like 502 00:30:21,880 --> 00:30:24,000 Speaker 1: it was the placebo that did it, when really it 503 00:30:24,120 --> 00:30:27,479 Speaker 1: just healed itself. Yeah, which is why they critics call 504 00:30:27,560 --> 00:30:31,200 Speaker 1: for studies where there is one group that has not 505 00:30:31,240 --> 00:30:35,280 Speaker 1: given any medication whatsoever exactly, which makes sense. So UM. 506 00:30:37,680 --> 00:30:39,960 Speaker 1: One of the other criticisms though, is that if a 507 00:30:40,080 --> 00:30:42,640 Speaker 1: doctor is is saying and there are, like you said, 508 00:30:42,640 --> 00:30:45,760 Speaker 1: plenty of doctors who do this. Um. There there were 509 00:30:45,800 --> 00:30:49,160 Speaker 1: studies that found that UM. A two thou seven study 510 00:30:49,400 --> 00:30:54,040 Speaker 1: from the University of Chicago from doctors surveyed in the 511 00:30:54,120 --> 00:30:58,640 Speaker 1: Chicago area had prescribed placebos before at some point during 512 00:30:58,680 --> 00:31:00,600 Speaker 1: their career. In two thousand and eight, they did a 513 00:31:00,600 --> 00:31:03,280 Speaker 1: little more robust when six centre doctors all across the 514 00:31:03,360 --> 00:31:07,920 Speaker 1: US and half of them said that they had prescribed placebos. 515 00:31:08,040 --> 00:31:10,000 Speaker 1: So this is like, this is still going on. It's 516 00:31:10,000 --> 00:31:13,120 Speaker 1: a thing. It's pretty widespread. Yeah, And the criticism is, well, 517 00:31:13,200 --> 00:31:16,080 Speaker 1: that means doctors are lying to their patients, they're using 518 00:31:16,120 --> 00:31:20,920 Speaker 1: deception to practice medicine, and that's unethical. So the A 519 00:31:21,120 --> 00:31:23,800 Speaker 1: M A came out with it's a guideline that's kind 520 00:31:23,800 --> 00:31:26,040 Speaker 1: of flies in the face of the placebo effector of 521 00:31:26,080 --> 00:31:28,959 Speaker 1: the idea that if you give somebody a placebo and 522 00:31:28,960 --> 00:31:32,080 Speaker 1: tell them it's a placebo, that it shouldn't work, which 523 00:31:32,120 --> 00:31:35,040 Speaker 1: is not necessarily true. Yeah. In two thousand six, the 524 00:31:35,080 --> 00:31:39,360 Speaker 1: Amy came out and said, uh, quote, physicians may use 525 00:31:39,440 --> 00:31:42,760 Speaker 1: placebos for diagnosis or treatment only if they patient is 526 00:31:42,800 --> 00:31:45,840 Speaker 1: informed and agrees to it. To me, that means it's 527 00:31:45,840 --> 00:31:48,920 Speaker 1: not a placebo. I mean, I guess it is, but 528 00:31:49,560 --> 00:31:52,120 Speaker 1: if you know it is, I don't get it. Like, 529 00:31:52,160 --> 00:31:53,880 Speaker 1: what's the point of a doctor coming in and saying, 530 00:31:54,080 --> 00:31:56,600 Speaker 1: I'm going to give you the sugar pill? Would would 531 00:31:56,600 --> 00:31:59,000 Speaker 1: you like a prescription for sugar pills? And you say yes? 532 00:31:59,040 --> 00:32:02,960 Speaker 1: I would suppose believe there are um studies that show 533 00:32:03,200 --> 00:32:08,920 Speaker 1: the placebo effect is still post works sometimes, but the 534 00:32:09,320 --> 00:32:12,480 Speaker 1: across the board pretty much everyone believes that if the 535 00:32:12,480 --> 00:32:14,560 Speaker 1: placebo effect is a real thing, the cats out of 536 00:32:14,600 --> 00:32:17,720 Speaker 1: the bag. It is part of the imagination, and that 537 00:32:17,800 --> 00:32:20,040 Speaker 1: you do kind of have to fool the person into 538 00:32:20,080 --> 00:32:24,040 Speaker 1: thinking that it's a real thing. That expectation coupled with 539 00:32:24,120 --> 00:32:28,360 Speaker 1: imagination provides the placebo effect Yeah, and this article points 540 00:32:28,360 --> 00:32:30,400 Speaker 1: out to we're not just saying these doctors are lying 541 00:32:30,440 --> 00:32:35,640 Speaker 1: liars um. Apparently, one one tech that a doctor can 542 00:32:35,640 --> 00:32:39,959 Speaker 1: take is to say, uh, I have something that I 543 00:32:40,000 --> 00:32:42,800 Speaker 1: think can help, but I don't exactly know what the 544 00:32:42,840 --> 00:32:45,560 Speaker 1: deal is with it or how it works, but i'll 545 00:32:45,560 --> 00:32:47,720 Speaker 1: give it to if you want to try it. And 546 00:32:47,840 --> 00:32:49,640 Speaker 1: you know, people are a lot of people are like, sure, 547 00:32:49,680 --> 00:32:53,160 Speaker 1: I'll try anything. Right, Exactly, that's not really deception because 548 00:32:53,360 --> 00:32:56,120 Speaker 1: if the doctors are prescribing a placebo, he or she 549 00:32:56,240 --> 00:32:59,360 Speaker 1: obviously does believe in the placebo effects. So here she 550 00:32:59,400 --> 00:33:02,560 Speaker 1: does think it could work but doesn't know how, or 551 00:33:02,640 --> 00:33:06,000 Speaker 1: if it only really does work in of the population, 552 00:33:06,080 --> 00:33:09,880 Speaker 1: then you've got a seventy chance of striking out anyway 553 00:33:09,920 --> 00:33:13,680 Speaker 1: with this course of treatment. Uh So you're back to 554 00:33:13,680 --> 00:33:15,800 Speaker 1: where he started to begin with. Yeah, and again it's 555 00:33:15,840 --> 00:33:18,800 Speaker 1: cut that falls inunder what's the point category. Now, again, 556 00:33:18,840 --> 00:33:21,280 Speaker 1: we should say that a lot of physicians who do 557 00:33:21,400 --> 00:33:24,680 Speaker 1: prescribe placebos aren't just doing it to toy with their patients. 558 00:33:24,680 --> 00:33:28,960 Speaker 1: They're doing because they think that their patient will suffer 559 00:33:29,080 --> 00:33:33,360 Speaker 1: more without it, or they just don't have anything that 560 00:33:33,400 --> 00:33:36,520 Speaker 1: could be used to address the patient's problem, like they 561 00:33:36,520 --> 00:33:40,440 Speaker 1: can't find anything medically wrong with the patient, but to 562 00:33:40,480 --> 00:33:42,840 Speaker 1: saying that the patient's not going to help, so here's 563 00:33:42,840 --> 00:33:46,040 Speaker 1: a sugar pill. Um. The other tech that a doctor 564 00:33:46,080 --> 00:33:50,080 Speaker 1: can take to chuck is um to say, hey, new patient, 565 00:33:50,120 --> 00:33:52,560 Speaker 1: welcome to my practice. Let me tell you about the 566 00:33:52,560 --> 00:33:56,080 Speaker 1: placebo effect. And in the course of me treating you, 567 00:33:56,520 --> 00:33:59,680 Speaker 1: sometime during your lifetime, I may find that a placebo 568 00:33:59,680 --> 00:34:02,040 Speaker 1: will be the best thing to use. Are you okay 569 00:34:02,160 --> 00:34:05,040 Speaker 1: with me doing that to you at some point possibly 570 00:34:05,320 --> 00:34:09,359 Speaker 1: basically like signing up for my own personal long term 571 00:34:09,360 --> 00:34:12,279 Speaker 1: study kind of as a doctor. But wouldn't you from 572 00:34:12,320 --> 00:34:14,640 Speaker 1: that point on be like, you just gave me the placeboy, 573 00:34:14,960 --> 00:34:17,279 Speaker 1: it's a placebo. Yeah, I know it's a placebo. I 574 00:34:17,280 --> 00:34:19,160 Speaker 1: wouldn't know which way was up, Like, I don't know 575 00:34:19,200 --> 00:34:23,919 Speaker 1: how to feel that's the better worse side effects none, yep. 576 00:34:24,680 --> 00:34:27,399 Speaker 1: And the other tech doctors can take is to knock 577 00:34:27,440 --> 00:34:30,040 Speaker 1: off early and go hit the golf course, which they 578 00:34:30,080 --> 00:34:32,839 Speaker 1: do that one a lot on TV. That's a that's 579 00:34:32,840 --> 00:34:35,479 Speaker 1: a that's such an old bit trope. It's like, yeah, 580 00:34:35,560 --> 00:34:38,279 Speaker 1: cops in their donuts, is that doctors in golf? I 581 00:34:38,360 --> 00:34:41,040 Speaker 1: think that's pretty accurate. I mean in Caddyshack, the doctor 582 00:34:41,160 --> 00:34:45,759 Speaker 1: was Dr Beeper. He was the one who just got 583 00:34:45,800 --> 00:34:48,360 Speaker 1: mad all the time. Right now, that was Judge Smails. 584 00:34:49,200 --> 00:34:52,240 Speaker 1: Dr Beeper was he was just one of the guys, 585 00:34:52,440 --> 00:34:56,840 Speaker 1: one of the foursome, okay that I think he played. 586 00:34:58,040 --> 00:35:01,759 Speaker 1: Was it Buck Henry? Was he the doctor? No, I can't, 587 00:35:01,760 --> 00:35:05,719 Speaker 1: I can. I can picture the guy. It's Buck Henry, right? 588 00:35:05,760 --> 00:35:09,400 Speaker 1: Is that? I don't think? So we'll figure this out offline. 589 00:35:09,400 --> 00:35:11,799 Speaker 1: How about that? Yeah? All right? If you want to 590 00:35:11,840 --> 00:35:14,279 Speaker 1: know more about the placebo effect, and believe us, there 591 00:35:14,360 --> 00:35:16,960 Speaker 1: is plenty more to know about it, you can type 592 00:35:16,960 --> 00:35:19,000 Speaker 1: those two words in the search part how stuff works 593 00:35:19,040 --> 00:35:22,520 Speaker 1: dot com. And uh, since I said that, it's time 594 00:35:22,560 --> 00:35:27,680 Speaker 1: for listener mail, I'm gonna call this Australian last name. 595 00:35:28,239 --> 00:35:32,040 Speaker 1: This is, he says, dear Josh, Chuck and Jerry and 596 00:35:32,080 --> 00:35:35,000 Speaker 1: anyone else I should think, And I think we never 597 00:35:35,040 --> 00:35:37,399 Speaker 1: mentioned other people that support us. Didn't we already talk 598 00:35:37,400 --> 00:35:41,240 Speaker 1: about in Australian last name? Yeah, that was the joke. Okay, 599 00:35:41,440 --> 00:35:45,600 Speaker 1: let's call the callback. I just felt like the man. 600 00:35:45,840 --> 00:35:47,719 Speaker 1: This listener mail, though, made me realize that we don't 601 00:35:47,760 --> 00:35:49,880 Speaker 1: think other folks all lot. Besides Jerry and like Noelan 602 00:35:49,960 --> 00:35:54,960 Speaker 1: Matt but um, let's do that now, okay, Like Rebecca 603 00:35:55,440 --> 00:35:58,399 Speaker 1: m Rebecca is, uh, what's your official title? I don't 604 00:35:58,400 --> 00:36:02,839 Speaker 1: even know what titles are around producer web producer maybe yeah. 605 00:36:02,840 --> 00:36:05,799 Speaker 1: I mean she handles our website. It makes everything look great. 606 00:36:06,280 --> 00:36:08,680 Speaker 1: And Sherry, even though we do our own social media, 607 00:36:08,760 --> 00:36:11,040 Speaker 1: Sherry does social media for how stuff works, and she 608 00:36:11,160 --> 00:36:12,759 Speaker 1: like throws to us a lot, throws to us and 609 00:36:12,800 --> 00:36:15,360 Speaker 1: helps us out a lot. And Joe, our buddy, Joe 610 00:36:16,080 --> 00:36:19,080 Speaker 1: is a huge help um. And that's kind of the 611 00:36:19,080 --> 00:36:22,759 Speaker 1: crack staff. I mean, we're answering our own emails and 612 00:36:22,840 --> 00:36:25,480 Speaker 1: we're doing a lot of our own stuff. But it 613 00:36:25,560 --> 00:36:27,359 Speaker 1: doesn't mean we don't have help. You know what I'm saying. 614 00:36:27,400 --> 00:36:28,560 Speaker 1: We have tons of help. So you know, I just 615 00:36:28,560 --> 00:36:30,400 Speaker 1: want to say thanks to this. It's very nice if 616 00:36:30,400 --> 00:36:33,160 Speaker 1: you chuck everybody. And I figured six years in, seven 617 00:36:33,200 --> 00:36:34,799 Speaker 1: years in we might as well shout out some of 618 00:36:34,840 --> 00:36:37,439 Speaker 1: our health. Uh. So this from Alex and he said 619 00:36:37,440 --> 00:36:39,359 Speaker 1: to thank anyone else he doesn't know about. And he's 620 00:36:39,400 --> 00:36:44,600 Speaker 1: from Perth, Western Australia, which is nothing like Eastern Australia. 621 00:36:45,320 --> 00:36:48,560 Speaker 1: I'm a nineteen year old aspiring electrician trapped in the 622 00:36:48,600 --> 00:36:52,080 Speaker 1: depths of Western Australia's mining downturn due to layoffs in 623 00:36:52,080 --> 00:36:54,759 Speaker 1: the mining sector, have been unable to find an apprenticeship 624 00:36:55,360 --> 00:36:57,280 Speaker 1: and I would have lost hope if it weren't for you, guys. 625 00:36:57,719 --> 00:36:59,919 Speaker 1: I was just after New Year's It was just after 626 00:37:00,000 --> 00:37:04,480 Speaker 1: New Year's January when I came across the magical production 627 00:37:04,520 --> 00:37:07,440 Speaker 1: called Stuff You Should Know um as. At the time 628 00:37:07,480 --> 00:37:10,759 Speaker 1: of this writing, it is May tent uh and I 629 00:37:10,800 --> 00:37:14,800 Speaker 1: have finished the epic adventure of six hundred episodes pluts. 630 00:37:15,760 --> 00:37:18,279 Speaker 1: That's in a very short time, my friend. Yeah, it's 631 00:37:18,280 --> 00:37:20,600 Speaker 1: been an amazing journey, and I want to thank you 632 00:37:20,640 --> 00:37:23,359 Speaker 1: for pulling me through the hard days of resume writing 633 00:37:23,360 --> 00:37:27,120 Speaker 1: and delivering long days of waiting. Uh. Previously we're mind numbing, 634 00:37:27,120 --> 00:37:29,799 Speaker 1: but have since been filled with interesting, insightful and overall 635 00:37:29,840 --> 00:37:34,880 Speaker 1: incredible enjoyable content. My favorites gene patents, Lobotomies and the 636 00:37:35,040 --> 00:37:39,680 Speaker 1: masterfully dictated Halloween episodes. We like those two because are 637 00:37:39,880 --> 00:37:42,240 Speaker 1: some of my favorites. Christmas, I think it's the best 638 00:37:42,719 --> 00:37:46,280 Speaker 1: uh so que the exist existential crisis after um you guys, 639 00:37:46,280 --> 00:37:48,799 Speaker 1: forming such an integral part of my life over the 640 00:37:48,800 --> 00:37:51,000 Speaker 1: past five months. I don't know, I'm going to acclimate 641 00:37:51,040 --> 00:37:54,480 Speaker 1: myself to just to a week. Um. And we hear 642 00:37:54,480 --> 00:37:56,720 Speaker 1: that a lot from people who mainline the show. Yeah, 643 00:37:56,760 --> 00:38:01,200 Speaker 1: there's like a withdrawal period. Yeah, and I've done that 644 00:38:01,239 --> 00:38:04,120 Speaker 1: with TV shows, you know. I do that first year 645 00:38:04,840 --> 00:38:08,520 Speaker 1: you mainline it, and then you're like, well I need it. Yeah. Um. 646 00:38:08,640 --> 00:38:10,520 Speaker 1: I would just like to sincerely say thank you to 647 00:38:10,600 --> 00:38:12,520 Speaker 1: both of you and Jerry and anyone else for pulling 648 00:38:12,520 --> 00:38:14,759 Speaker 1: me through these times, and hope the future contains a 649 00:38:14,760 --> 00:38:17,799 Speaker 1: stable job for myself, more content for yourselves to pass 650 00:38:17,840 --> 00:38:19,680 Speaker 1: on to the stuff you should know, army, and an 651 00:38:19,680 --> 00:38:21,799 Speaker 1: evergroing fan base that you can both woo with your 652 00:38:21,880 --> 00:38:25,960 Speaker 1: dulcet tones and enlightening information yours faithfully, that is Alex 653 00:38:26,040 --> 00:38:31,480 Speaker 1: gettings from Peth. Thanks Alex, Alex, Yeah, yeah, thank you 654 00:38:31,600 --> 00:38:34,359 Speaker 1: very much. Do you get a job, buddy, Yeah, for sure. 655 00:38:34,400 --> 00:38:38,200 Speaker 1: If you're in person you're looking for an electrician, contact Alex. 656 00:38:39,440 --> 00:38:43,759 Speaker 1: He's shockingly good, nice, terrible. We're ending on that one. 657 00:38:44,160 --> 00:38:46,279 Speaker 1: If you want to get in touch with us, you 658 00:38:46,280 --> 00:38:48,360 Speaker 1: can tweet to us at s Y s K podcast. 659 00:38:48,600 --> 00:38:50,640 Speaker 1: You can join us on Facebook dot com slash stuff 660 00:38:50,640 --> 00:38:52,640 Speaker 1: you Should Know. You can send us an email to 661 00:38:53,440 --> 00:38:56,840 Speaker 1: stuff podcast at how stuff Works dot com and as always, 662 00:38:56,920 --> 00:38:58,799 Speaker 1: joined us at at home on the web. Stuff you 663 00:38:58,800 --> 00:39:03,520 Speaker 1: Should Know dot Com. Stuff you Should Know is a 664 00:39:03,560 --> 00:39:06,120 Speaker 1: production of I Heart Radio's How Stuff Works. For more 665 00:39:06,160 --> 00:39:08,600 Speaker 1: podcasts for my heart Radio, visit the iHeart Radio app, 666 00:39:08,680 --> 00:39:11,320 Speaker 1: Apple Podcasts, or wherever you listen to your favorite shows. 667 00:39:14,120 --> 00:39:14,160 Speaker 1: M