WEBVTT - SYSK Selects: How the Placebo Effect Works 0:00:00.040 --> 0:00:04.000 M Hey everybody, it's me Josh, and for this week's 0:00:04.120 --> 0:00:07.560 S Y s K Select, I've chosen an episode on Placebos. 0:00:08.160 --> 0:00:11.760 It's an episode chock full of facts of the podcast, 0:00:12.240 --> 0:00:14.520 and yet Chuck comes out with one of the all 0:00:14.560 --> 0:00:17.840 time greats right out of the gate. But don't stop listening. 0:00:17.880 --> 0:00:21.440 Then the whole episode is amazingly wonderful, which is why 0:00:21.480 --> 0:00:26.520 I chose it. So enjoy it. Welcome to Stuff you 0:00:26.560 --> 0:00:35.640 should know, a production of I Heart Radios How Stuff Works. Hey, 0:00:35.680 --> 0:00:38.000 and welcome to the podcast. I'm Josh Clark, and there's 0:00:38.040 --> 0:00:43.320 Charles W. Chuck Bryant, and there's Jerry Jerry place cebo, 0:00:43.560 --> 0:00:50.440 do sir? No? No, that was bad, Chuck. Yes. Have 0:00:50.560 --> 0:00:55.800 you ever heard of the word placebo? Do sir? Yeah? Placebo? 0:00:56.160 --> 0:01:00.640 You know what I mean. I'll tell every buddy, I 0:01:00.760 --> 0:01:05.360 shall see, No, I will please, I shall please. That's 0:01:05.360 --> 0:01:08.600 what I meant. I shall see. We'll see about that. 0:01:08.920 --> 0:01:14.000 I shall please. That's what I meant in Latin. Yes, right, 0:01:14.160 --> 0:01:18.840 so placebo. Everybody's heard of a placebo, and very famously 0:01:18.920 --> 0:01:22.800 the placebo effect. Do you wonder where that comes from? 0:01:22.920 --> 0:01:28.480 The placebo effect? The word placebo um fourteenth century. It 0:01:28.680 --> 0:01:33.559 referred to hired mourners at funerals. What they would hire 0:01:33.640 --> 0:01:37.319 mourners in place of family members, and they would start 0:01:37.360 --> 0:01:41.120 their morning wailing with that mourning. But as in m O, 0:01:41.200 --> 0:01:47.000 you are with placebo domino in region vivorum, which means 0:01:47.040 --> 0:01:48.880 I shall please the Lord in the land of the living. 0:01:50.320 --> 0:01:54.200 But in that it means placebo. Uh this article, so 0:01:54.360 --> 0:01:59.040 it carries the connotation of substitution. Weird. Yeah, that is 0:01:59.120 --> 0:02:02.200 fantastic stuff, I thought. So this is from placebos and 0:02:02.200 --> 0:02:08.239 placebo effects in Medicine. Colon Historical Overview by Tisson cap 0:02:08.320 --> 0:02:15.120 Chuck Green and Legion Catchuck. That guy is high quality. Yeah, 0:02:15.160 --> 0:02:18.960 a lot of skeptics Catchuck, Catchuck. He's at Harvard. Let 0:02:18.960 --> 0:02:22.280 me tell you a little bit about Ted Kapchuck the 0:02:22.360 --> 0:02:25.040 coney Allen cap Chuck's I just raised a lot of 0:02:25.200 --> 0:02:28.520 skeptics hackles because some people see him as a huckster 0:02:28.600 --> 0:02:31.720 of fraud or everything that's wrong with placebos. These people, 0:02:32.360 --> 0:02:35.520 um would probably have a problem with us even talking 0:02:35.520 --> 0:02:38.520 seriously about the placebo effect in the first place. So 0:02:38.600 --> 0:02:40.160 I don't know that it's a really big deal that 0:02:40.200 --> 0:02:44.360 I just raised their hackles. But Ted Catchuk is a 0:02:44.480 --> 0:02:47.639 former owes me fifty bucks. Right, let me tell you 0:02:47.680 --> 0:02:53.160 about Catchuck. Now. He's a former acupuncturist, and he apparently 0:02:53.280 --> 0:02:57.120 had some sort of um epiphany one day when he 0:02:57.320 --> 0:03:02.280 was he was treating somebody and they started to feel 0:03:02.320 --> 0:03:07.600 better before he even used the acupuncture. So he started wondering, like, okay, 0:03:07.639 --> 0:03:10.800 what's going on here? And he started investigating the placebo effect, 0:03:11.160 --> 0:03:15.239 and in short order he ended up as an instructor 0:03:15.320 --> 0:03:19.200 at Harvard and became one of the leading researchers into 0:03:19.280 --> 0:03:24.040 the placebo effect, which is a really strange journey because 0:03:24.280 --> 0:03:29.839 Harvard Medical School doesn't usually hire acupuncturists. And he had 0:03:29.880 --> 0:03:31.520 like kind of a rocky road at first, like he 0:03:31.520 --> 0:03:33.840 didn't know what he was doing with clinical trials, and 0:03:34.080 --> 0:03:36.400 he got publicly called out in the New England Journal 0:03:36.400 --> 0:03:39.640 of Medicine and UM over the years, over the decades, 0:03:39.680 --> 0:03:42.040 I think this is the eighties that he really started 0:03:42.080 --> 0:03:45.560 to look into it. He um, like I said, became 0:03:45.680 --> 0:03:51.200 the foremost researcher in in coming up with quality clinical 0:03:51.240 --> 0:03:53.920 trials for trying to get to the root of what 0:03:53.960 --> 0:03:56.240 the placebo effect is and how to use it. What 0:03:56.400 --> 0:03:59.880 years was that, you know, he's still doing it. But 0:04:00.000 --> 0:04:02.600 when was this? When he was started all that stuff, 0:04:02.960 --> 0:04:05.080 he got called out and I think a two thousand 0:04:05.120 --> 0:04:08.280 one issue of the New England Journal of Medicine, UM, 0:04:08.320 --> 0:04:13.560 basically for not using a control group in his placebo study. 0:04:13.800 --> 0:04:16.120 So you know, when you do a study, you have 0:04:16.160 --> 0:04:19.440 a placebo group which is your control group, and that 0:04:19.600 --> 0:04:22.960 basically is I'm giving you real medicine, but I'm giving 0:04:23.080 --> 0:04:27.520 Jerry a sugar pill. And in a proper study, I 0:04:27.560 --> 0:04:29.679 don't know who's getting the sugar pill and who's getting 0:04:29.680 --> 0:04:34.000 the medicine. It's called double blind, right, um. So you know, 0:04:34.080 --> 0:04:37.520 if you're studying just the placebo effect, I should be 0:04:37.560 --> 0:04:40.120 giving you a placebo and I should be giving Jerry 0:04:40.120 --> 0:04:43.839 no treatment whatsoever. To truly, I thought you needed three people, 0:04:43.920 --> 0:04:46.200 one with a real treatment, one with placebo, and one 0:04:46.240 --> 0:04:48.799 with no treatment. It's another way to do it, Okay, 0:04:48.839 --> 0:04:51.400 at the very least, though, you need the placebo group 0:04:51.480 --> 0:04:55.000 and somebody who's receiving no treatment. Gotcha, you see. Yeah, yeah, 0:04:55.120 --> 0:04:58.279 if we're skinning cats, well, if you're doing good science 0:04:58.440 --> 0:05:03.240 researching into the placebo. But what's ironic is is this 0:05:03.279 --> 0:05:10.159 whole double blind placebo study came about because the placebo 0:05:10.200 --> 0:05:14.960 effect was first noticed by Western practitioner by the name 0:05:15.000 --> 0:05:18.800 of Dr Henry Beecher, who in World War Two supposedly 0:05:19.760 --> 0:05:22.520 saw a nurse give a shot of sailine to a 0:05:22.560 --> 0:05:26.000 soldier because they'd run out of morphine. But the nurse 0:05:26.080 --> 0:05:29.000 told them it was morphine, and the soldier responded to 0:05:29.080 --> 0:05:32.760 this shot of sailine like it was morphine, And from 0:05:32.760 --> 0:05:35.320 that Beecher was like, what is going on here, started 0:05:35.360 --> 0:05:38.640 to investigate the placebo effect and ended up proposing the 0:05:38.680 --> 0:05:43.000 double blind placebo study to prove the efficacy of drugs. 0:05:43.680 --> 0:05:46.240 It goes back further than that, my friend, let's hear 0:05:46.240 --> 0:05:52.040 it man uh try sev five the New Medical Dictionary, 0:05:52.240 --> 0:05:55.320 they described the placebo as a commonplace method or medicine, 0:05:55.440 --> 0:05:57.760 and then a short time later, in eighteen eleven and 0:05:57.880 --> 0:06:03.200 Quincy's lexicon uh Medicum, he defined the placebo as an 0:06:03.200 --> 0:06:07.360 epithet given to any medicine adapted more to please than 0:06:07.400 --> 0:06:10.440 to benefit the patient, like heroin. So they were on 0:06:10.520 --> 0:06:14.720 it back in the early eighteen hundreds, which is surprising. Yeah, 0:06:14.760 --> 0:06:16.679 but I mean, like that's the basis of like snake 0:06:16.720 --> 0:06:19.440 oil and hucksterism, right, Yeah, Well, they called him bread 0:06:19.480 --> 0:06:21.320 pills back then, because I guess it was. It was 0:06:21.320 --> 0:06:24.080 probably some sort of like pill made of yeast. As 0:06:24.240 --> 0:06:27.680 my guests UH and Thomas Jefferson in eighteen o seven 0:06:27.720 --> 0:06:31.560 even recorded what he called the Pious Fraud, and he 0:06:31.640 --> 0:06:34.320 observed quote that one of the most successful positions I've 0:06:34.320 --> 0:06:37.720 ever known has assured me that he used more bread pills, 0:06:38.080 --> 0:06:41.200 drops of colored water, and powders of hickory ash than 0:06:41.279 --> 0:06:46.200 all other medicines put together. Um. And people treated people 0:06:46.200 --> 0:06:48.039 with bread pills in the early eighteen hundreds. It was 0:06:48.040 --> 0:06:50.400 a thing, and like they were way onto the placebo 0:06:50.440 --> 0:06:53.760 effect and and the fact that it seemed to work. 0:06:54.560 --> 0:06:58.440 UH and another dude named John Haygarth in the early 0:06:58.520 --> 0:07:01.960 eighteen hundreds UH actually started performing the first studies on 0:07:02.000 --> 0:07:06.159 placebo's effect and UM, he said it went back to 0:07:06.160 --> 0:07:10.680 the Renaissance idea that imagination was the major mediator between 0:07:10.680 --> 0:07:14.200 body and mind, which is starting to be proven is 0:07:14.200 --> 0:07:17.400 possibly correct. Yeah, it's pretty interesting. And in the nineties 0:07:17.480 --> 0:07:20.560 is when they started publishing papers on the placebo U 0:07:20.720 --> 0:07:25.600 and actually doing clinical trials and UM. They said one 0:07:25.640 --> 0:07:28.240 of their points in the nineteen thirties would confidence aroused 0:07:28.240 --> 0:07:32.240 in a treatment, the encouragement afforded by a new procedure, 0:07:32.400 --> 0:07:35.280 even like just people getting treated in a new way. 0:07:35.960 --> 0:07:38.240 People would say, oh, well, this is gonna work, and 0:07:38.320 --> 0:07:40.360 it maybe he did work. And then we're up to 0:07:40.400 --> 0:07:44.320 the forties where Beacher comes along notices the placebo effect 0:07:44.360 --> 0:07:48.120 himself ultimately comes up with the double blind placebo based study. 0:07:48.680 --> 0:07:51.760 And what's ironic about that is the placebo based double 0:07:51.800 --> 0:07:55.600 blind study ultimately has split back off into the study 0:07:55.600 --> 0:07:59.080 of placebo again. Yeah, because there are so many trials 0:07:59.080 --> 0:08:01.680 where the placebo was more effective than the drug, even 0:08:01.680 --> 0:08:04.840 though the drug worked, but the placebo worked even better. 0:08:05.480 --> 0:08:08.280 And finally in the nine people were like, what is 0:08:08.320 --> 0:08:11.600 going on here? We need to study this thing in 0:08:11.640 --> 0:08:14.000 and of itself. Well, yeah, because one of the things 0:08:14.080 --> 0:08:18.880 I had no idea. I thought placebos were only used 0:08:19.040 --> 0:08:23.000 in studies for efficacy rates. I did not know that 0:08:23.040 --> 0:08:26.640 they are. There are doctors, always have been, and still 0:08:26.640 --> 0:08:31.840 are prescribing placebos as medicine unknowingly even though they're not 0:08:31.880 --> 0:08:35.160 supposed to. We'll get to that later. No knowingly, no 0:08:35.280 --> 0:08:38.280 unknowingly for the patient, even though they're supposed to tell 0:08:38.280 --> 0:08:40.360 the patient. Yeah, but we'll get to that towards the end, 0:08:40.440 --> 0:08:43.040 but I had no idea that they were prescribing placebos 0:08:43.040 --> 0:08:45.280 to people. Yeah, And in their defense, a lot of 0:08:45.280 --> 0:08:48.880 times doctors are carrying on a tradition where they don't 0:08:48.880 --> 0:08:53.199 have anything else to prescribe. But they can't say if 0:08:53.240 --> 0:08:55.240 they say that to their patients, their patients is going 0:08:55.280 --> 0:08:57.240 to go off and suffer. So at the very least 0:08:57.280 --> 0:09:02.600 they can use the last ditch attempt of saying psychological trickery. Yeah, yeah, 0:09:02.640 --> 0:09:04.679 And I'm not knocking to I just was surprised to 0:09:04.760 --> 0:09:06.760 learn that that still happens. And I'm wondering if I've 0:09:06.760 --> 0:09:10.120 ever been given a placebo. And it makes me feel 0:09:10.160 --> 0:09:12.839 dumb as a patient to say, like, yeah, man, that 0:09:12.920 --> 0:09:14.840 whatever you give me really helped. And the doctors like 0:09:16.040 --> 0:09:18.439 because it's the same thing as that prank of like 0:09:18.920 --> 0:09:21.680 giving somebody non alcoholic beer and telling it's a real 0:09:21.720 --> 0:09:24.079 beer and watching them make a jerk out of themselves 0:09:24.080 --> 0:09:27.880 getting drunk. It's exactly the same thing. So let's talk 0:09:27.920 --> 0:09:31.560 about placebo. We assume that everybody knows what placebo is, 0:09:31.600 --> 0:09:36.960 but let's define it a little more clearly. The placebo effect, specifically, 0:09:37.880 --> 0:09:43.400 is the very real phenomenon that people when given a 0:09:43.480 --> 0:09:49.840 pill or a some sort of medical intervention, that feel better. Yes, 0:09:49.880 --> 0:09:52.600 they feel better, even though what they've been given is 0:09:52.679 --> 0:09:56.840 not medicine and is was not actually a real intervention. Yeah. 0:09:56.880 --> 0:10:00.800 And the placebo is the pill itself. That that that is 0:10:01.040 --> 0:10:04.400 the placebo, and the effect is what you just described, right, 0:10:04.400 --> 0:10:05.600 And it doesn't have to be a pill. It can 0:10:05.600 --> 0:10:09.920 be an injection, it can be fake surgery, there's true. 0:10:09.920 --> 0:10:13.800 And it doesn't even have to be uh, pharmacologically inert 0:10:13.920 --> 0:10:17.760 It can be a vitamin or like an aspirin, even 0:10:17.760 --> 0:10:21.480 though some argue that's not a true placebo. But um, 0:10:21.520 --> 0:10:24.240 sometimes that's what the doctor will give you, uh and 0:10:24.440 --> 0:10:28.680 call it, you know, medication. But there there um very 0:10:28.720 --> 0:10:32.160 often things like a sugar pill. Yeah, like you said, 0:10:32.200 --> 0:10:38.320 pharmacologically inert um. And astoundingly, depending on the size of 0:10:38.360 --> 0:10:40.319 the pill, the shape of the pill, the color of 0:10:40.360 --> 0:10:44.640 the pill, people will have different effects and responses to 0:10:44.720 --> 0:10:48.640 these things that are just sugar. Um. So there's some 0:10:48.760 --> 0:10:54.600 really strange psychological things going on here. And at first, 0:10:55.320 --> 0:10:58.160 for a long time, everybody just kind of assumed it 0:10:58.200 --> 0:11:02.000 was just psychology, that we we're tricking ourselves into feeling better, 0:11:02.440 --> 0:11:05.400 or we hadn't really felt bad in the first place, 0:11:06.080 --> 0:11:10.240 and we were being tricked into not feeling bad any longer, 0:11:10.400 --> 0:11:12.600 or not thinking we were feeling bad any like an 0:11:12.600 --> 0:11:17.480 offshoot of hypochondria, maybe very much. So. Yeah, um, they 0:11:17.679 --> 0:11:19.520 this article says they've been shown to work in about 0:11:19.520 --> 0:11:22.880 thirty percent of patients, and that was actually that's based 0:11:22.880 --> 0:11:26.360 on Beacher's finding. It was like thirty thirty five point two. Yeah, 0:11:26.440 --> 0:11:28.720 that's what he found out in nine that's what they're 0:11:28.720 --> 0:11:32.040 still basing that on. Yeah, but there's been other studies 0:11:32.080 --> 0:11:35.920 that have gone back through Beacher's studies and said, no, no, no, 0:11:36.040 --> 0:11:38.800 that's not that much. Other people have found up to 0:11:38.880 --> 0:11:43.439 six respond to it, right, And basically one of the 0:11:43.480 --> 0:11:46.640 big questions is is it a psychological effect or are 0:11:46.679 --> 0:11:51.079 there excell actual physical responses that are going on. And 0:11:51.160 --> 0:11:53.760 there's been a lot of research lately that's pretty interesting, 0:11:53.760 --> 0:11:56.520 I think. Right. So, like we were saying that the 0:11:56.520 --> 0:12:01.920 the initial idea was that it was all psychological, right, yeah, Like, uh, well, 0:12:01.960 --> 0:12:04.360 I guess we can talk about the two effects. The 0:12:04.400 --> 0:12:09.679 subject expectancy effect, which is basically, if you know the 0:12:09.720 --> 0:12:11.400 result ahead of time and the pill you're gonna take, 0:12:11.400 --> 0:12:15.400 you're gonna end up feeling that result, right. So that's 0:12:15.400 --> 0:12:18.520 what a blind study seeks to prevent, is a subject 0:12:18.640 --> 0:12:23.400 expectancy effect and also the observer expectancy effect, which is 0:12:23.400 --> 0:12:26.000 what a double blind study seeks to prevent. Yeah, and 0:12:26.040 --> 0:12:29.920 that's important because it's are different because it's all self reported, right, 0:12:30.120 --> 0:12:33.319 which is always a little you know, right. So the 0:12:33.360 --> 0:12:36.280 other idea, if it has a psychological basis, is that 0:12:36.360 --> 0:12:39.960 it's classical conditioning. That we are raised from birth to 0:12:40.559 --> 0:12:44.199 think that if somebody gives you a pill, you're going 0:12:44.280 --> 0:12:47.760 to respond to it because it has medicine. Yeah, and 0:12:47.760 --> 0:12:52.360 that is not self reported. That is actually seeing physical responses, right. 0:12:52.640 --> 0:12:58.079 And with classical conditioning established very famously by Pavlov and 0:12:58.160 --> 0:13:04.800 his dogs, right, um, you are you're having you're responding 0:13:05.679 --> 0:13:10.880 physically to a psychological stimulus, right, so you you are 0:13:10.920 --> 0:13:15.280 getting a physiological response. So classical conditioning eventually kind of 0:13:15.320 --> 0:13:19.679 came to be viewed as the more um reasonable explanation 0:13:19.720 --> 0:13:24.320 for what was going on, because, uh, study after study 0:13:24.320 --> 0:13:28.440 after study has shown that we are having a physical 0:13:28.520 --> 0:13:32.320 reaction to these inert placebos. Yeah, one of them in 0:13:32.360 --> 0:13:35.680 two thousand two from U. C. L As Neuropsychiatric Institute. 0:13:35.960 --> 0:13:38.800 They had a couple of groups of patients and a 0:13:38.800 --> 0:13:43.840 lot of the placebo studies are uh for mental conditions. Um, 0:13:43.880 --> 0:13:45.319 not all of them, but a lot of them are 0:13:45.559 --> 0:13:50.319 or in UM like the clinical trials. Yeah, yeah, exactly. UM. 0:13:50.400 --> 0:13:53.840 So this one was for any depressants, and they had 0:13:53.840 --> 0:13:58.880 two groups that got UM experimental drugs like real drugs, 0:13:59.200 --> 0:14:01.760 and then the third was given the placebo. Uh. They 0:14:01.760 --> 0:14:04.240 spent a few weeks on these pills and monitored their 0:14:04.280 --> 0:14:08.840 brain activity with the old E. G. Wonder machine and 0:14:09.000 --> 0:14:11.559 well it's not the Wonder machine, the Mrs Wonder, it's 0:14:11.600 --> 0:14:15.080 it's a wonder machine, not the Wonder machine. Uh. And 0:14:15.160 --> 0:14:18.480 the patients on the placebo reported positive effects and showed 0:14:18.520 --> 0:14:22.160 greater increase of brain activity than those who had responded 0:14:22.200 --> 0:14:25.920 to the drug. You know, I remember that it was 0:14:26.120 --> 0:14:31.240 the study. Yeah, totally undermined people's faith in antidepressants because 0:14:31.280 --> 0:14:33.440 it was on the other end of like the whole 0:14:33.560 --> 0:14:37.200 nineties where everybody was on antidepressants and wasn't This study 0:14:37.280 --> 0:14:39.880 came out and was like people were saying, like, do 0:14:39.960 --> 0:14:42.480 these things even work? It was it was kind of 0:14:42.520 --> 0:14:45.520 taken the opposite way rather than Wow, the placebo effect 0:14:45.560 --> 0:14:49.000 is really something. It was wow and it depressence, right, fraudulent, 0:14:49.320 --> 0:14:51.720 right right? Right? Well, I wonder what they were trying 0:14:51.760 --> 0:14:54.520 to It was a placebo study though, right, so it 0:14:54.560 --> 0:14:57.120 kind of backfired or did they even care? No, I 0:14:57.160 --> 0:15:00.640 think it very much cared because there when compared to 0:15:00.640 --> 0:15:03.800 place with the whole point of a drug trial is 0:15:03.840 --> 0:15:07.000 to show that this drug is more effective than placebo. 0:15:07.080 --> 0:15:10.280 It's more effective than the imagination, right right, And if 0:15:10.320 --> 0:15:12.560 it's not, then that means that drugs shouldn't be brought 0:15:12.600 --> 0:15:16.240 to market. Even though now the thinking is more like, hmm, 0:15:16.480 --> 0:15:19.320 that's not necessarily true, because we're coming to understand the 0:15:19.360 --> 0:15:23.400 placebo effect can be very powerful, especially depending on the 0:15:23.400 --> 0:15:27.160 individual too. Yeah, for sure. Uh. The interesting thing about 0:15:27.200 --> 0:15:29.960 that study is when the E E G. Lit up um, 0:15:30.000 --> 0:15:33.160 the activity was in different parts of the brain. Um 0:15:33.200 --> 0:15:36.160 that I think that the placebo patients said the preformal 0:15:36.200 --> 0:15:39.680 cortex was lighting up, and basically that says that the 0:15:39.680 --> 0:15:43.280 brain isn't being fooled, it's just doing something different. Yeah, 0:15:43.320 --> 0:15:48.160 they responded better to the treatment then the people who 0:15:48.600 --> 0:15:52.120 responded to the drug. So some people did respond to 0:15:52.120 --> 0:15:54.680 the drug, but different parts of their brain were activated 0:15:54.680 --> 0:15:56.760 by the drug than the people who responded well to 0:15:56.800 --> 0:15:59.880 the placebos, right, even though they felt better. Yeah, that's 0:16:00.000 --> 0:16:02.480 mind boggling. It is. So they had they reached the 0:16:02.520 --> 0:16:05.480 same conclusion but using a totally different regions of their brain, 0:16:05.480 --> 0:16:09.200 and they actually felt better. Um. That wasn't the first 0:16:09.200 --> 0:16:12.240 study to prove that there is a physiological response to 0:16:12.280 --> 0:16:16.160 placebos or last there's a dental study from the seventies 0:16:16.200 --> 0:16:18.920 that I think was the first that showed that if 0:16:18.960 --> 0:16:25.040 you blocked endorphins, which are nature's pain relievers, uh, you 0:16:25.080 --> 0:16:29.880 can also block the placebo effect. So the people weren't 0:16:29.920 --> 0:16:32.400 responding to the placebo like you would expect them to 0:16:32.760 --> 0:16:38.000 a pain reliever placebo because they weren't able to release 0:16:38.080 --> 0:16:40.880 their natural pain relievers. Yeah, and that's backed up I 0:16:40.880 --> 0:16:43.920 guess by this two thousand four study from the University 0:16:43.920 --> 0:16:50.600 of Michigan, uh Go wolverines. They basically demonstrated that it 0:16:50.680 --> 0:16:54.680 is related to endorphins specifically. Uh So that I guess 0:16:54.680 --> 0:16:57.640 that backs up that study because if you can block them. 0:16:57.720 --> 0:17:01.200 So here's the thing. It's not that study was related 0:17:01.240 --> 0:17:04.720 to endorphins specifically. Other studies have found that it can 0:17:04.760 --> 0:17:08.840 be related to how much a person expresses dopamine specifically. 0:17:09.359 --> 0:17:12.400 So there's like this idea that there's a genetic basis 0:17:12.400 --> 0:17:17.600 to our predisposition to UM placebos. But I think that 0:17:17.720 --> 0:17:23.000 it's depending on the drug or the effect that you're 0:17:23.000 --> 0:17:26.199 trying to induce using the placebo effect, because think about it, 0:17:27.080 --> 0:17:31.600 if you are somebody who naturally produces more endorphins than 0:17:31.640 --> 0:17:37.760 somebody else, Uh, you're going to naturally produce more endorphins 0:17:37.760 --> 0:17:41.480 when it's UM triggered by a placebo than somebody who 0:17:41.520 --> 0:17:46.000 doesn't produce more endorphins naturally. So there's a genetic basis 0:17:46.080 --> 0:17:48.000 to it, I guess. But I think the genetic basis 0:17:48.080 --> 0:17:51.399 is that the individual must be predisposition to be able 0:17:51.440 --> 0:17:56.679 to have that genetic response UM to the drug or 0:17:56.680 --> 0:18:01.159 the placebo and have that that UM I guess response 0:18:01.240 --> 0:18:03.600 to it. Yeah, And it's like you said, it's also 0:18:03.720 --> 0:18:08.040 personal because they found that it is even affected by 0:18:08.080 --> 0:18:12.560 a person's personal experience with past pills. The color of 0:18:12.600 --> 0:18:15.520 the pill, the shape and size of the bill will 0:18:15.880 --> 0:18:19.000 have a different reaction because the person had maybe took 0:18:19.520 --> 0:18:22.640 another little blue pill for something else. Sure, and actually 0:18:22.680 --> 0:18:26.280 blue pills in in particular are known to be um 0:18:26.280 --> 0:18:29.600 to have sedative effects as place Ebo's red pills are 0:18:29.640 --> 0:18:33.600 known to have stimulating and pain relieving effects as placebo. 0:18:33.760 --> 0:18:38.000 That's odd that they made viagrab blue. Yeah, like inhabitedly 0:18:38.240 --> 0:18:43.280 marketed it as the little blue pill. Interesting sedative effect, Yes, 0:18:43.400 --> 0:18:49.679 I don't think so, so, Chuck, Well, not that i'd know. Well, 0:18:49.440 --> 0:18:53.000 we've got more stuff about all this coming up. I 0:18:53.040 --> 0:18:54.640 don't know what we're going to talk about next. It's 0:18:54.680 --> 0:19:16.720 a grab bag right now. We're back, buddy, and I 0:19:16.760 --> 0:19:18.720 tell you what we're going to talk about. Something that 0:19:18.760 --> 0:19:21.120 I had never heard of, which I think is super interesting, 0:19:21.920 --> 0:19:25.080 the no sebo effect. It is super cool. And that 0:19:25.240 --> 0:19:27.520 is when well, it's a there's a couple of things. 0:19:27.560 --> 0:19:30.080 That is, when you are taking a placebo and you 0:19:30.240 --> 0:19:34.400 experience maybe the effects of the pill, which is great, 0:19:34.840 --> 0:19:38.080 and the side effects of that pill that you think 0:19:38.480 --> 0:19:41.800 might be but you're supposed to have, right, you're actually 0:19:41.800 --> 0:19:44.720 experiencing side effects that aren't shouldn't be there, right, And 0:19:45.000 --> 0:19:47.680 it's a sugar pill. They noticed this in clinical trials too, 0:19:47.800 --> 0:19:50.159 because when you're carrying out a clinical trial, you have 0:19:50.200 --> 0:19:53.400 to warn the patients, Yeah, this drug may give you 0:19:53.560 --> 0:19:57.040 these terrible side effects, and so they started noticing like 0:19:57.160 --> 0:20:01.400 people who were who were on placebo, we're still experiencing 0:20:01.400 --> 0:20:05.959 the side effect like physical reactions like hives and itching 0:20:06.119 --> 0:20:09.360 in things. Right, so there is a there's a negative 0:20:09.400 --> 0:20:11.520 side to placebo as well, and no sebo means I 0:20:11.560 --> 0:20:16.280 shall harm like placebo means I shall please. Yeah, yeah um. 0:20:16.359 --> 0:20:19.679 And they found that and this is definitely backed up 0:20:19.680 --> 0:20:22.919 by the idea that it's classical conditioning. They found that 0:20:23.040 --> 0:20:27.800 people who have gone through chemotherapy can become nauseated when 0:20:27.840 --> 0:20:30.119 they enter a room that's painted the same color as 0:20:30.160 --> 0:20:33.600 the room where they receive chemo before. Yeah, that makes sense. Yeah, 0:20:33.680 --> 0:20:36.080 So there's all sorts of ways that the no sebo 0:20:36.119 --> 0:20:39.920 effect can pop up, but it's pretty mind boggling as well. Yeah, 0:20:39.920 --> 0:20:42.159 and then no seabow can doesn't even have to be 0:20:42.240 --> 0:20:45.359 just with the placebo. You can experience side effects that 0:20:45.400 --> 0:20:48.080 aren't on the list of a real drug because of 0:20:48.119 --> 0:20:50.280 what we were talking about, because it looked like another 0:20:50.320 --> 0:20:55.520 pill you might have had before. Man, the brain powerful stuff. So, 0:20:56.119 --> 0:20:58.840 going back to Kapchuk, whom I'm just kind of a 0:20:58.840 --> 0:21:03.560 fan of, Yeah, I think if you're into like a 0:21:03.680 --> 0:21:08.920 long form articles, which I love. Go to Harvard Magazine 0:21:09.200 --> 0:21:12.520 and search for the placebo phenomenon and it's a profile 0:21:12.520 --> 0:21:16.159 at him and his work. It's really interesting stuff. But 0:21:16.240 --> 0:21:20.040 he was saying that kind of in line with the 0:21:20.080 --> 0:21:21.800 idea that like the color of the pill or the 0:21:21.800 --> 0:21:24.320 shape of the pill will have an effect, won't either 0:21:24.400 --> 0:21:27.840 on the no sebo or the placebo effect. Um. He 0:21:27.880 --> 0:21:30.639 was saying that it seems like the basis of the 0:21:30.680 --> 0:21:35.919 placebo effect is what's called ritual, and ritual is it 0:21:35.960 --> 0:21:39.760 involves everything from like the physician's bedside manner, to how 0:21:39.800 --> 0:21:44.119 expensive the patient thinks the pill is, to how effective 0:21:44.240 --> 0:21:47.320 the patient thinks the pillows and um. He did a 0:21:47.359 --> 0:21:51.399 study where he carried out what was called schmaltzy um, 0:21:51.720 --> 0:21:56.199 like a schmalty care to where he was just lavishing 0:21:56.240 --> 0:22:00.240 attention on the patient and telling him how bad he 0:22:00.320 --> 0:22:03.520 felt that they were going through this, but this pill 0:22:04.000 --> 0:22:08.840 is really effective with your condition. And apparently not just 0:22:08.920 --> 0:22:11.360 this study, but other studies show that there's a positive 0:22:11.359 --> 0:22:18.960 correlation between the ritual yeah and response to the placebo effect. 0:22:19.320 --> 0:22:22.040 So the more you think that this drug is expensive, 0:22:22.240 --> 0:22:25.880 that this drug is effective, that this physician cares about you, 0:22:26.720 --> 0:22:30.880 the greater of a placebo response you're going to have. Yeah, 0:22:31.080 --> 0:22:33.119 you know, I have you ever been accused of being 0:22:33.119 --> 0:22:37.000 a hypochondract by anyone? Know, it's kind to be very demeaning. 0:22:38.640 --> 0:22:41.880 It is because it happened to me. Oh yeah, Yeah. 0:22:41.920 --> 0:22:43.439 I went to the emergency room in New York, as 0:22:43.480 --> 0:22:45.920 you know, when we were up there recently for our trip. 0:22:46.280 --> 0:22:50.160 I went to the e R and uh something, it 0:22:50.240 --> 0:22:53.600 was something and it was a result of it was 0:22:53.640 --> 0:22:59.199 it was throwing up in uh nausea from UM I 0:22:59.280 --> 0:23:02.359 learned from anti inflammatory pills I was taking at the 0:23:02.400 --> 0:23:04.480 time for something else. I had nothing to do with 0:23:04.520 --> 0:23:08.639 being sick, and they figured that out, but they kept. 0:23:08.800 --> 0:23:10.560 You know, this guy, I called him Nurse Jackie. He 0:23:10.600 --> 0:23:12.359 was just like Nurse Jackie exap. He was a dude. 0:23:12.760 --> 0:23:14.680 He kept coming by and treating me with things and 0:23:14.680 --> 0:23:16.160 giving me the I V. Drip And I was like, dude, 0:23:16.160 --> 0:23:18.920 I'm not feeling better and I'm not a hypochondric in 0:23:18.960 --> 0:23:20.840 any way. I didn't go to the doctor for like 0:23:21.080 --> 0:23:24.560 eighteen years straight. And uh, I could tell he was 0:23:24.560 --> 0:23:28.200 looking at me like I got one of these guys. Yeah, 0:23:28.200 --> 0:23:29.800 And I was like no, no, And I could tell 0:23:29.840 --> 0:23:32.640 I could could sense it, and so he finally gave 0:23:32.680 --> 0:23:36.120 me this thing to drink that um knocked me out. 0:23:36.240 --> 0:23:38.680 I woke up like twenty minutes later and felt felt better. 0:23:39.320 --> 0:23:42.359 What was it, I can't remember. It was something to 0:23:42.560 --> 0:23:45.040 gata now. It was like three different things. It was 0:23:45.040 --> 0:23:48.480 like a cocktail of stomach pleasing things and what's the 0:23:48.520 --> 0:23:52.960 stuff that like numbs? You numb my throat? And I 0:23:52.960 --> 0:23:56.000 can't remember light to cane, I think um and it 0:23:56.040 --> 0:23:57.840 worked with Yeah, it worked. I woke up and I 0:23:57.880 --> 0:23:59.280 felt better. I said, you know, I don't feel so 0:23:59.359 --> 0:24:01.760 nauseous now, and they were checking me out and I 0:24:01.760 --> 0:24:05.439 reached up and I felt behind my ear for some reason, 0:24:05.480 --> 0:24:07.640 and it felt like a golf ball behind my ear. 0:24:08.160 --> 0:24:11.399 And it popped up in the last twenty minutes, and 0:24:11.400 --> 0:24:12.720 so I was literally leaving. I was like, oh, wait 0:24:12.720 --> 0:24:14.280 a minute, I got this thing behind my ear all 0:24:14.320 --> 0:24:16.679 of a sudden, and this guy looked at me like 0:24:16.960 --> 0:24:19.560 h and he called the doctor over and she was like, yeah, 0:24:19.640 --> 0:24:22.080 it's it's very swollen at your lymph node. But he 0:24:22.119 --> 0:24:24.280 wasn't there for that, so he came back over. He's like, hey, 0:24:24.320 --> 0:24:25.879 what did she say? I said, well, she said the 0:24:25.920 --> 0:24:28.879