June 10, 2014 • 38 mins
For centuries, doctors have prescribed drugs they knew weren't real - but that still somehow worked. It wasn't until the 1980s that the placebo effect, the phenomenon where an inert substance can have a genuine impact on a patient's recovery, was studied.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff you should know from house Stuff Works
dot com. Hey, and welcome to the podcast. I'm Josh Clark,
and there's Charles W. Chuck Bryant, and there's Jerry. Jerry
the placebo do sir? No, No, that was bad, Chuck. Yes.
(00:25):
Have you ever heard of the word placebo? Do, sir? Yeah? Placebo?
You know what I mean? I do. Tell everybody I
shall see, No, I will please, I shall please. That's right,
met ill see, We'll see about that. I shall please.
That's what I meant in Latin. Yes, all right, so placebo.
(00:51):
Everybody's heard of a placebo and very famously the placebo effect.
You wonder where that comes from? The placebo effect. The
word placebo um fourteenth century. It referred to hired mourners
at funerals. What they would hire mourners in place of
family members, and they would start their morning wailing with
(01:15):
that mourning. But as in m O, you are with
placebo domino in region vivorum, which means I shall please
the Lord in the land of the living. But in
that it means placebo. Uh. This article said, it carries
the connotation of substitution. Weird. Yeah, that is fantastic stuff.
(01:35):
I thought. So this is from Placebo's and Placebo Effects
in Medicine Colon Historical Overview by Tisson cap Chuck Green
and Legion Catchuck. That guy is high quality. Oh yeah, yeah,
a lot of skeptics. He's at Harevard. Let me tell
you a little bit about Ted Kapchuck. Okay, the coney
(01:58):
Allen cap Chuck's I just raised a lot of skeptics
hackles because some people see him as a huckster of
fraud or everything that's wrong with placebos. These people, um
would probably have a problem with us even talking seriously
about the placebo effect in the first place. So I
don't know that it's a really big deal that I
just raised their hackles. But Ted Katchuk is a former right,
(02:22):
let me tell you about capture. Now. He's a former
acupuncturist and he apparently had some sort of epiphany one
day when he was he was treating somebody and they
started to feel better before he even used the acupuncture.
So he started wondering, like, okay, what's going on here?
(02:44):
And he started investigating the placebo effect, and in short
order he ended up as an instructor at Harvard and
became one of the leading researchers into the placebo effect,
which is a really strange journey because every medical school
doesn't usually hire acupuncturists. And he had like kind of
(03:05):
a rocky road at first, like he didn't know what
he was doing with clinical trials, and he got publicly
called out in the New England Journal of Medicine and
UM over the years, over the decades, I think this
is the eighties that he really started to look into it.
He um, like I said, became the foremost researcher in
in coming up with quality clinical trials for trying to
(03:28):
get to the root of what the placebo effect is
and how to use it. What years was that? You
know he's still doing it, but when was this? When
he was started all that stuff. He got called out
and I think a two thousand one issue of the
New England Journal of Medicine UM basically for not using
a control group in his placebo study. So you know,
(03:50):
when you do a study, you have a placebo group
which is your control group, and that basically is I'm
giving you real medicine, but I'm giving Jerry a sugar pill.
And in a proper study, I don't know who's getting
the sugar pill and who's getting the medicine. It's called
double blind. Um so in if you're studying just the
(04:10):
placebo effect, I should be giving you a placebo and
I should be giving Jerry no treatment whatsoever. To truly,
I thought you needed three people, one with a real treatment,
one with placebo, and one with no treatment. It's another
way to do it, Okay, at the very least, though,
you need the placebo group and somebody who's receiving no treatment, gotcha. Yeah, yeah,
if we're skinning cats, well, if you're doing good science
(04:34):
researching into the placebo effect. But what's ironic is is
this whole double blind placebo study came about because the
placebo effect was first noticed by Western practitioner by the
name of Dr Henry Beecher, who in World War Two
supposedly saw a nurse give a shot of sailing to
(04:57):
a soldier because they'd run out a morphine, but the
nurse told them it was morphine, and the soldier responded
to this shot of saline like it was morphine, And
from that Beecher was like, what is going on here?
Started to investigate the placebo effect and ended up proposing
the double blind placebo study to prove the efficacy of drugs.
(05:19):
That goes back further than that, my friend, let's hear
it man UH try seventy five the New Medical Dictionary,
they described the placebo as a commonplace method or medicine,
and then a short time later, in eighteen eleven and
Quincy's lexicon uh Medicum, he defined the placebo as an
epithet given to any medicine adapted more to please than
(05:42):
to benefit the patient, like heroin. So they were on
it back in the early eighteen hundreds, which is surprising. Yeah,
but I mean, like that's the basis of like snake
oil and hucksterism, right, Yeah, Well they called him bread
pills back then because I guess it was it was
probably some sort of like pill made of yeast, as
my us UH and Thomas Jefferson in eighteen o seven
(06:03):
even Uh recorded what he called the Pious Fraud, and
he observed quote that one of the most successful positions
I've ever known has assured me that he used more
bread pills, drops of colored water, and powders of hickory
ash than all other medicines put together. UM, and people
treated people with bread pills. In the early eighteen hundreds,
(06:23):
it was a thing and like they were way onto
the placebo effect and and the fact that it seemed
to work. Uh. And another dude named John Haygarth in
the early eighteen hundreds actually started performing the first studies
on placebo effect, and um, he said it went back
to the renaissance idea that imagination was the major mediator
(06:45):
between body and mind, which is starting to be proven
is possibly correct. Yeah, it's pretty interesting. And in the
nineties is when they started publishing papers on the placebo
uh and actually doing clinical trials and um. They said.
One of their points in the nineteen thirties would confidence
aroused in a treatment, the encouragement afforded by a new procedure,
(07:07):
even like just people getting treated in a new way.
People would say, oh, well, this is gonna work, and
it maybe he did work. And then we're up to
the forties where Beacher comes along notices the placebo effect
himself ultimately comes up with the double blind placebo based study.
And what's ironic about that is the placebo based double
blind study ultimately has split back off into the study
(07:31):
of placebo again because there are so many trials where
the placebo was more effective than the drug, even though
the drug worked, but the placebo worked even better. And
finally in the nine nineties, people were like, what is
going on here? We need to study this thing in
and of itself. Well, yeah, because one of the things
I had no idea. I thought placebos were only used
(07:54):
in studies for efficacy rates. I did not know that
they are. There are doctors, always have been, and still
are prescribing placebos as medicine unknowingly even though they're not
supposed to. We'll get to that later. No knowingly, no
unknowingly for the patient, even though they're supposed to tell
the patient. Yeah, but we'll get to that towards the end.
(08:15):
But I had no idea that they were prescribing placebos
to people. Yeah, And in their defense, a lot of
times doctors are carrying on a tradition where they don't
have anything else to prescribe. But they can't say if
they say that to their patients, the patients are going
to go off and suffer. So at the very least
they can use the last ditch attempt of saying psychological traitor. Yeah. Yeah,
(08:38):
and I'm not knocking it. I just was surprised to
learn that that still happens. And I'm wondering if I've
ever been given a placebo. And it makes me feel
dumb as a patient to say, like, yeah, man, that
whatever you give me really helped. And the doctors like
because it's the same thing as that prank of like
giving somebody non alcoholic beer un telling the real beer
and watching them make a jerk out of themselves getting
(09:00):
or wrong. It's exactly the same thing. So let's talk
about placebo. We assume that everybody knows what placebo is,
but let's define it a little more clearly. The placebo effect, specifically,
is the very real phenomenon that people, when given a
pill or a some sort of medical intervention that feel better. Yes,
(09:25):
they feel better, even though what they've been given is
not medicine and it was not actually a real intervention. Yeah,
And the placebo is the pill itself. That that is
the placebo, and the effect is what you just described, right,
And it doesn't have to be a pill, can be
an injection, it can be fake surgery, there's true. And
(09:45):
it doesn't even have to be uh pharmacologically inert. It
can be a vitamin or like an aspirin, even though
some argue that's not a true placebo. But um, sometimes
that's what the doctor will give you and call it,
you know, medication, But they're there. Um very often, things
like a sugar pill. Yeah, like you said, pharmacologically inert
(10:09):
um and astoundingly, depending on the size of the pill,
the shape of the pill, the color of the pill,
people will have different effects and responses to these things
that are just sugar. Um. So there's some really strange
psychological things going on here. And at first, for a
(10:31):
long time, everybody just kind of assumed it was just psychology,
that we were tricking ourselves into feeling better, or we
hadn't really felt bad in the first place, and we
were being tricked into not feeling bad any longer, or
not thinking we were feeling bad. In any hypochondria, maybe
very much. So. Yeah, Um, they this article says they've
(10:54):
been shown to work in about thirty percent of patients,
and that was actually that's based on Beacher's finding. It
was like alretty, thirty five point two. Yeah, that's what
he found out in nineteen fifty five. That's what they're
still basing that on. Yeah, but there's been other studies
that have gone back through beat your studies and said no, no, no,
that's not that much. Other people have found up to
(11:15):
respond to it, right, And basically one of the big
questions is is it a psychological effect or are there extual,
actual physical responses that are going on. And there's been
a lot of research lately that's pretty interesting. I think,
like we're saying that the the initial idea was that
it was all psychological, right, Yeah, Like, uh, well, I
(11:37):
guess we can talk about the two effects. The subject
expectancy effect, which is basically, if you know the result
ahead of time and the pill you're gonna take, you're
gonna end up feeling that result. Right. That's what a
blind study seeks to prevent, is a subject expectancy effect,
and also the observer expectancy effect, which is what a
(11:59):
double blind studies seeks to prevent. Yeah, and that's important
because it's are different because it's all self reported, right,
which is always a little you know, right. So the
other idea, if it has a psychological basis, is that
it's classical conditioning that we are raised from birth to
think that if somebody gives you a pill, you're going
(12:19):
to respond to it because it has medicine and that
is not self reported. That is actually seeing physical responses. Right.
And with classical conditioning established very famously by Pavlov and
his dogs, right, um, you are you're having You're responding
(12:41):
physically to a psychological stimulus. Right, So you are getting
a physiological response. So classical conditioning eventually kind of came
to be viewed as the more um reasonable explanation for
what was going on because, uh, study after study, if
the study has shown that we are having a physical
(13:04):
reaction to these inert placebos. Yeah, one of them. In
two thousand two from u C. L As Neuropsychiatric Institute,
they had a couple of groups of patients and a
lot of the placebo studies are uh for mental conditions. Um,
not all of them, but a lot of them are
in um like the clinical trials. Yeah, yeah, exactly. Um.
(13:25):
So this one was for any depressants and they had
two groups that got um experimental drugs like real drugs,
and then the third was given the placebo. Uh. They
spent a few weeks on these pills and monitored their
brain activity with the old E G. Wonder machine and well,
it's not the wonder machine. It's it's a wonder machine,
(13:48):
not the wonder machine. Uh. And the patients on the
placebo reported positive effects and showed greater increase of brain
activity than those who had responded to the drug. You know,
I remember or that it was, Yeah, totally undermined people's
faith in antidepressants because it was on the other end
of like the whole nineties where everybody was on antidepressants,
(14:11):
and this study came out and was like people were saying, like,
do these things even work? It was it was kind
of taken the opposite way. Rather than wow, the placebo
effect is really something, it was wow and indepressance or fraudulent. Well,
I wonder what they were trying to It was a
placebo study though, right, so kind of backfired or did
they even care? No, I think it very much carry
(14:34):
because there when compared to place with the whole point
of a drug trial is to show that this drug
is more effective than placebo, it's more effective than the imagination,
and if it's not, then that means that drugs shouldn't
be brought to market. Even though now the thinking is
more like m that's not necessarily true. Because we're coming
to understand the placebo effect can be very powerful, especially
(14:58):
depending on the individual too. Yeah for sure. Uh. The
interesting thing about that study is when the E e g.
Lit up um, the activity was in different parts of
the brain. Um. I think that the placebo patients said
the preformal cortex was lighting up, and basically that says
that the brain isn't being fooled, it's just doing something different. Yeah,
(15:18):
they responded better to the treatment then the people who
responded to the drug. So some people did respond to
the drug, but different parts of their brain were activated
by the drug than the people who responded well to
the placebo, even though they felt better. Yeah, that's mind boggling.
It is. So they had they reached the same conclusion,
(15:39):
but using a totally different region of their brain and
they actually felt better. Um. That wasn't the first study
to prove that there is a physiological response to placebos
or last there's a dental study from the seventies that
I think was the first that showed that if you
blocked endorphins, which are nature's pain relievers, you can also
(16:01):
block the placebo effect. So the people weren't responding to
the placebo like you would expect them to a pain
reliever placebo because they weren't able to release their natural
pain relievers. Yeah, and that's backed up I guess by
this two thousand four study from the University of Michigan
uh Go wolverines. They basically demonstrated that it is related
(16:26):
to endorphins specifically. Uh, So that I guess that backs
up that study because if you can block them. So
here's the thing. It's not that study was related to
endorphins specifically. Other studies have found that it can be
related to how much a person expresses dopamine specifically. So
there's like this idea that there's a genetic basis to
(16:48):
our predisposition to UM placebos. But I think that it's
depending on the drug or the effect that you're trying
to induce using the placebo effects. Because think about it.
If you are somebody who naturally produces more endorphins than
somebody else, Uh, you're going to naturally produce more endorphins
(17:13):
when it's UM triggered by a placebo than somebody who
doesn't produce more endorphins naturally. Yeah, So there's a genetic
basis to it, I guess, But I think the genetic
basis is that the individual must be predisposition to be
able to have that genetic response UM to the drug
or the placebo and have that that um that I
(17:35):
guess response to it. Yeah, And it's like you said,
it's also personal because they found that it is even
affected by a person's personal experience with past pills. The
color of the pill, the shape and size of the
pill will have a different reaction because the person had
maybe took another little blue pill for something else. Sure,
(17:57):
And actually blue pills in in particular, they are known
to be um to have sedative effects as placebo's. Red
pills are known to have stimulating and pain relieving effects
as placebo. That's odd that they made by agraab blue. Yeah,
like in Heavinaly marketed it as the little blue pill.
Interesting sedative effect, Yes, I don't think so. So. Chok, Well,
(18:21):
not that i'd know. Well, we've got more stuff about
all this coming up. But I don't know what we're
gonna talk about next. It's a grab bag right now. Yeah,
but we're gonna come right back after these messages. All right,
we're back, buddy, And I tell you what we're going
to talk about. Something that I had never heard of,
(18:43):
which I think is super interesting, the no sebo effect.
It is super cool, and that is when well, it's
there's a couple of things. That is, when you are
taking a placebo and you experience maybe the effects of
the pill, which is great, and the side effec of
that pill that you think might be but you're supposed
(19:03):
to have, right, you're actually experiencing side effects that aren't
shouldn't be there, right, and then a sugar bill. They
noticed this in clinical trials too, because when you're carrying
out a clinical trial, you have to warn the patients
this drug may give you these terrible side effects. And
so they started noticing like people who were who were
on placebo were still experiencing the side effect like physical
(19:26):
reactions like hives and itch in things. Right, So there
is a there's a negative side to placebo as well,
and no cibo means I shall harm like placebo means
I shall please yeah um. And they found that this
is definitely backed up by the idea that it's classical conditioning.
They found that people who have gone through chemotherapy UH
(19:49):
can become nauseated when they enter a room that's painted
the same color as the room where they received chemo before. Yeah,
that makes sense. Yeah, so there's all sorts of ways
that the no cebo effect can pop up, but it's
pretty mind boggling as well. Yeah, and then no sebo
can doesn't even have to be just with the placebo.
You can experience side effects that aren't on the list
of a real drug because of what we were talking about,
(20:12):
because it looked like another pill you might have had before. Man,
the brain powerful stuff. So going back to kat Chuk,
who I'm I'm just kind of a fan of. Yeah,
I think if you're into like a long form articles,
which I love, go to Harvard Magazine and search for
(20:33):
the placebo phenomenon and it's a profile of him and
his work. It's really interesting stuff. But he was saying
that kind of in line with the idea that like
the color of the pill or the shape of the
pill will have an effect, will either on the no
sebo or the placebo effect. Um. He was saying that
it seems like the basis of the placebo effect is
(20:56):
what's called ritual yea, and ritual is it involves everything
from like the physician's bedside manner to how expensive the
patient thinks the pill is to how effective the patient
thinks the pillars and um. He did a study where
he carried out what was called schmaltzy um like a
smalty care to where he was just lavishing attention on
(21:20):
the patient and telling him how badly he felt that
they were going through this. But this pill is really
effective with your condition. And apparently not just this study,
but other studies show that there's a positive correlation between
the ritual and response to the placebo effect. So the
(21:43):
more you think that this drug is expensive, that this
drug is effective, that this physician cares about you, the
greater of a placebo response you're going to have. Yeah,
you know, I have you ever been accused of being
a hypochondract by anyone? Know, it's got to be very demeaning.
It is because it happened to me. And yeah, I
(22:05):
went to the emergency room in New York, as you know,
when we were up there recently for a trip. I
went to the e R and uh, it was something
and it was a result of it was it was
throwing up in uh nausea from UM I learned from
anti inflammatory pills I was taking at the time for
(22:26):
something else I had nothing to do with being sick,
and they figured that out, but they kept you know
this guy, I called him Nurse Jackie. He was just
like Nurse Jackie, except he was a dude. He kept
coming by and treating me with things and giving me
the I V. Drip and I was like, dude, I'm
not feeling better and I'm not a hypochondrac in any way.
I didn't go to the doctor for like eighteen years straight.
And uh, I could tell he was looking at me
(22:48):
like I got one of these guys. Yeah, And I
was like, no, no, and I could tell. I could
could sense it. And so he finally gave me this
thing to drink that um knocked me out, woke up
like twenty minutes later and felt felt better. I can't remember.
It was something to gatorade now. It was like three
different things. It was like a cocktail of stomach pleasing
(23:10):
things and what's the stuff that like numbs you numb
my throat and I can't remember light to can I think? Um? Yeah,
it worked. I woke up and I felt better. I said,
you know, I don't feel so naxious now, and they
were checking me out and I reached up and I
felt behind my ear for some reason, and it felt
like a golf ball behind my ear and it had
(23:32):
popped up in the last twenty minutes, and so I
was literally leaving. I was like, oh, wait a minute,
I got this thing behind my ear all of a sudden,
and this guy looked at me like h and he
called the doctor over and she was like, yeah, it's
it's very swollen at your limp node. But he wasn't
there for that, so he came back over. It's like,
what did she say. I said, well, she said the
swollen and he said that you're a hypochondriac. And I
was so mad at nursed Jackie. I was like, dude,
(23:55):
look at it. It's huge. I'm not making this up.
And I started defending myself like I never go to
doctors and I'm not one of those people. And he
was just he was like, I was just kidding. I
was just kidding, and I was just kidding. Yeah, but
it made it totally made me feel like a jerk. Yeah,
I mean imagine if like you, if that happened to
you a lot too, I mean, well that means you're
a hypocontract right. But now it definitely made me felt
(24:19):
and I know he was kidding, but it made me
feel really bad, like I'm in there just uh, what's
what's the syndrome? Is that it? Yeah, we did an
episode on that too. Yeah. Uh anyway, sorry about that. Yeah, well,
I'm sorry that that happened to you. I mean, that
is b S. But you mentioned the I V guarantee
(24:40):
you that was just sailing, and that's a placebo in itself. No,
I mean they told me that. I mean they didn't
say like this is the wonder bag, but there's basically
I'm no reason to give you sailing solution. Well to
hydrate me, I guess if i'd been throwing up. Oh yeah, okay,
but um yeah, I guess you're right though to see
like something dripping into your arm, like surely that's got
(25:01):
to be doing something. Yeah. Uh. Well, one interesting thing
is back to placebo's, there have been studies that have
shown that, uh, if you don't tell the patient what
they're supposed to do, that they don't work as well. Yeah.
They even found that with drugs that they know for
a fact work, if you don't tell them it won't work. Yeah.
(25:21):
They did a placebo based trial with a pain killer
and the pain killer proved more effective than placebo. And
then they did another trial with the same pain killer,
didn't tell anybody what it was and it didn't work. Interesting.
And then conversely, this is the one that gets me
(25:41):
to study where they so crazy? Where you're going. They
used an injection that they put into patient's jaws in
the study, which me to induce pain Like that was
the point. They were trying to induce pain in somebody's
jaw using harmless but pain full jaw injections, and they
(26:02):
would inject sailine into the jaw um to keep the
patient's self reported pain level steady throughout the study. And
then they used another injection and gave them sline but
told them this was a pain reliever, and everybody's pain
across the board dropped as a result in the study.
(26:23):
Unbelievable placebo effect. I could just sit around and rattle
off studies all day. It's pretty interesting. What do you
think about obacalp Yeah, it seems kids are done. You
could just call it placebo anyway, I think it's unnecessary. Well,
obacalp is placebo spelled backwards obviously, and that in two
thousand eight was I guess sort of invented or not
(26:45):
invented but coined and packaged by a mother I think
Australian named jin Boutner. She Australian, I don't know. I
think so is that an Australian last name? And then
I don't think there's such a thing. Um, And so
that's basically Placebo's for kids. It's marketed. You can you
can buy a bottle of obacalp and it's for when
(27:06):
your kid isn't feeling good. But um, you but you
know your kids not sick, that kind of thing, and
so you give the kid the pill and it makes
them feel better. And some people have problems with this
and say you're teaching your child that you get relief
from pills only when they're you know, I don't necessarily
need to be taking pills all the time. And proponents say,
(27:28):
you know what, it's it's the same thing as putting
a bandage or kissing a boo boo. It's like you said,
these are dumb little kids. Well, I remember growing up
with the children's aspirin, the orange aspirin. I'm pretty sure
those were just sugar pills. You think I had a
whole bottle of them, and I was fine, but those
are vitamins. It was children's aspirin. Oh I think they
(27:48):
were orange flavored. Yeah, I totally remember those. Yeah, I
think those are probably place I remember the taste, like
I can still sense that they're good, the whole bottle
of them once because I was a little fat kid,
you didn't eat and get sick sugar pills. I have
I think so, because I even remember I was old
enough thinking like I probably shouldn't have eaten that whole
(28:09):
bottle of those things because it's medicine, and watched it
down with the sky and I was right and that
was fine. Afterwards, Well, they do have legit baby aspert
now though, they I'm starting to doubt everything, so starting
to talk about doubt. There are plenty of criticisms of
all this, and we'll talk about him right after this.
(28:41):
So Chuck, I'm a big time into the placebo effect.
Your big time into the placebo effect. There are people
who are not that's true. There Uh, it raises plenty
of skepticism, which again is one of the reasons why
my hat is off to Ted Katchuk because he has
responded to the criticism. He's adjusted his methodolog g he's
doing really good science in the investigation of the placebo effect.
(29:04):
I like that guy. Still, skeptics say, there are a
lot of things that you can use to explain away
the placebo effect. For example, it's possible the person was
actually a hypochondriac, they weren't actually sick in the first place. Yeah,
It's possible that some people get better with no treatment.
(29:24):
It's possible that some diseases do treat themselves, just get
better over the course of time. And if if you
overlay a placebo effect or a placebo and and you
put that over the same course of time, it's gonna
look like it was the placebo that did it, when
really it's just heal itself. Yeah, which is why they
critics call for studies where there is one UH group
(29:48):
that has not given any medication whatsoever exactly, which makes sense.
So UM. One of the other criticisms, though, is that
if a doctor is is saying and there are, like
you said, plenty of doctors who do this, UM. There
there were studies that found that UM. A two thousand
seven study from the University of Chicago found doctors surveyed
(30:11):
in the Chicago area had prescribed placebos before at some
point during their career. In two thousand and eight, they
did a little more robust when six hundred doctors all
across the US and half of them said that they
had prescribed placebos. So this is like, this is still
going on the thing. It's pretty widespread, and the criticism
is well, that means doctors are lying to their patients.
(30:33):
They're using deception to practice medicine, and that's unethical. So
the A m A came out with it's a guideline
that's kind of flies in the face of the placebo
effector of the idea that if you give somebody a
placebo and tell them it's a placebo, that it shouldn't work,
which is not necessarily true. Yeah, in two thousand six,
the AMY came out and said, uh, quote, physicians may
(30:56):
use placebos for diagnosis or treatment only if they patient
is informed and agrees to it. To me, that means
it's not a placebo. I mean I guess it is,
but if you know it is, I don't get it. Like,
what's the point of a doctor coming in and saying,
I'm going to give you the sugar pill? Would would
you like a prescription for sugar pills, and you say, yes,
I would. Supposedly, there are um studies that show the
(31:21):
placebo effect is still works sometimes, but the across the board,
pretty much everyone believes that if the placebo effect is
a real thing, the cats out of the bag. It
is part of the imagination, and that you do kind
of have to fool the person into thinking that it's
a real thing. That expectation coupled with imagination provides the
(31:43):
placebo effect. Yeah, and this article points out to we're
not just saying these doctors are lying liars um. Apparently,
one one tech that a doctor can take is to say, uh,
I have something that I think can help, but I
don't know exactly know what the deal is with it
or how it works, but i'll give it to you
if you want to try it. And you know how
(32:05):
people are a lot of people are like, sure, I'll
try anything. Right Exactly, that's not really deception because if
the doctors are prescribing a placebo he or she obviously
does believe in the placebo effects, so here she does
think it could work but doesn't know how, or if
it only really does work in of the population, then
you've got a seventy chance of striking out anyway with
(32:27):
this course of treatment. Uh so you're back to where
he started to begin with. Yeah, and again it's got
that falls into what's the point category? Now again, we
should say that a lot of physicians who do prescribe
placebos aren't just doing it to toy with their patients.
They're doing because they think that their patient will suffer
more without it, or they just don't have anything that
(32:51):
could be used to address the patient's problem, like they
can't find anything medically wrong with the patient, but just
saying that the patient's not going to help. So here's
a sugar pill. UM. The other tech that a doctor
can take to chuck is um to say, hey, new patient,
welcome to my practice. Let me tell you about the
placebo effect. And in the course of me treating you,
(33:14):
sometime during your lifetime, I may find that a placebo
will be the best thing to use. Are you okay
with me doing that to you at some point possibly
basically like signing up for my own personal U long
term study kind of as a doctor. But wouldn't you
from that point on be like you just gave me
the placeboy, it's a placebo. I know it's a placebo.
(33:34):
I wouldn't know which way was up, Like, I don't
know how to feel. That's the better worse side effects? None, yep.
And the other tech doctors can take is to knock
off early and go hit the golf course, which they
do that one a lot on TV. That's a that's
a that's such an old bit trope. It's like, yeah,
cops in their doughnuts? Is that doctors in golf? I
(33:56):
think that was pretty accurate. I mean in Caddyshack, the
doctor was Dr Beeper. He was the one who just
got mad all the time, right now. That was Judge Smailes.
Dr Beeper was he was just one of the guys,
one of the foursome, okay that I think he played.
Was it Buck Henry? Was he the doctor? No? I can't,
(34:19):
I can. I can picture the guy. It's Buck Henry, right,
I don't think so we'll figure this out offline. How
about that? Yeah? All right? If you want to know
more about the placebo effect, and believe us there is
plenty more to know about it, you can type those
two words in the search part how stuff works dot
com and uh, since I said that, it's time for
(34:40):
a listener mail. I'm gonna call this Australian last name.
This is, he says, dear Josh, Chuck and Jerry and
anyone else I should think, And I think we never
mentioned other people that support us. Didn't we already talk
about in Australian last name? Yeah, that was the joke. Okay,
let's call the call back, gotcha. I just felt like
(35:03):
this listener mail, though, made me realize that we don't
think other folks a lot besides Jerry and like Noelan Matt.
But um, let's do that noway. Like Rebecca h Rebecca
is uh, what's her official title? I don't even know
what titles are around producer web producer maybe yeah, I
mean she handles our website. It makes everything look great.
(35:24):
And Sherry, even though we do our own social media,
Sherry does social media for how stuff works. And she
throws to us a lot, throws to us and helps
us out a lot. And Joe, our buddy, Joe is
a huge help um, and that's kind of the crack staff.
I mean, we're answering our own emails and we're doing
a lot of our own stuff, but it doesn't mean
we don't have help. You know what I'm saying. We
(35:45):
have tons of help, so you know, I just want
to say thanks to this. It's very nice if you
chuck thanks everybody. I figured six years and seven years
and we might as well shout out some of our help.
Uh So this from Alex and he said to thank
anyone else he doesn't know about. And he's from Perth,
Western Australia, which is nothing like Eastern Australia. I'm a
nineteen year old aspiring electrician trapped in the depths of
(36:06):
Western Australia's mining downturn due to layoffs in the mining sector.
Have been unable to find an apprenticeship and I would
have lost hope if it weren't for you guys. I
was just after New Year's It was just after New
Year's January six when I came across the magical production
called Stuff You Should Know um As. At the time
of this writing, it is May tent uh and I
(36:28):
have finished the epic adventure of six hundred episodes plus.
That's in a very short time, my friend. It's been
an amazing journey and I want to thank you for
pulling me through the hard days of resume writing and
delivering long days of waiting. Uh Previously we're mind numbing,
but have since been filled with interesting, insightful, and overall
incredible enjoyable content. My favorites gene patents, lobotomies, and the
(36:52):
masterfully dictated Halloween episodes. We like those two. Those are
some of my favorites. Christmas. I think it's the best
uh so que the exist existential crisis. After um, you
guys forming such an integral part of my life over
the past five months, I don't know I'm going to
acclimate myself to just to a week. Um. And we
hear that a lot from people who mainline the show. Yeah,
(37:14):
there's like a withdrawal period. Yeah, and I've done that
with TV shows, you know. I do that for sure.
You mainline it and then you're like, well I need it. Yeah. Um.
I would just like to sincerely say thank you to
both of you and Jerry and anyone else for pulling
me through these times, and hope the future contains a
stable job for myself, more content for yourselves to pass
(37:35):
on to the stuff you should know, Army, and an
ever growing fan base that you can both woo with
your dulcet tones. And then lightening information. Yours faithfully, That
is Alex gettings from Peth. Thanks Alec, Alex, Yeah, yeah,
thank you very much. Will you get a job buddy,
Yeah for sure. If you're in Perthon you're looking for
an electrician, contact Alex. He's shockingly good. Nice sit there.
(38:00):
We're ending on that one. If you want to get
in touch with us, you can tweet to us at
s y s K podcast. You can join us on
Facebook dot com, slash stuff you Should Know. You can
send us an email to Stuff Podcast at how stuff
works dot com, and as I always join us at
at home on the web, Stuff you Should Know dot com.
(38:22):
For more on this and thousands of other topics, is
that how stuff Works dot com
Welcome to Stuff you should know from house Stuff Works
dot com. Hey, and welcome to the podcast. I'm Josh Clark,
and there's Charles W. Chuck Bryant, and there's Jerry. Jerry
the placebo do sir? No, No, that was bad, Chuck. Yes.
(00:25):
Have you ever heard of the word placebo? Do, sir? Yeah? Placebo?
You know what I mean? I do. Tell everybody I
shall see, No, I will please, I shall please. That's right,
met ill see, We'll see about that. I shall please.
That's what I meant in Latin. Yes, all right, so placebo.
(00:51):
Everybody's heard of a placebo and very famously the placebo effect.
You wonder where that comes from? The placebo effect. The
word placebo um fourteenth century. It referred to hired mourners
at funerals. What they would hire mourners in place of
family members, and they would start their morning wailing with
(01:15):
that mourning. But as in m O, you are with
placebo domino in region vivorum, which means I shall please
the Lord in the land of the living. But in
that it means placebo. Uh. This article said, it carries
the connotation of substitution. Weird. Yeah, that is fantastic stuff.
(01:35):
I thought. So this is from Placebo's and Placebo Effects
in Medicine Colon Historical Overview by Tisson cap Chuck Green
and Legion Catchuck. That guy is high quality. Oh yeah, yeah,
a lot of skeptics. He's at Harevard. Let me tell
you a little bit about Ted Kapchuck. Okay, the coney
(01:58):
Allen cap Chuck's I just raised a lot of skeptics
hackles because some people see him as a huckster of
fraud or everything that's wrong with placebos. These people, um
would probably have a problem with us even talking seriously
about the placebo effect in the first place. So I
don't know that it's a really big deal that I
just raised their hackles. But Ted Katchuk is a former right,
(02:22):
let me tell you about capture. Now. He's a former
acupuncturist and he apparently had some sort of epiphany one
day when he was he was treating somebody and they
started to feel better before he even used the acupuncture.
So he started wondering, like, okay, what's going on here?
(02:44):
And he started investigating the placebo effect, and in short
order he ended up as an instructor at Harvard and
became one of the leading researchers into the placebo effect,
which is a really strange journey because every medical school
doesn't usually hire acupuncturists. And he had like kind of
(03:05):
a rocky road at first, like he didn't know what
he was doing with clinical trials, and he got publicly
called out in the New England Journal of Medicine and
UM over the years, over the decades, I think this
is the eighties that he really started to look into it.
He um, like I said, became the foremost researcher in
in coming up with quality clinical trials for trying to
(03:28):
get to the root of what the placebo effect is
and how to use it. What years was that? You
know he's still doing it, but when was this? When
he was started all that stuff. He got called out
and I think a two thousand one issue of the
New England Journal of Medicine UM basically for not using
a control group in his placebo study. So you know,
(03:50):
when you do a study, you have a placebo group
which is your control group, and that basically is I'm
giving you real medicine, but I'm giving Jerry a sugar pill.
And in a proper study, I don't know who's getting
the sugar pill and who's getting the medicine. It's called
double blind. Um so in if you're studying just the
(04:10):
placebo effect, I should be giving you a placebo and
I should be giving Jerry no treatment whatsoever. To truly,
I thought you needed three people, one with a real treatment,
one with placebo, and one with no treatment. It's another
way to do it, Okay, at the very least, though,
you need the placebo group and somebody who's receiving no treatment, gotcha. Yeah, yeah,
if we're skinning cats, well, if you're doing good science
(04:34):
researching into the placebo effect. But what's ironic is is
this whole double blind placebo study came about because the
placebo effect was first noticed by Western practitioner by the
name of Dr Henry Beecher, who in World War Two
supposedly saw a nurse give a shot of sailing to
(04:57):
a soldier because they'd run out a morphine, but the
nurse told them it was morphine, and the soldier responded
to this shot of saline like it was morphine, And
from that Beecher was like, what is going on here?
Started to investigate the placebo effect and ended up proposing
the double blind placebo study to prove the efficacy of drugs.
(05:19):
That goes back further than that, my friend, let's hear
it man UH try seventy five the New Medical Dictionary,
they described the placebo as a commonplace method or medicine,
and then a short time later, in eighteen eleven and
Quincy's lexicon uh Medicum, he defined the placebo as an
epithet given to any medicine adapted more to please than
(05:42):
to benefit the patient, like heroin. So they were on
it back in the early eighteen hundreds, which is surprising. Yeah,
but I mean, like that's the basis of like snake
oil and hucksterism, right, Yeah, Well they called him bread
pills back then because I guess it was it was
probably some sort of like pill made of yeast, as
my us UH and Thomas Jefferson in eighteen o seven
(06:03):
even Uh recorded what he called the Pious Fraud, and
he observed quote that one of the most successful positions
I've ever known has assured me that he used more
bread pills, drops of colored water, and powders of hickory
ash than all other medicines put together. UM, and people
treated people with bread pills. In the early eighteen hundreds,
(06:23):
it was a thing and like they were way onto
the placebo effect and and the fact that it seemed
to work. Uh. And another dude named John Haygarth in
the early eighteen hundreds actually started performing the first studies
on placebo effect, and um, he said it went back
to the renaissance idea that imagination was the major mediator
(06:45):
between body and mind, which is starting to be proven
is possibly correct. Yeah, it's pretty interesting. And in the
nineties is when they started publishing papers on the placebo
uh and actually doing clinical trials and um. They said.
One of their points in the nineteen thirties would confidence
aroused in a treatment, the encouragement afforded by a new procedure,
(07:07):
even like just people getting treated in a new way.
People would say, oh, well, this is gonna work, and
it maybe he did work. And then we're up to
the forties where Beacher comes along notices the placebo effect
himself ultimately comes up with the double blind placebo based study.
And what's ironic about that is the placebo based double
blind study ultimately has split back off into the study
(07:31):
of placebo again because there are so many trials where
the placebo was more effective than the drug, even though
the drug worked, but the placebo worked even better. And
finally in the nine nineties, people were like, what is
going on here? We need to study this thing in
and of itself. Well, yeah, because one of the things
I had no idea. I thought placebos were only used
(07:54):
in studies for efficacy rates. I did not know that
they are. There are doctors, always have been, and still
are prescribing placebos as medicine unknowingly even though they're not
supposed to. We'll get to that later. No knowingly, no
unknowingly for the patient, even though they're supposed to tell
the patient. Yeah, but we'll get to that towards the end.
(08:15):
But I had no idea that they were prescribing placebos
to people. Yeah, And in their defense, a lot of
times doctors are carrying on a tradition where they don't
have anything else to prescribe. But they can't say if
they say that to their patients, the patients are going
to go off and suffer. So at the very least
they can use the last ditch attempt of saying psychological traitor. Yeah. Yeah,
(08:38):
and I'm not knocking it. I just was surprised to
learn that that still happens. And I'm wondering if I've
ever been given a placebo. And it makes me feel
dumb as a patient to say, like, yeah, man, that
whatever you give me really helped. And the doctors like
because it's the same thing as that prank of like
giving somebody non alcoholic beer un telling the real beer
and watching them make a jerk out of themselves getting
(09:00):
or wrong. It's exactly the same thing. So let's talk
about placebo. We assume that everybody knows what placebo is,
but let's define it a little more clearly. The placebo effect, specifically,
is the very real phenomenon that people, when given a
pill or a some sort of medical intervention that feel better. Yes,
(09:25):
they feel better, even though what they've been given is
not medicine and it was not actually a real intervention. Yeah,
And the placebo is the pill itself. That that is
the placebo, and the effect is what you just described, right,
And it doesn't have to be a pill, can be
an injection, it can be fake surgery, there's true. And
(09:45):
it doesn't even have to be uh pharmacologically inert. It
can be a vitamin or like an aspirin, even though
some argue that's not a true placebo. But um, sometimes
that's what the doctor will give you and call it,
you know, medication, But they're there. Um very often, things
like a sugar pill. Yeah, like you said, pharmacologically inert
(10:09):
um and astoundingly, depending on the size of the pill,
the shape of the pill, the color of the pill,
people will have different effects and responses to these things
that are just sugar. Um. So there's some really strange
psychological things going on here. And at first, for a
(10:31):
long time, everybody just kind of assumed it was just psychology,
that we were tricking ourselves into feeling better, or we
hadn't really felt bad in the first place, and we
were being tricked into not feeling bad any longer, or
not thinking we were feeling bad. In any hypochondria, maybe
very much. So. Yeah, Um, they this article says they've
(10:54):
been shown to work in about thirty percent of patients,
and that was actually that's based on Beacher's finding. It
was like alretty, thirty five point two. Yeah, that's what
he found out in nineteen fifty five. That's what they're
still basing that on. Yeah, but there's been other studies
that have gone back through beat your studies and said no, no, no,
that's not that much. Other people have found up to
(11:15):
respond to it, right, And basically one of the big
questions is is it a psychological effect or are there extual,
actual physical responses that are going on. And there's been
a lot of research lately that's pretty interesting. I think,
like we're saying that the the initial idea was that
it was all psychological, right, Yeah, Like, uh, well, I
(11:37):
guess we can talk about the two effects. The subject
expectancy effect, which is basically, if you know the result
ahead of time and the pill you're gonna take, you're
gonna end up feeling that result. Right. That's what a
blind study seeks to prevent, is a subject expectancy effect,
and also the observer expectancy effect, which is what a
(11:59):
double blind studies seeks to prevent. Yeah, and that's important
because it's are different because it's all self reported, right,
which is always a little you know, right. So the
other idea, if it has a psychological basis, is that
it's classical conditioning that we are raised from birth to
think that if somebody gives you a pill, you're going
(12:19):
to respond to it because it has medicine and that
is not self reported. That is actually seeing physical responses. Right.
And with classical conditioning established very famously by Pavlov and
his dogs, right, um, you are you're having You're responding
(12:41):
physically to a psychological stimulus. Right, So you are getting
a physiological response. So classical conditioning eventually kind of came
to be viewed as the more um reasonable explanation for
what was going on because, uh, study after study, if
the study has shown that we are having a physical
(13:04):
reaction to these inert placebos. Yeah, one of them. In
two thousand two from u C. L As Neuropsychiatric Institute,
they had a couple of groups of patients and a
lot of the placebo studies are uh for mental conditions. Um,
not all of them, but a lot of them are
in um like the clinical trials. Yeah, yeah, exactly. Um.
(13:25):
So this one was for any depressants and they had
two groups that got um experimental drugs like real drugs,
and then the third was given the placebo. Uh. They
spent a few weeks on these pills and monitored their
brain activity with the old E G. Wonder machine and well,
it's not the wonder machine. It's it's a wonder machine,
(13:48):
not the wonder machine. Uh. And the patients on the
placebo reported positive effects and showed greater increase of brain
activity than those who had responded to the drug. You know,
I remember or that it was, Yeah, totally undermined people's
faith in antidepressants because it was on the other end
of like the whole nineties where everybody was on antidepressants,
(14:11):
and this study came out and was like people were saying, like,
do these things even work? It was it was kind
of taken the opposite way. Rather than wow, the placebo
effect is really something, it was wow and indepressance or fraudulent. Well,
I wonder what they were trying to It was a
placebo study though, right, so kind of backfired or did
they even care? No, I think it very much carry
(14:34):
because there when compared to place with the whole point
of a drug trial is to show that this drug
is more effective than placebo, it's more effective than the imagination,
and if it's not, then that means that drugs shouldn't
be brought to market. Even though now the thinking is
more like m that's not necessarily true. Because we're coming
to understand the placebo effect can be very powerful, especially
(14:58):
depending on the individual too. Yeah for sure. Uh. The
interesting thing about that study is when the E e g.
Lit up um, the activity was in different parts of
the brain. Um. I think that the placebo patients said
the preformal cortex was lighting up, and basically that says
that the brain isn't being fooled, it's just doing something different. Yeah,
(15:18):
they responded better to the treatment then the people who
responded to the drug. So some people did respond to
the drug, but different parts of their brain were activated
by the drug than the people who responded well to
the placebo, even though they felt better. Yeah, that's mind boggling.
It is. So they had they reached the same conclusion,
(15:39):
but using a totally different region of their brain and
they actually felt better. Um. That wasn't the first study
to prove that there is a physiological response to placebos
or last there's a dental study from the seventies that
I think was the first that showed that if you
blocked endorphins, which are nature's pain relievers, you can also
(16:01):
block the placebo effect. So the people weren't responding to
the placebo like you would expect them to a pain
reliever placebo because they weren't able to release their natural
pain relievers. Yeah, and that's backed up I guess by
this two thousand four study from the University of Michigan
uh Go wolverines. They basically demonstrated that it is related
(16:26):
to endorphins specifically. Uh, So that I guess that backs
up that study because if you can block them. So
here's the thing. It's not that study was related to
endorphins specifically. Other studies have found that it can be
related to how much a person expresses dopamine specifically. So
there's like this idea that there's a genetic basis to
(16:48):
our predisposition to UM placebos. But I think that it's
depending on the drug or the effect that you're trying
to induce using the placebo effects. Because think about it.
If you are somebody who naturally produces more endorphins than
somebody else, Uh, you're going to naturally produce more endorphins
(17:13):
when it's UM triggered by a placebo than somebody who
doesn't produce more endorphins naturally. Yeah, So there's a genetic
basis to it, I guess, But I think the genetic
basis is that the individual must be predisposition to be
able to have that genetic response UM to the drug
or the placebo and have that that um that I
(17:35):
guess response to it. Yeah, And it's like you said,
it's also personal because they found that it is even
affected by a person's personal experience with past pills. The
color of the pill, the shape and size of the
pill will have a different reaction because the person had
maybe took another little blue pill for something else. Sure,
(17:57):
And actually blue pills in in particular, they are known
to be um to have sedative effects as placebo's. Red
pills are known to have stimulating and pain relieving effects
as placebo. That's odd that they made by agraab blue. Yeah,
like in Heavinaly marketed it as the little blue pill.
Interesting sedative effect, Yes, I don't think so. So. Chok, Well,
(18:21):
not that i'd know. Well, we've got more stuff about
all this coming up. But I don't know what we're
gonna talk about next. It's a grab bag right now. Yeah,
but we're gonna come right back after these messages. All right,
we're back, buddy, And I tell you what we're going
to talk about. Something that I had never heard of,
(18:43):
which I think is super interesting, the no sebo effect.
It is super cool, and that is when well, it's
there's a couple of things. That is, when you are
taking a placebo and you experience maybe the effects of
the pill, which is great, and the side effec of
that pill that you think might be but you're supposed
(19:03):
to have, right, you're actually experiencing side effects that aren't
shouldn't be there, right, and then a sugar bill. They
noticed this in clinical trials too, because when you're carrying
out a clinical trial, you have to warn the patients
this drug may give you these terrible side effects. And
so they started noticing like people who were who were
on placebo were still experiencing the side effect like physical
(19:26):
reactions like hives and itch in things. Right, So there
is a there's a negative side to placebo as well,
and no cibo means I shall harm like placebo means
I shall please yeah um. And they found that this
is definitely backed up by the idea that it's classical conditioning.
They found that people who have gone through chemotherapy UH
(19:49):
can become nauseated when they enter a room that's painted
the same color as the room where they received chemo before. Yeah,
that makes sense. Yeah, so there's all sorts of ways
that the no cebo effect can pop up, but it's
pretty mind boggling as well. Yeah, and then no sebo
can doesn't even have to be just with the placebo.
You can experience side effects that aren't on the list
of a real drug because of what we were talking about,
(20:12):
because it looked like another pill you might have had before. Man,
the brain powerful stuff. So going back to kat Chuk,
who I'm I'm just kind of a fan of. Yeah,
I think if you're into like a long form articles,
which I love, go to Harvard Magazine and search for
(20:33):
the placebo phenomenon and it's a profile of him and
his work. It's really interesting stuff. But he was saying
that kind of in line with the idea that like
the color of the pill or the shape of the
pill will have an effect, will either on the no
sebo or the placebo effect. Um. He was saying that
it seems like the basis of the placebo effect is
(20:56):
what's called ritual yea, and ritual is it involves everything
from like the physician's bedside manner to how expensive the
patient thinks the pill is to how effective the patient
thinks the pillars and um. He did a study where
he carried out what was called schmaltzy um like a
smalty care to where he was just lavishing attention on
(21:20):
the patient and telling him how badly he felt that
they were going through this. But this pill is really
effective with your condition. And apparently not just this study,
but other studies show that there's a positive correlation between
the ritual and response to the placebo effect. So the
(21:43):
more you think that this drug is expensive, that this
drug is effective, that this physician cares about you, the
greater of a placebo response you're going to have. Yeah,
you know, I have you ever been accused of being
a hypochondract by anyone? Know, it's got to be very demeaning.
It is because it happened to me. And yeah, I
(22:05):
went to the emergency room in New York, as you know,
when we were up there recently for a trip. I
went to the e R and uh, it was something
and it was a result of it was it was
throwing up in uh nausea from UM I learned from
anti inflammatory pills I was taking at the time for
(22:26):
something else I had nothing to do with being sick,
and they figured that out, but they kept you know
this guy, I called him Nurse Jackie. He was just
like Nurse Jackie, except he was a dude. He kept
coming by and treating me with things and giving me
the I V. Drip and I was like, dude, I'm
not feeling better and I'm not a hypochondrac in any way.
I didn't go to the doctor for like eighteen years straight.
And uh, I could tell he was looking at me
(22:48):
like I got one of these guys. Yeah, And I
was like, no, no, and I could tell. I could
could sense it. And so he finally gave me this
thing to drink that um knocked me out, woke up
like twenty minutes later and felt felt better. I can't remember.
It was something to gatorade now. It was like three
different things. It was like a cocktail of stomach pleasing
(23:10):
things and what's the stuff that like numbs you numb
my throat and I can't remember light to can I think? Um? Yeah,
it worked. I woke up and I felt better. I said,
you know, I don't feel so naxious now, and they
were checking me out and I reached up and I
felt behind my ear for some reason, and it felt
like a golf ball behind my ear and it had
(23:32):
popped up in the last twenty minutes, and so I
was literally leaving. I was like, oh, wait a minute,
I got this thing behind my ear all of a sudden,
and this guy looked at me like h and he
called the doctor over and she was like, yeah, it's
it's very swollen at your limp node. But he wasn't
there for that, so he came back over. It's like,
what did she say. I said, well, she said the
swollen and he said that you're a hypochondriac. And I
was so mad at nursed Jackie. I was like, dude,
(23:55):
look at it. It's huge. I'm not making this up.
And I started defending myself like I never go to
doctors and I'm not one of those people. And he
was just he was like, I was just kidding. I
was just kidding, and I was just kidding. Yeah, but
it made it totally made me feel like a jerk. Yeah,
I mean imagine if like you, if that happened to
you a lot too, I mean, well that means you're
a hypocontract right. But now it definitely made me felt
(24:19):
and I know he was kidding, but it made me
feel really bad, like I'm in there just uh, what's
what's the syndrome? Is that it? Yeah, we did an
episode on that too. Yeah. Uh anyway, sorry about that. Yeah, well,
I'm sorry that that happened to you. I mean, that
is b S. But you mentioned the I V guarantee
(24:40):
you that was just sailing, and that's a placebo in itself. No,
I mean they told me that. I mean they didn't
say like this is the wonder bag, but there's basically
I'm no reason to give you sailing solution. Well to
hydrate me, I guess if i'd been throwing up. Oh yeah, okay,
but um yeah, I guess you're right though to see
like something dripping into your arm, like surely that's got
(25:01):
to be doing something. Yeah. Uh. Well, one interesting thing
is back to placebo's, there have been studies that have
shown that, uh, if you don't tell the patient what
they're supposed to do, that they don't work as well. Yeah.
They even found that with drugs that they know for
a fact work, if you don't tell them it won't work. Yeah.
(25:21):
They did a placebo based trial with a pain killer
and the pain killer proved more effective than placebo. And
then they did another trial with the same pain killer,
didn't tell anybody what it was and it didn't work. Interesting.
And then conversely, this is the one that gets me
(25:41):
to study where they so crazy? Where you're going. They
used an injection that they put into patient's jaws in
the study, which me to induce pain Like that was
the point. They were trying to induce pain in somebody's
jaw using harmless but pain full jaw injections, and they
(26:02):
would inject sailine into the jaw um to keep the
patient's self reported pain level steady throughout the study. And
then they used another injection and gave them sline but
told them this was a pain reliever, and everybody's pain
across the board dropped as a result in the study.
(26:23):
Unbelievable placebo effect. I could just sit around and rattle
off studies all day. It's pretty interesting. What do you
think about obacalp Yeah, it seems kids are done. You
could just call it placebo anyway, I think it's unnecessary. Well,
obacalp is placebo spelled backwards obviously, and that in two
thousand eight was I guess sort of invented or not
(26:45):
invented but coined and packaged by a mother I think
Australian named jin Boutner. She Australian, I don't know. I
think so is that an Australian last name? And then
I don't think there's such a thing. Um, And so
that's basically Placebo's for kids. It's marketed. You can you
can buy a bottle of obacalp and it's for when
(27:06):
your kid isn't feeling good. But um, you but you
know your kids not sick, that kind of thing, and
so you give the kid the pill and it makes
them feel better. And some people have problems with this
and say you're teaching your child that you get relief
from pills only when they're you know, I don't necessarily
need to be taking pills all the time. And proponents say,
(27:28):
you know what, it's it's the same thing as putting
a bandage or kissing a boo boo. It's like you said,
these are dumb little kids. Well, I remember growing up
with the children's aspirin, the orange aspirin. I'm pretty sure
those were just sugar pills. You think I had a
whole bottle of them, and I was fine, but those
are vitamins. It was children's aspirin. Oh I think they
(27:48):
were orange flavored. Yeah, I totally remember those. Yeah, I
think those are probably place I remember the taste, like
I can still sense that they're good, the whole bottle
of them once because I was a little fat kid,
you didn't eat and get sick sugar pills. I have
I think so, because I even remember I was old
enough thinking like I probably shouldn't have eaten that whole
(28:09):
bottle of those things because it's medicine, and watched it
down with the sky and I was right and that
was fine. Afterwards, Well, they do have legit baby aspert
now though, they I'm starting to doubt everything, so starting
to talk about doubt. There are plenty of criticisms of
all this, and we'll talk about him right after this.
(28:41):
So Chuck, I'm a big time into the placebo effect.
Your big time into the placebo effect. There are people
who are not that's true. There Uh, it raises plenty
of skepticism, which again is one of the reasons why
my hat is off to Ted Katchuk because he has
responded to the criticism. He's adjusted his methodolog g he's
doing really good science in the investigation of the placebo effect.
(29:04):
I like that guy. Still, skeptics say, there are a
lot of things that you can use to explain away
the placebo effect. For example, it's possible the person was
actually a hypochondriac, they weren't actually sick in the first place. Yeah,
It's possible that some people get better with no treatment.
(29:24):
It's possible that some diseases do treat themselves, just get
better over the course of time. And if if you
overlay a placebo effect or a placebo and and you
put that over the same course of time, it's gonna
look like it was the placebo that did it, when
really it's just heal itself. Yeah, which is why they
critics call for studies where there is one UH group
(29:48):
that has not given any medication whatsoever exactly, which makes sense.
So UM. One of the other criticisms, though, is that
if a doctor is is saying and there are, like
you said, plenty of doctors who do this, UM. There
there were studies that found that UM. A two thousand
seven study from the University of Chicago found doctors surveyed
(30:11):
in the Chicago area had prescribed placebos before at some
point during their career. In two thousand and eight, they
did a little more robust when six hundred doctors all
across the US and half of them said that they
had prescribed placebos. So this is like, this is still
going on the thing. It's pretty widespread, and the criticism
is well, that means doctors are lying to their patients.
(30:33):
They're using deception to practice medicine, and that's unethical. So
the A m A came out with it's a guideline
that's kind of flies in the face of the placebo
effector of the idea that if you give somebody a
placebo and tell them it's a placebo, that it shouldn't work,
which is not necessarily true. Yeah, in two thousand six,
the AMY came out and said, uh, quote, physicians may
(30:56):
use placebos for diagnosis or treatment only if they patient
is informed and agrees to it. To me, that means
it's not a placebo. I mean I guess it is,
but if you know it is, I don't get it. Like,
what's the point of a doctor coming in and saying,
I'm going to give you the sugar pill? Would would
you like a prescription for sugar pills, and you say, yes,
I would. Supposedly, there are um studies that show the
(31:21):
placebo effect is still works sometimes, but the across the board,
pretty much everyone believes that if the placebo effect is
a real thing, the cats out of the bag. It
is part of the imagination, and that you do kind
of have to fool the person into thinking that it's
a real thing. That expectation coupled with imagination provides the
(31:43):
placebo effect. Yeah, and this article points out to we're
not just saying these doctors are lying liars um. Apparently,
one one tech that a doctor can take is to say, uh,
I have something that I think can help, but I
don't know exactly know what the deal is with it
or how it works, but i'll give it to you
if you want to try it. And you know how
(32:05):
people are a lot of people are like, sure, I'll
try anything. Right Exactly, that's not really deception because if
the doctors are prescribing a placebo he or she obviously
does believe in the placebo effects, so here she does
think it could work but doesn't know how, or if
it only really does work in of the population, then
you've got a seventy chance of striking out anyway with
(32:27):
this course of treatment. Uh so you're back to where
he started to begin with. Yeah, and again it's got
that falls into what's the point category? Now again, we
should say that a lot of physicians who do prescribe
placebos aren't just doing it to toy with their patients.
They're doing because they think that their patient will suffer
more without it, or they just don't have anything that
(32:51):
could be used to address the patient's problem, like they
can't find anything medically wrong with the patient, but just
saying that the patient's not going to help. So here's
a sugar pill. UM. The other tech that a doctor
can take to chuck is um to say, hey, new patient,
welcome to my practice. Let me tell you about the
placebo effect. And in the course of me treating you,
(33:14):
sometime during your lifetime, I may find that a placebo
will be the best thing to use. Are you okay
with me doing that to you at some point possibly
basically like signing up for my own personal U long
term study kind of as a doctor. But wouldn't you
from that point on be like you just gave me
the placeboy, it's a placebo. I know it's a placebo.
(33:34):
I wouldn't know which way was up, Like, I don't
know how to feel. That's the better worse side effects? None, yep.
And the other tech doctors can take is to knock
off early and go hit the golf course, which they
do that one a lot on TV. That's a that's
a that's such an old bit trope. It's like, yeah,
cops in their doughnuts? Is that doctors in golf? I
(33:56):
think that was pretty accurate. I mean in Caddyshack, the
doctor was Dr Beeper. He was the one who just
got mad all the time, right now. That was Judge Smailes.
Dr Beeper was he was just one of the guys,
one of the foursome, okay that I think he played.
Was it Buck Henry? Was he the doctor? No? I can't,
(34:19):
I can. I can picture the guy. It's Buck Henry, right,
I don't think so we'll figure this out offline. How
about that? Yeah? All right? If you want to know
more about the placebo effect, and believe us there is
plenty more to know about it, you can type those
two words in the search part how stuff works dot
com and uh, since I said that, it's time for
(34:40):
a listener mail. I'm gonna call this Australian last name.
This is, he says, dear Josh, Chuck and Jerry and
anyone else I should think, And I think we never
mentioned other people that support us. Didn't we already talk
about in Australian last name? Yeah, that was the joke. Okay,
let's call the call back, gotcha. I just felt like
(35:03):
this listener mail, though, made me realize that we don't
think other folks a lot besides Jerry and like Noelan Matt.
But um, let's do that noway. Like Rebecca h Rebecca
is uh, what's her official title? I don't even know
what titles are around producer web producer maybe yeah, I
mean she handles our website. It makes everything look great.
(35:24):
And Sherry, even though we do our own social media,
Sherry does social media for how stuff works. And she
throws to us a lot, throws to us and helps
us out a lot. And Joe, our buddy, Joe is
a huge help um, and that's kind of the crack staff.
I mean, we're answering our own emails and we're doing
a lot of our own stuff, but it doesn't mean
we don't have help. You know what I'm saying. We
(35:45):
have tons of help, so you know, I just want
to say thanks to this. It's very nice if you
chuck thanks everybody. I figured six years and seven years
and we might as well shout out some of our help.
Uh So this from Alex and he said to thank
anyone else he doesn't know about. And he's from Perth,
Western Australia, which is nothing like Eastern Australia. I'm a
nineteen year old aspiring electrician trapped in the depths of
(36:06):
Western Australia's mining downturn due to layoffs in the mining sector.
Have been unable to find an apprenticeship and I would
have lost hope if it weren't for you guys. I
was just after New Year's It was just after New
Year's January six when I came across the magical production
called Stuff You Should Know um As. At the time
of this writing, it is May tent uh and I
(36:28):
have finished the epic adventure of six hundred episodes plus.
That's in a very short time, my friend. It's been
an amazing journey and I want to thank you for
pulling me through the hard days of resume writing and
delivering long days of waiting. Uh Previously we're mind numbing,
but have since been filled with interesting, insightful, and overall
incredible enjoyable content. My favorites gene patents, lobotomies, and the
(36:52):
masterfully dictated Halloween episodes. We like those two. Those are
some of my favorites. Christmas. I think it's the best
uh so que the exist existential crisis. After um, you
guys forming such an integral part of my life over
the past five months, I don't know I'm going to
acclimate myself to just to a week. Um. And we
hear that a lot from people who mainline the show. Yeah,
(37:14):
there's like a withdrawal period. Yeah, and I've done that
with TV shows, you know. I do that for sure.
You mainline it and then you're like, well I need it. Yeah. Um.
I would just like to sincerely say thank you to
both of you and Jerry and anyone else for pulling
me through these times, and hope the future contains a
stable job for myself, more content for yourselves to pass
(37:35):
on to the stuff you should know, Army, and an
ever growing fan base that you can both woo with
your dulcet tones. And then lightening information. Yours faithfully, That
is Alex gettings from Peth. Thanks Alec, Alex, Yeah, yeah,
thank you very much. Will you get a job buddy,
Yeah for sure. If you're in Perthon you're looking for
an electrician, contact Alex. He's shockingly good. Nice sit there.
(38:00):
We're ending on that one. If you want to get
in touch with us, you can tweet to us at
s y s K podcast. You can join us on
Facebook dot com, slash stuff you Should Know. You can
send us an email to Stuff Podcast at how stuff
works dot com, and as I always join us at
at home on the web, Stuff you Should Know dot com.
(38:22):
For more on this and thousands of other topics, is
that how stuff Works dot com
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Josh Clark
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