M Hey everybody, it's me Josh, and for this week's S Y s K Select, I've chosen an episode on Placebos. It's an episode chock full of facts of the podcast, and yet Chuck comes out with one of the all time greats right out of the gate. But don't stop listening. Then the whole episode is amazingly wonderful, which is why I chose it. So enjoy it. Welcome to Stuff you should know, a production of I Heart Radios How Stuff Works. Hey, and welcome to the podcast. I'm Josh Clark, and there's Charles W. Chuck Bryant, and there's Jerry Jerry place cebo, do sir? No? No, that was bad, Chuck. Yes. Have you ever heard of the word placebo? Do sir? Yeah? Placebo? You know what I mean. I'll tell every buddy, I shall see, No, I will please, I shall please. That's what I meant. I shall see. We'll see about that. I shall please. That's what I meant in Latin. Yes, right, so placebo. Everybody's heard of a placebo, and very famously the placebo effect. Do 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 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, so it carries the connotation of substitution. Weird. Yeah, that is fantastic stuff, I thought. So this is from placebos and placebo effects in Medicine. Colon Historical Overview by Tisson cap Chuck Green and Legion Catchuck. That guy is high quality. Yeah, a lot of skeptics Catchuck, Catchuck. He's at Harvard. Let me tell you a little bit about Ted Kapchuck the coney 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 Catchuk is a former owes me fifty bucks. Right, let me tell you about Catchuck. Now. He's a former acupuncturist, and he apparently had some sort of um 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? 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 Harvard Medical School doesn't usually hire acupuncturists. And he had like kind of 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 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, 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, right, um. So you know, if you're studying just the 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, you see. Yeah, yeah, if we're skinning cats, well, if you're doing good science researching into the placebo. 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 sailine to a soldier because they'd run out of morphine. But the nurse told them it was morphine, and the soldier responded to this shot of sailine 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. It goes back further than that, my friend, let's hear it man uh try sev 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 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 guests UH and Thomas Jefferson in eighteen o seven even 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. 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 UH actually started performing the first studies on placebo's effect and UM, he said it went back to the Renaissance idea that imagination was the major mediator 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 U 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, 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 of placebo again. Yeah, 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 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 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, 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, their patients is going to go off and suffer. So at the very least they can use the last ditch attempt of saying psychological trickery. Yeah, yeah, And I'm not knocking to 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 and telling it's a real beer and watching them make a jerk out of themselves getting drunk. 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, they feel better, even though what they've been given is not medicine and is was not actually a real intervention. Yeah. And the placebo is the pill itself. That that that is the placebo, and the effect is what you just described, right, And it doesn't have to be a pill. It can be an injection, it can be fake surgery, there's true. And 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, uh and call it, you know, medication. But there there um very often things like a sugar pill. Yeah, like you said, pharmacologically inert 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 long time, everybody just kind of assumed it was just psychology, that we we're 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 any like an offshoot of hypochondria, maybe very much. So. Yeah, um, they this article says they've been shown to work in about thirty percent of patients, and that was actually that's based on Beacher's finding. It was like thirty thirty five point two. Yeah, that's what he found out in nine that's what they're still basing that on. Yeah, but there's been other studies that have gone back through Beacher's studies and said, no, no, no, that's not that much. Other people have found up to six respond to it, right, And basically one of the big questions is is it a psychological effect or are there excell actual physical responses that are going on. And there's been a lot of research lately that's pretty interesting, I think. Right. So, like we were saying that the the initial idea was that it was all psychological, right, yeah, Like, uh, well, I 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. So that's what a blind study seeks to prevent, is a subject expectancy effect and also the observer expectancy effect, which is what a double blind study 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 to respond to it because it has medicine. Yeah, 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 physically to a psychological stimulus, right, so you 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 after study has shown that we are having a physical 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 or in UM like the clinical trials. Yeah, yeah, exactly. UM. 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, the Mrs Wonder, it's it's a wonder machine, 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 that it was the study. 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 and wasn't 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 it depressence, right, fraudulent, right right? Right? Well, I wonder what they were trying to It was a placebo study though, right, so it kind of backfired or did they even care? No, I think it very much cared 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, right right, And if it's not, then that means that drugs shouldn't be brought to market. Even though now the thinking is more like, hmm, that's not necessarily true, because we're coming to understand the placebo effect can be very powerful, especially 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 that 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, 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 placebos, right, even though they felt better. Yeah, that's mind boggling. It is. So they had they reached the same conclusion but using a totally different regions 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, uh, you can also 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 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 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 effect, 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 when it's UM triggered by a placebo than somebody who doesn't produce more endorphins naturally. 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 I 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 bill will have a different reaction because the person had maybe took another little blue pill for something else. Sure, and actually blue pills in in particular are known to be um to have sedative effects as place Ebo's red pills are known to have stimulating and pain relieving effects as placebo. That's odd that they made viagrab blue. Yeah, like inhabitedly marketed it as the little blue pill. Interesting sedative effect, Yes, I don't think so, so, Chuck, Well, not that i'd know. Well, we've got more stuff about all this coming up. I don't know what we're going to talk about next. It's a grab bag right now. We're back, buddy, and I tell you what we're going to talk about. Something that I had never heard of, which I think is super interesting, the no sebo effect. It is super cool. And that is when well, it's a 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 effects of that pill that you think might be but you're supposed to have, right, you're actually experiencing side effects that aren't shouldn't be there, right, And it's a sugar pill. They noticed this in clinical trials too, because when you're carrying out a clinical trial, you have to warn the patients, Yeah, this drug may give you these terrible side effects, and so they started noticing like people who were who were on placebo, we're still experiencing the side effect like physical reactions like hives and itching in things. Right, so there is a there's a negative side to placebo as well, and no sebo means I shall harm like placebo means I shall please. Yeah, yeah um. And they found that and this is definitely backed up by the idea that it's classical conditioning. They found that people who have gone through chemotherapy can become nauseated when they enter a room that's painted the same color as the room where they receive chemo before. Yeah, that makes sense. Yeah, So there's all sorts of ways that the no sebo effect can pop up, but it's pretty mind boggling as well. Yeah, and then no seabow 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, because it looked like another pill you might have had before. Man, the brain powerful stuff. So, going back to Kapchuk, whom 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 the placebo phenomenon and it's a profile at 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, won't either on the no sebo or the placebo effect. Um. He was saying that it seems like the basis of the placebo effect is what's called ritual, 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 pillows and um. He did a study where he carried out what was called schmaltzy um, like a schmalty care to where he was just lavishing attention on the patient and telling him how bad 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 yeah and response to the placebo effect. So the 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 kind to be very demeaning. It is because it happened to me. Oh yeah, Yeah. I went to the emergency room in New York, as you know, when we were up there recently for our trip. I went to the e R and uh something, 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 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 exap. 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 hypochondric 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 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. I woke up like twenty minutes later and felt felt better. What was it, I can't remember. It was something to gata now. It was like three different things. It was like a cocktail of stomach pleasing things and what's the stuff that like numbs? You numb my throat? And I can't remember light to cane, I think um and it worked with Yeah, it worked. I woke up and I felt better. I said, you know, I don't feel so nauseous 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 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 lymph node. But he wasn't there for that, so he came back over. He's like, hey, what did she say? I said, well, she said the swollen and he said that you're a hypochondriac. And I was so mad. It nursed Jackie. I was like, dude, 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 that's all that means, you're a hypochondriact. But now it definitely made me felt 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? Lynch? Is that it? Yeah? We did want an episode on that too. Yeah, uh, anyway, sorry about that. Yeah, well I'm sorry that that happened to you. Thanks. I mean that is b s. But you mentioned the I V guarantee 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 that this is the wonder bag, right, But there's basically, I'm no reason to give you sailine 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 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. Yeah, if you don't tell them, it won't work. Yeah. 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, the study where they so crazy. They used an injection that they put into patient's jaws in the study, which is mean to induce pain, Like that was the point. They were trying to induce pain in somebody's jaw using harmless but painful jaw injections, and they 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 sailine but told them this was a pain reliever, and everybody's pain across the board dropped as a result in the study. 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 kid just call it placebo anyway, I think it's unnecessary. Well, Obacalp is placebo spelled backwards obviously, and that in two thousand and eight was I guess, sort of invented or not 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 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, 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 ate a whole bottle of them when I was fine, But those were vitamins. It was children's aspirin. Oh, I think they were orange flavored. Yeah, I totally remember those. Yeah, I think those were probably a placeba. I remember the taste, like I can still sense that they were good, a whole bottle of them once. Because I was a little fat kid. You didn't eat and get sick those 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 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 aspirin now though they I'm starting to doubt every thing, so start to talk about doubt. There are plenty of criticisms of all this, and we'll talk about him right after this. So Chuck, I'm a big time into the placebo effect. I can tell 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 methodology. He's doing really good science in the investigation of the placebo effect. 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 were and actually sick in the first place. Yeah, it's possible that some people get better with no treatment. Yeah, 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 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 just healed itself. Yeah, which is why they critics call for studies where there is one group 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 thou seven study from the University of Chicago from doctors surveyed 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 centre doctors all across the US and half of them said that they had prescribed placebos. So this is like, this is still going on. It's a thing. It's pretty widespread. Yeah, And the criticism is, well, that means doctors are lying to their patients, 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 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 suppose believe there are um studies that show the placebo effect is still post 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 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 exactly know what the deal is with it or how it works, but i'll give it to if you want to try it. And you know, 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 this course of treatment. Uh So you're back to where he started to begin with. Yeah, and again it's cut that falls inunder 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 could be used to address the patient's problem, like they can't find anything medically wrong with the patient, but to 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, 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 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. Yeah, I know it's a placebo. 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 donuts, is that doctors in golf? I think that's 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 Smails. 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, I can. I can picture the guy. It's Buck Henry, right? Is that? 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 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 callback. I just felt like the man. This listener mail, though, made me realize that we don't think other folks all lot. Besides Jerry and like Noelan Matt but um, let's do that now, okay, Like Rebecca m Rebecca is, uh, what's your 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. And Sherry, even though we do our own social media, Sherry does social media for how stuff works, and she like 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 have tons of help. So you know, I just want to say thanks to this. It's very nice if you chuck everybody. And I figured six years in, seven years in we might as well shout out some of our health. 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 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 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 have finished the epic adventure of six hundred episodes pluts. That's in a very short time, my friend. Yeah, 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 masterfully dictated Halloween episodes. We like those two because 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, there's like a withdrawal period. Yeah, and I've done that with TV shows, you know. I do that first year 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 on to the stuff you should know, army, and an evergroing fan base that you can both woo with your dulcet tones and enlightening information yours faithfully, that is Alex gettings from Peth. Thanks Alex, Alex, Yeah, yeah, thank you very much. Do you get a job, buddy, Yeah, for sure. If you're in person you're looking for an electrician, contact Alex. He's shockingly good, nice, terrible. 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 always, joined us at at home on the web. Stuff you Should Know dot Com. Stuff you Should Know is a production of I Heart Radio's How Stuff Works. For more podcasts for my heart Radio, visit the iHeart Radio app, Apple Podcasts, or wherever you listen to your favorite shows. M

M Hey everybody, it's me Josh, and for this week's S Y s K Select, I've chosen an episode on Placebos. It's an episode chock full of facts of the podcast, and yet Chuck comes out with one of the all time greats right out of the gate. But don't stop listening. Then the whole episode is amazingly wonderful, which is why I chose it. So enjoy it. Welcome to Stuff you should know, a production of I Heart Radios How Stuff Works. Hey, and welcome to the podcast. I'm Josh Clark, and there's Charles W. Chuck Bryant, and there's Jerry Jerry place cebo, do sir? No? No, that was bad, Chuck. Yes. Have you ever heard of the word placebo? Do sir? Yeah? Placebo? You know what I mean. I'll tell every buddy, I shall see, No, I will please, I shall please. That's what I meant. I shall see. We'll see about that. I shall please. That's what I meant in Latin. Yes, right, so placebo. Everybody's heard of a placebo, and very famously the placebo effect. Do 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 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, so it carries the connotation of substitution. Weird. Yeah, that is fantastic stuff, I thought. So this is from placebos and placebo effects in Medicine. Colon Historical Overview by Tisson cap Chuck Green and Legion Catchuck. That guy is high quality. Yeah, a lot of skeptics Catchuck, Catchuck. He's at Harvard. Let me tell you a little bit about Ted Kapchuck the coney 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 Catchuk is a former owes me fifty bucks. Right, let me tell you about Catchuck. Now. He's a former acupuncturist, and he apparently had some sort of um 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? 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 Harvard Medical School doesn't usually hire acupuncturists. And he had like kind of 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 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, 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, right, um. So you know, if you're studying just the 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, you see. Yeah, yeah, if we're skinning cats, well, if you're doing good science researching into the placebo. 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 sailine to a soldier because they'd run out of morphine. But the nurse told them it was morphine, and the soldier responded to this shot of sailine 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. It goes back further than that, my friend, let's hear it man uh try sev 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 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 guests UH and Thomas Jefferson in eighteen o seven even 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. 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 UH actually started performing the first studies on placebo's effect and UM, he said it went back to the Renaissance idea that imagination was the major mediator 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 U 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, 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 of placebo again. Yeah, 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 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 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, 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, their patients is going to go off and suffer. So at the very least they can use the last ditch attempt of saying psychological trickery. Yeah, yeah, And I'm not knocking to 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 and telling it's a real beer and watching them make a jerk out of themselves getting drunk. 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, they feel better, even though what they've been given is not medicine and is was not actually a real intervention. Yeah. And the placebo is the pill itself. That that that is the placebo, and the effect is what you just described, right, And it doesn't have to be a pill. It can be an injection, it can be fake surgery, there's true. And 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, uh and call it, you know, medication. But there there um very often things like a sugar pill. Yeah, like you said, pharmacologically inert 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 long time, everybody just kind of assumed it was just psychology, that we we're 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 any like an offshoot of hypochondria, maybe very much. So. Yeah, um, they this article says they've been shown to work in about thirty percent of patients, and that was actually that's based on Beacher's finding. It was like thirty thirty five point two. Yeah, that's what he found out in nine that's what they're still basing that on. Yeah, but there's been other studies that have gone back through Beacher's studies and said, no, no, no, that's not that much. Other people have found up to six respond to it, right, And basically one of the big questions is is it a psychological effect or are there excell actual physical responses that are going on. And there's been a lot of research lately that's pretty interesting, I think. Right. So, like we were saying that the the initial idea was that it was all psychological, right, yeah, Like, uh, well, I 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. So that's what a blind study seeks to prevent, is a subject expectancy effect and also the observer expectancy effect, which is what a double blind study 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 to respond to it because it has medicine. Yeah, 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 physically to a psychological stimulus, right, so you 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 after study has shown that we are having a physical 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 or in UM like the clinical trials. Yeah, yeah, exactly. UM. 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, the Mrs Wonder, it's it's a wonder machine, 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 that it was the study. 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 and wasn't 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 it depressence, right, fraudulent, right right? Right? Well, I wonder what they were trying to It was a placebo study though, right, so it kind of backfired or did they even care? No, I think it very much cared 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, right right, And if it's not, then that means that drugs shouldn't be brought to market. Even though now the thinking is more like, hmm, that's not necessarily true, because we're coming to understand the placebo effect can be very powerful, especially 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 that 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, 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 placebos, right, even though they felt better. Yeah, that's mind boggling. It is. So they had they reached the same conclusion but using a totally different regions 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, uh, you can also 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 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 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 effect, 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 when it's UM triggered by a placebo than somebody who doesn't produce more endorphins naturally. 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 I 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 bill will have a different reaction because the person had maybe took another little blue pill for something else. Sure, and actually blue pills in in particular are known to be um to have sedative effects as place Ebo's red pills are known to have stimulating and pain relieving effects as placebo. That's odd that they made viagrab blue. Yeah, like inhabitedly marketed it as the little blue pill. Interesting sedative effect, Yes, I don't think so, so, Chuck, Well, not that i'd know. Well, we've got more stuff about all this coming up. I don't know what we're going to talk about next. It's a grab bag right now. We're back, buddy, and I tell you what we're going to talk about. Something that I had never heard of, which I think is super interesting, the no sebo effect. It is super cool. And that is when well, it's a 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 effects of that pill that you think might be but you're supposed to have, right, you're actually experiencing side effects that aren't shouldn't be there, right, And it's a sugar pill. They noticed this in clinical trials too, because when you're carrying out a clinical trial, you have to warn the patients, Yeah, this drug may give you these terrible side effects, and so they started noticing like people who were who were on placebo, we're still experiencing the side effect like physical reactions like hives and itching in things. Right, so there is a there's a negative side to placebo as well, and no sebo means I shall harm like placebo means I shall please. Yeah, yeah um. And they found that and this is definitely backed up by the idea that it's classical conditioning. They found that people who have gone through chemotherapy can become nauseated when they enter a room that's painted the same color as the room where they receive chemo before. Yeah, that makes sense. Yeah, So there's all sorts of ways that the no sebo effect can pop up, but it's pretty mind boggling as well. Yeah, and then no seabow 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, because it looked like another pill you might have had before. Man, the brain powerful stuff. So, going back to Kapchuk, whom 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 the placebo phenomenon and it's a profile at 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, won't either on the no sebo or the placebo effect. Um. He was saying that it seems like the basis of the placebo effect is what's called ritual, 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 pillows and um. He did a study where he carried out what was called schmaltzy um, like a schmalty care to where he was just lavishing attention on the patient and telling him how bad 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 yeah and response to the placebo effect. So the 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 kind to be very demeaning. It is because it happened to me. Oh yeah, Yeah. I went to the emergency room in New York, as you know, when we were up there recently for our trip. I went to the e R and uh something, 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 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 exap. 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 hypochondric 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 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. I woke up like twenty minutes later and felt felt better. What was it, I can't remember. It was something to gata now. It was like three different things. It was like a cocktail of stomach pleasing things and what's the stuff that like numbs? You numb my throat? And I can't remember light to cane, I think um and it worked with Yeah, it worked. I woke up and I felt better. I said, you know, I don't feel so nauseous 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 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 lymph node. But he wasn't there for that, so he came back over. He's like, hey, what did she say? I said, well, she said the swollen and he said that you're a hypochondriac. And I was so mad. It nursed Jackie. I was like, dude, 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 that's all that means, you're a hypochondriact. But now it definitely made me felt 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? Lynch? Is that it? Yeah? We did want an episode on that too. Yeah, uh, anyway, sorry about that. Yeah, well I'm sorry that that happened to you. Thanks. I mean that is b s. But you mentioned the I V guarantee 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 that this is the wonder bag, right, But there's basically, I'm no reason to give you sailine 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 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. Yeah, if you don't tell them, it won't work. Yeah. 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, the study where they so crazy. They used an injection that they put into patient's jaws in the study, which is mean to induce pain, Like that was the point. They were trying to induce pain in somebody's jaw using harmless but painful jaw injections, and they 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 sailine but told them this was a pain reliever, and everybody's pain across the board dropped as a result in the study. 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 kid just call it placebo anyway, I think it's unnecessary. Well, Obacalp is placebo spelled backwards obviously, and that in two thousand and eight was I guess, sort of invented or not 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 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, 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 ate a whole bottle of them when I was fine, But those were vitamins. It was children's aspirin. Oh, I think they were orange flavored. Yeah, I totally remember those. Yeah, I think those were probably a placeba. I remember the taste, like I can still sense that they were good, a whole bottle of them once. Because I was a little fat kid. You didn't eat and get sick those 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 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 aspirin now though they I'm starting to doubt every thing, so start to talk about doubt. There are plenty of criticisms of all this, and we'll talk about him right after this. So Chuck, I'm a big time into the placebo effect. I can tell 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 methodology. He's doing really good science in the investigation of the placebo effect. 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 were and actually sick in the first place. Yeah, it's possible that some people get better with no treatment. Yeah, 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 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 just healed itself. Yeah, which is why they critics call for studies where there is one group 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 thou seven study from the University of Chicago from doctors surveyed 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 centre doctors all across the US and half of them said that they had prescribed placebos. So this is like, this is still going on. It's a thing. It's pretty widespread. Yeah, And the criticism is, well, that means doctors are lying to their patients, 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 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 suppose believe there are um studies that show the placebo effect is still post 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 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 exactly know what the deal is with it or how it works, but i'll give it to if you want to try it. And you know, 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 this course of treatment. Uh So you're back to where he started to begin with. Yeah, and again it's cut that falls inunder 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 could be used to address the patient's problem, like they can't find anything medically wrong with the patient, but to 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, 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 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. Yeah, I know it's a placebo. 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 donuts, is that doctors in golf? I think that's 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 Smails. 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, I can. I can picture the guy. It's Buck Henry, right? Is that? 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 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 callback. I just felt like the man. This listener mail, though, made me realize that we don't think other folks all lot. Besides Jerry and like Noelan Matt but um, let's do that now, okay, Like Rebecca m Rebecca is, uh, what's your 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. And Sherry, even though we do our own social media, Sherry does social media for how stuff works, and she like 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 have tons of help. So you know, I just want to say thanks to this. It's very nice if you chuck everybody. And I figured six years in, seven years in we might as well shout out some of our health. 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 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 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 have finished the epic adventure of six hundred episodes pluts. That's in a very short time, my friend. Yeah, 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 masterfully dictated Halloween episodes. We like those two because 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, there's like a withdrawal period. Yeah, and I've done that with TV shows, you know. I do that first year 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 on to the stuff you should know, army, and an evergroing fan base that you can both woo with your dulcet tones and enlightening information yours faithfully, that is Alex gettings from Peth. Thanks Alex, Alex, Yeah, yeah, thank you very much. Do you get a job, buddy, Yeah, for sure. If you're in person you're looking for an electrician, contact Alex. He's shockingly good, nice, terrible. 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 always, joined us at at home on the web. Stuff you Should Know dot Com. Stuff you Should Know is a production of I Heart Radio's How Stuff Works. For more podcasts for my heart Radio, visit the iHeart Radio app, Apple Podcasts, or wherever you listen to your favorite shows. M