Muscle for Life with Mike Matthews - Kurtis Frank on the Surprising Truth About the Placebo Effect

Episode Date: August 13, 2020

What if I told you that with one pill, you could boost your energy levels, supercharge your strength, and even melt away mental and physical pain and discomfort? And what if this pill could do those things naturally and safely? And what if I even told you that it’s just a sugar pill, but so long as you truly believe in its ability to work, it will? If that sounds like science fiction, I understand, but the underlying mechanism is actually science fact, and it’s called the placebo effect. Many people have heard of the placebo effect, but it’s much deeper than many people realize, filled with quite a few surprising and interesting aspects. That’s why I invited Kurtis Frank back onto the podcast to give us a little lesson on the placebo effect, including ... The most surprising effects of placebo and how it works How the placebo effect can improve your workouts How resilient is the placebo effect and does it wear off? Why it's important to have researchers blinded from the placebo in experiments Why you shouldn’t seek out the placebo effect How placebo relates to homeopathy, chiropractic, and acupuncture Oh and in case you’re not familiar with Kurtis, he’s the co-founder and former lead researcher and writer of Examine.com, as well as the Director of Research for my sports nutrition company, Legion, which means he’s responsible for improving existing formulations and creating new ones. So if you want a basic overview on what the placebo effect is and why it’s important, listen to this episode! 6:11 - What is the placebo effect? 6:46 - What are some examples of the placebo effect? 10:43 - What are examples of nocebo that are documented in literature? 18:58 - How does the placebo effect work if you are already aware of it? 21:40 - What are some other examples of the placebo effect that could help you with workouts? 26:08 - How durable is the placebo effect? 27:07 - Do you have any anecdotes for the placebo effect? 28:12 - What are your thoughts on medication and the placebo effect? 31:31 - Does not notifying the doctor of the placebo medication eliminate the chances of the placebo effect not working? 39:37 - Is homeopathy a placebo effect? 54:58 - How does placebo affect acupuncture? --- Mentioned on The Show:  Books by Mike Matthews: https://legionathletics.com/products/books/ --- Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.legionathletics.com/signup/

Hello, and welcome to another episode of Muscle for Life. I'm your host, Mike Matthews, and thank you for taking some time out of your day to join me for a discussion about the placebo effect. Now, check this out. What if I told you that with one little pill every day, you could boost your energy levels, you could supercharge your strength, and you could even melt away mental and physical pain and discomfort. And what if this pill could do those things naturally and safely, no drugs involved? And what if I even told you that actually it's just a sugar pill, but so long as you truly believe in its ability to work, which you actually can because of the placebo effect, it will work.

Well, if that sounds like science fiction to you, I understand, but the underlying mechanism is very much science fact and it is called the placebo effect. Now, chances are you have heard of the placebo effect, but it probably also is a much deeper topic than you realize. It certainly is a lot deeper than many people realize. me before I really started looking into it, the placebo effect is filled with quite a few surprising and interesting and even practical aspects. And that's why I invited Curtis Frank back onto the podcast to give us a little crash course on the placebo effect. And if you're not familiar with Curtis, he is the co-founder and the former lead researcher and writer of examine.com. So if you've ever been to that website and poked around in the

highly technical writing on the website, on the blog, you have stuff that is more layman friendly, but really the core of examine is very technical. Pretty much all of that was researched and written by Curtis over the course of six or seven years. And now Curtis is the director of research and development for my sports nutrition company, Legion. And that means that he is responsible for improving all of our existing formulations as well as creating new ones. He's the guy I go to for new product ideas, or I go to with new product ideas and ask him, Curtis, is this possible? Curtis, is it possible to make a natural testosterone booster? No, Mike, it's still not possible. Okay. Curtis, is there any reason for people to take BCAAs?

Because they keep on asking for BCAAs. No, Mike, there's still no reason to take BCAAs. Okay, fine. So anyway, in this episode, Curtis and I talk about many elements of many aspects of the placebo effect, including some of the more surprising ones about how it actually works, how it can improve your workouts. There are a couple cool little immediately useful tips that can help you gain strength faster in the gym in particular. And of course, if you do that enough over time, then you gain muscle faster. We talk about how resilient the placebo effect is, and we talk about how the placebo effect relates to chiropractic, homeopathy, and acupuncture, and more. Also, if you like what I'm doing here on the podcast and elsewhere, definitely check out my

health and fitness books, including the number one best-selling weightlifting books for men and women in the world, Bigger Leaner Stronger and Thinner Leaner Stronger, as well as the leading flexible dieting cookbook, The Shredded Chef. Now, these books have sold well over 1 million copies and have helped thousands of people build their best body ever. And you can find them on all major online retailers like Audible, Amazon, iTunes, Kobo, and Google Play, as well as in select Barnes & Noble stores. And I should also mention that you can get any of the audiobooks 100% free when you sign up for an Audible account.

And this is a great way to make those pockets of downtime, like commuting, meal prepping, and cleaning, more interesting, entertaining, and productive. And so if you want to take Audible up on this offer, and if you want to get one of my audiobooks for free, just go to www.buylegion.com slash audible and sign up for your account. So again, if you appreciate my work and if you want to see more of it, and if you want to learn time-proven and evidence-based strategies for

losing fat, building muscle and getting healthy and strategies that work for anyone and everyone, regardless of age or circumstances, please do consider picking up one of my best-selling books, Bigger Leaner Stronger for Men, Thinner Leaner Stronger for Women, and The Shredded Chef for my favorite fitness-friendly recipes. Curtis Frank is back. We made it. We've rescheduled this several times, but here we are. Finally, we can get it done with. Get at it, as the tough people say. Yeah. So we're here to talk about the placebo effect, which is, we were just talking offline and you

were concerned that it's such a complex and multifaceted and nuanced topic that you weren't sure if you were ready to go that deep. And assuaged, I'm checking the pronunciation, A, you know, you run into those words, you can spell, what is it? Yeah. Assuage, assuage. So I assuaged your misgivings by letting you know that, okay, let's do like a placebo effect 101 talk here because I'm sure that most people listening have heard of the placebo effect, but don't know much more than maybe like, oh, that's where something that shouldn't work works, right? And it works because you think it's going to work, but there's a lot more to it, right?

And it works because you think it's going to work, but there's a lot more to it. And that's why we're here today. And I think where we should start is, let's just start at the top. What is the placebo effect? Obviously, I kind of just summarized it, but there's a few accepted definitions of it. They're all kind of the same, but we don't know which is the best definition yet. The one that I like the most is that they're measurable changes to the body that are based on your expectations and beliefs in a treatment, regardless of what the treatment is. So it's pretty much a psychological response based on what you think will happen. And what are some of the more interesting examples of that? Because there are some very striking ones that really drive home how powerful it can be. Well, the most interesting one that I've found, I haven't delved too much into it, but basically when it comes to the placebo effect, it's based on your perception of the treatment, right? So it's going to have more power in anything that is both psychogenic and acute. And can you just define psychogenic? Born of just the psyche. So something like anxiety attacks, panic attacks, hot flashes,

So something like anxiety attacks, panic attacks, hot flashes, acute pain, just like getting hit. Those are psychogenic and they're acute because they happen really fast. Those things are the most subject to the placebo effect. And I believe, especially when it comes to hot flashes, up to 50% of all benefit seen to hot flashes is attributable to the placebo effect. Wow. Literally on par with the drug treatments, like best of the drug treatments. Which I guess if they are primarily stemming from the mind, then that would make sense that they could be heavily manipulated by somehow changing whatever is going on upstairs that is producing it, right?

Correct. And then in comparison to that, things that are not psychogenic and they're chronic are either very resistant to placebo effect or placebo just has pretty much no effect on them. Like regardless of your expectations in a therapy, you can't placebo your way into a cancer cure because you don't just accidentally think yourself into cancer. Cancer doesn't happen immediately. It happens over the course of many years. So placebo effect doesn't really influence cancer that much. It's very specific and they can show you, here's the problem. See that tumor right there? That's no good. Whereas I'm sure that you have come across the sham surgery examples in your research for this episode, which I thought were pretty fascinating, that you had people with actual physical problems.

Now, why they had these problems was not clear, but their knee hurt. There's no question. Every day their knee hurt, they get a sham surgery, meaning that they thought they got a surgery. There was a little incision that was made. They were put under, but nothing else was done. And all of a sudden their knees better. There's also, I think the example that sticks with me the most is the heart surgery where normally it'd be a very invasive surgery where they have to go through your breastbone and there was a sham surgery, which you'd think the person would know that they didn't get the surgery because they didn't get destroyed by it. But where getting a sham surgery improved a heart condition in a patient you've, you've got across those. I'm sure.

condition in a patient. You've come across those, I'm sure. The first example, the knee surgery, that's pretty obvious. I'm about to explain why it's obvious. Because the placebo effect works mostly through the HPA access and HPTA for men. So the fight or flight response, the stress responses, but also the opioid system, which is why pain is very subject to placebo effects. So if you do experience a placebo effect, pain can be very much reduced. And if you're subject to the opposite, the nocebo effect, which is just like the bad side of the coin, you can actually greatly increase pain even when you shouldn't normally have it. And just to be clear on nocebo, so that'd be something that shouldn't cause a negative effect, but it does. Pretty much. Placebo is there is no actual drug treatment, but there's a positive effect. Nocebo is there is no actual drug treatment, but there's a negative

effect. And what are some examples of that that have just been documented in the literature? Usually worsening of anxiety attacks, because some people, when they have anxiety or whatever, they can just breathe and it gets better. Some people, even though the stimuli, the stressor is gone, they pretty much psych themselves into more fear. And then they legitimately get worse symptoms, even when there's no stressor anymore. That sort of repeated effect, that downward spiral is somewhat related to nocebo. And then of course, there is a whole pain thing where if you tell someone that doing this will cause you pain, even when doing that thing will not normally cause them pain, they do tend to report a bit more pain associated with that.

Interesting. Like what, for example? I'm sure these are benign activities. There's one that I saw a while ago. It was old people doing really small plyometric box jumps, and it was like half a foot and they're basically yeah so something that's kind of believable if you didn't quite know how the body works like oh yeah that maybe could hurt yeah like apparently there was like one i think it was actually three groups one group was just saying like do these box jumps another was saying do these box jumps don't worry they're not going to hurt your knees at all then another was saying do these box jumps don't worry they're not going to hurt your knees at all then another one saying do these box jumps they do tend to hurt the knees but if that happens we

have some treatment on standby ready for you and just those prompts influence the pain it reminds me of a lot of the research that i've read regarding well the practical application would be marketing but just persuasion and psychology as applied to marketing and there's a lot of similarity there in that there's so much that is happening subconsciously and how this is all of us how impressionable we really are even those of us who think we're pretty savvy consumers and yeah maybe we're immune to some of the crudest tricks used, but we're not immune to all of them. And anyways, there's just interesting research that shows just even the choice of words, how much of a difference that can make in terms of how people receive what's

essentially the same communication. Yeah. And also, I just want to head on back a little bit because back to the question you said, what's the most surprising thing about the placebo response that I've seen? Because we got a little bit sidetracked when I was warming up to the answer. The answer is that the placebo effect works in schizophrenia, to a degree. Explain. Well, if you're schizophrenic, there is actually an appreciable placebo response. It's not as strong on something like pain or hot flashes, but it's present. And this is important because schizophrenia is associated with the inability to, well, at times, the inability to differentiate between reality and delusions and just not knowing what is real and what is not. And because of that, you would think that you wouldn't have expectations associated with the treatment that could be reliable in any sense. Because if your delusions just switch all the time, your expectations should be all over the

chart like you should just get you're getting random placebo effects random nocebo effects every like the other day yeah but there is actually a reliable placebo effect in schizophrenia and i think researchers know how is it true that i do not know i was trying to look into it okay uh but right now, it seems like there's a bunch of theories. But a lot of the theories are, this is what we think is happening right now, but we need to confirm it later. Well, what intervention is the reliable one? If I'm understanding you correctly, but I may not be understanding. Oh, it's not like any specific intervention. It's just whenever

there is a study, you would expect a placebo effect to occur just for everything. Hence why there's like double-blind placebo effects. Sorry, the double-blind placebo controlled study is the gold standard because you can literally never avoid the placebo effect. You have to make science built around it. But when it comes to schizophrenia, everything we know about the placebo effect, we should be saying, you know, schizophrenia should not have a reliable placebo effect. It doesn't make sense for them to have it. But they do. And so we're still trying to figure out well, I'm still trying to figure out like, maybe some researchers know exactly why. But yeah, like it normally should not happen. But it does. So that's kind of cool.

why. But yeah, it normally should not happen, but it does. So that's kind of cool. And I guess the other interesting thing is how I still adore the fact that placebo effect works, even if you know there's a placebo effect. That's what I was going to ask you about next, because that makes it even more interesting and in some ways practical, I guess, right? Because in a way, if it's all based on expectations and beliefs, then you could argue that at least a certain aspect of the placebo effect could be Pavlonian in nature. And what do you mean by that? Well, your expectations towards something. When you, say, take a drug. Oh, no.

So I just meant the Pavlonian just to be clear. Are you talking about stimulus response? Yes, like Pavlov's dogs and all that. Sure. Because I know like a lot of weightlifters who they go to the gym, they're tired or whatever. They take a pre-workout and all of a sudden they're like super amped, but they're amped in like literally two seconds. And you're like, you can't absorb the nutrients that fast in two seconds. Take caffeine alone, right?

It's about 30 minutes when it peaks after taking it? Yeah, pretty much, unless you're sublingual. But even then, I remember seeing a few of the guys I used to work out with, whenever they got a new pre-workout, that spark was gone. It's like they had to train themselves to get used to the new pre-workout because they had their old pre-workout. They had their baby and now they switched it. And it's like, yeah, I still got to get used to this one. So they're basically training themselves to get expected to that new pre-workout.

That does seem a bit Pavlonian. And at least in my position, like, first of all, what I'm about to say, I haven't really looked in the science on it yet because I really only thought about this yesterday when I was doing prep work and I still need to double check it. Ergogenic response to music. How much does placebo play a role in there? Because when I was just working working on my prime I always had a little secret playlist so to speak yep yeah same I had a few songs I had my like three songs were my deadlift songs slash squat songs like when I was going heavy there were a few songs I would go to yeah I had my uh leg press song my crock row song Widowmaker song. And I never listened to them aside from those

exercises. And I gotta say, I would just be chilling in my room or whatever. That song would accidentally come on my playlist, and all of a sudden, I would just get jazzed out of my head. I'm just like, oh no, I need to do leg day right now, then I have to switch to the song. And so,

I'm just wondering how much crossover that Pavlonian conditioning has with the placebo effect if they're both based well i mean generals have known the power of music for a long time there's a reason why armies going back to antiquity had drummers and they used music just to amp their troops up i don't know like that's just a huge can of worms like that's the main reason why i was a little bit cautious about getting into the podcast today because the placebo effect

is definitely a topic where every time you answer one question, two more rise up. Yeah. And plus like it just delves into psychology and that's not necessarily my field. So it takes a while for me to learn all this stuff.

Yeah, that's why again, I think we can just cover the main questions that people have when they hear about it and some of the main points that are made. If you were just to Google around for a little bit and what you're going to find, and we can discuss, I think just at a high level, what it is, how it works. So then in terms of making it work, even when you know it's a placebo effect, so how does that work?

So does that, what you're saying is that I could have a sugar pill, but if I were able to convince myself that it's going to do something for my pain because of listening to this podcast, where I learned that that's how it can work, that could generate enough buy-in to then actually reduce pain, even though I know it's a sugar pill? Yes. That's very inception-like, right? Yeah. The only problem is that you actually have to legitimately convince yourself.

And simply saying, I want to reduce my pain is not necessarily enough. You have to believe it, right? This is why, like, do you know where the placebo effect first was discovered? No, actually, I don't. World War I trenches. Basically, supply lines were running out, and soldiers were coming back really wounded, really sick, and they needed medical treatment. And the medical staff had nothing, like literally nothing. had nothing like literally nothing so they would pretend to give medical treatment to the soldiers although what they were doing was essentially like pouring out a band-aid it's like i kiss your boo-boo better hey go go back on the fields and die now you still you still have one good arm

you're okay yeah like they were doing that kind of stuff but they were saying that they were actually giving treatment and it actually worked. Pain was being reduced. And all the soldiers are thanking the medical staff for their effort. And the medical staff is thinking, what the hell? We literally didn't give them anything. And so that's why initially, when people were first looking at the placebo effect, they thought it was all based on trickery. Because trickery is the easiest way to get someone to truly believe something.

The second one would be faith itself, hence why the focus on belief systems. And then the hardest, but perhaps most ethical way in my mind would be the conditioning effect, expectations. But ultimately, it's just, you have to truly believe in something. And unless you want to get tricked or unless you want to intertwine it with some sort of faith or belief system, sometimes you just got to do the exact same thing all the time and eventually associate it with your successes. Interesting. So if we're talking about then, let's say, improving workout performance, we'll keep it on topic for the podcast. So you mentioned something like you mentioned pre-workout, you mentioned music. What are some other, we're kind of talking about almost like rituals, right? There could be beliefs or there could just be things that you do? What are some other examples that might just help you have better workouts, even though they may be technically quote unquote, shouldn't, you know? Well, I can answer this question, but I can't necessarily call them placebo effects at this moment in time, but ritual is a good example of what you just said. The other one would be like little habits

or quirks that you have in the gym. Like for me, whenever I'm about to bench press, I have a little habit where I grip the bar on the rings and then I immediately like sort of rub the sweat between my pinky and ring finger on the bar. Then my ring finger, middle finger on the bar. And I just sort of like do that on each hand just to get the sweat out.

And that's just a sort of like ritual and quirk that I have. And it really helps. And why does that, why do you think that, like, how did you come up with that? Like for me, I don't do that. I just try to squeeze the bar as hard as I can and kind of try to like bend it in half. Those are my cues for bench that reliably make a difference. Well, for me, it was just because the first time I did it, it's because I was going for bench and there was a lot of sweat in between my fingers.

And I'm like, ew, sweat. I don't want to do that. So I just rubbed the sweat off and I had a really good bench session that day. And then the next time I felt sweat there, I rubbed it off, had a really good bench session. And then I essentially time I felt sweat there, I rubbed it off, had a really good bench session. And then I essentially started to associate the rubbing of the sweat with a good bench press. So it's kind of finding what works for you. It's almost like, and this is something we were talking about offline, almost like personalizing your placebo. Yeah, like trial and error. It's just like, if it works for you, do it. If it doesn't, don't do it. But ultimately, you have to train your mind to associate itself

with success in a way. Yeah, which means that you have to actually succeed. If you do something and then you have a bad set, then maybe you should abandon that one and try something else. Because if we're talking about conditioning, there needs to be that positive association and it needs to be reinforced probably a number of times before it becomes reliably useful, I would think. And also everything that we're talking about for maximizing the placebo effect also applies to the nocebo effect. So if you routinely do something and it only results in failure, stop doing that thing. It's not going to work out in your favor. It's one of those things that shouldn't even need to be said, but it's a good point.

Like if it's not going well, make some changes, just stop doing the same thing, just make some changes. And especially if we're talking about working out, it's funny how these little changes could be the thing where you find something that just works for you for whatever reason. And I guess this is kind of an intuitive type of process, right? You almost just go, hey, what sounds like a good idea right now? There's that. And then there's maybe weightlifting cues would be something a little bit more standardized, I guess you could say. And anybody listening, if you want to learn more about that, I just recorded a podcast. We published it, I don't know, maybe a week ago where I think it was nine different cues. I share some different

cues that have helped me. And I think that there's probably some overlap here in that some of the cues, they're more just reminding you of your form and just how to keep your technique in. But then some of them are probably just kind of placebo-y that you're imagining a certain thing. And then that helps you do a little bit better on the exercise. And then you just do that a few times. And now that is, it just works for you, even though there's no technical reason why it should be working, you know? Yeah. It just, you know, reminds your body of its successes. Yeah. Yeah. Which actually reminds me of, there was a, I read about this, I don't remember what book, Pele, I think is how you pronounce his name, the famous soccer player, and how before games he used to spend, I believe it was like 30 minutes, just remembering his prior stellar performances, the times when by his own standard he did really

well, where he impressed himself with how well he played and i believe he also would envision i believe it was like a bit of both he would remember the times he played extremely well and then envision himself playing extremely well in the upcoming game yeah like i don't really know if that's placebo but that is definitely based on the whole cues and perhaps like even family it's just it's kind of a psychological priming effect. Yeah. Nothing else, right? They're all in the sort of same category in a sense. And how durable are the effects of the placebo effect? Because some people say that you can find something like this and it works for a little bit and then it wears off,

that it's not going to work, whether it's something like a pill that you're taking for pain or some other placebo for pain or the placebo effect as applied to working out. By durable, do you mean resilient? Yeah. Again, what I've seen is I've seen people say that the placebo effect tends to wear off in a few weeks in most cases. You won't find something that just reliably works for you consistently for a long time. From what I've seen, I would actually liken the placebo effect to porcelain. Really strong yet fragile because the placebo effect can continue to give you great benefits over a very long period of time. But if you lose your

expectations or beliefs in it, it's just gone. It shatters. Interesting. And do you have any just anecdotes that you've come across in the literature of how that has happened? Where a person, they just lose confidence completely in it, which seems kind of strange because if it is working well for you, how do you lose confidence in it? Now, of course, you can, but I'm just curious. Not in the literature specifically, but when I was looking into belief systems, I did come across some, like, I'm not sure if these would be related to placebo effects. I believe they are, but there's people who were reformed Christians and basically they just had an irrationally strong belief in God that God would cure them of their pain disorders.

And they actually felt less pain because of that. But then when they became secular, they lost those benefits. Which I guess makes sense given what you've already covered. So they would have to find some new placebo effect. Yeah. Again, these aren't academic journals that I was looking at, so they could have been embellished. Sure, just personal. Yeah, but I've seen a few of those, so I think that there's something there. Interesting. What are your thoughts on the placebo effect in the context of medications and mechanisms of healing, surgeries? I'm sure some people have thought about those things, wondering then how many surgeries are actually unnecessary? How many medications are unnecessary?

How many people could just be treated with placebos instead of potentially harmful interventions? Well, I think that's a sort of, it's a bad line of thought to go down because again, like all science is based around the double blind placebo controlled study because placebo effects are omnipresent. Do you want to just quickly actually describe what that is just for anybody, if they haven't, maybe they've heard of the term, but they don't know exactly how it works. Yeah. So double blindblind placebo-controlled means that there's the active drug and then the placebo drug. And placebo drug is just something that is medically inert and only has the placebo effect, whereas the active drug has the actual drug acting, but also the placebo effect on top.

So if you assume that the placebo effects between the two groups are the same, then they negate each other statistically, and you're left with inert versus drug, and then you can see if the drug's better than just a sugar pill. And then the double blind just refers to neither the patients nor the medical doctors know which is which. And why is that important? How did that become a thing where at one point, obviously, it was not the practitioner wasn't also blinded? Why is that necessary to maximally minimize the placebo effects influence on the study? Well, the subjects are blinded because... I mean, that's obvious, right?

Well, I did mention earlier that the placebo effect still works even if you know it's placebo, but it works better if you have better expectations or you think it's going to work better. So if you know you're getting the drug, your placebo effects can be stronger. But the researchers are blinded because they may accidentally give physical cues to the patient. It's like, here's your drug. And if they're looking optimistic, maybe you're getting the good drug. And if they say like, here's your drug, and then they just like look to the side and have a little bit of shame on their face, you're like, that's not the drug, that's the placebo effect. So patients can actually pick up on that and it can influence the results. Okay, so that's the key. It's not on a deeper level where even if the

patients have no idea, but the doctors do that somehow that could influence the results. It potentially could. It's hard to determine, but whenever you have a study where you can't prove if X is a variable that screwed your results, but you think it might have, like that just gets annoying. And it's like, let's just make sure that variable X isn't an issue in the future. If you like what I'm doing here on the podcast and elsewhere, definitely check out my health and fitness books, including the number one bestselling weightlifting books for men and women in the world,

Bigger Leaner Stronger and Thinner Leaner Stronger, as well as the leading flexible dieting cookbook, The Shredded Chef. Does it neutralize the placebo effect enough to make it more or less a non-factor in the results of research? Or is there something else in play that just can't be controlled for? Is it just the best we've got? It's the best we've got at keeping the placebo effect similar between both groups. And as long as they're similar between both groups, they can sort of negate each other.

And all difference observed can be due to drug versus inert compound. But anyways, when it comes to just using the placebo effect as medical treatment, I don't like that line of thought because first and foremost, you will always have the placebo effect. Just always, whether it's small or whether it's large, it doesn't matter if you have inert or an active drug. You either have the placebo effect itself, or you have the active drug and the placebo effect. So it can have an additive effect. It can make an effective drug more effective. Yes. You're either choosing one benefit or you're choosing two benefits. And so you go for the two benefits, obviously.

Yeah, no, I understand that. But some people, and I don't disagree with you, but I know that some people would push back and say, well, medications and surgeries come with risks. And if you want to live a long, healthy, enjoyable life, it's probably a good idea to avoid medications and surgeries as much as possible. If you got to do it, you got to do it. But if you can not, then it's better to not. And so would a placebo treatment before you go there make sense? You know what I mean? In that sense, I would probably disagree mostly because at the end of the day, you shouldn't seek out the placebo treatment. You should just seek out the safest drug treatment because there are going to be

drugs that are highly effective with side effects. Then there are going to be some drugs like metformin, my baby, who pretty much has very few side effects and could very well improve health greatly. They're all going to give you a placebo effect. So if you simply choose whatever drug is the safest, you will get the drug effect and the placebo effect. But if you intentionally seek out the placebo effect, you run the risk of actually trying to argue for things like homeopathy. That's what I was going to say. You could turn to just like some quote unquote natural type of solution for something that if it's, let's say it's not a serious health condition, it's something that needs to be addressed, but could it be resolved through something that shouldn't make a difference? But in your case, we're going back to this personalization point, that placebo just works well for you. As much as I hate to say, if it

works, it works. But I would prefer trying to find the best treatment possible, even when there is no good treatment. A good example of this would be fibromyalgia, where there is no actual good pharmaceutical treatment for it yet. But coenzyme Q10 and PQQ might work. PQQ is super theoretical. Coenzyme Q10 is somewhat theoretical, no real good evidence, but they at least have a little bit of evidence and argumentation going for them. So if you get the placebo effect for those things, you get the placebo effect and you're basically gambling on also getting a good drug effect. But if you go for just something completely random, like lavender oil or whatever, you're gambling on the placebo effect and there's no chance for a drug effect. Makes sense. And if we're talking about

surgeries, take back surgery, for example, which I'm sure, I don't know how much you've looked into it. I haven't, I wouldn't say I'm an expert on it at all. I've spoken to some experts. Like I had Stuart McGill on my podcast and that it's very interesting. And he is, if anybody wants to go listen to that interview, if you want to hear his whole position, in what he was talking about. So he has a book called The Back Mechanic that has a self-diagnosis protocol. And then based on what you find, like, okay, move this way. Does that hurt? Move that way. Does that hurt? Can you do this? Can you do that? And based on what you find, he then describes this is what's going on. And here's some exercises and things, some remedial stuff you can do to resolve that. And he has some very interesting stories, resolving like really, really bad problems without surgery. And he talks about how hit and miss back surgery can be and how debilitating it can be. And so that to me, if I was somebody with a back problem, for example,

and I was being told that it's surgery, dude, it's surgery time, I would look for probably, again, unless it was very clearly an issue that, okay, you see this nerve right here, you see how it's happening, we have to fix that. And again, he talks about this, I would be very reluctant to just run into the operating room. I would be willing to try a lot of placebo things before I would do that. But I just do want to clarify, since we're on this topic, the placebo effect when it comes to issues like that would only affect the perception of pain. Whatever causes the pain would most likely not be fixed because that would most likely be either a nerve injury

or muscular bone injury. And that's neither psychogenic nor acute. So the placebo effect would be like literally a bandaid effect. It'll simply make your life a bit better to live, but it wouldn't actually fix the issue at hand. You would need something like what Miguel talked about, the actual exercises to fix the root of the issue. Yeah. I had Paul Ingram on, which will, I think- A good guy, good guy. Yeah. Yeah. I liked Paul. And we talked about repetitive stress injuries, but got into, of course, I mean, his wheelhouse is pain. And he just talked about some really interesting, just how mysterious pain is in many ways and how I really liked anybody who hasn't listened to that episode. I recommend go listening to it because there's some really practical stuff in there. He talked about trigger points, certain parts in the body that you just rub every day and you find

like he had, I think he called him what his 12 or 13 magical miracle points, magical points, something like that. But just points in the body that many people find are painful and that by rubbing them with their hands, or if you can't get to it with your hand, then you could use a lacrosse ball or a squash ball or in some cases a foam roller, but usually it's a ball because you need to get a bit more specific. And by just rubbing these points, you can make pain in other areas just go away. You can make back pain go away. You can make hip pain go away, knee pain, elbow pain, shoulder pain. Pretty cool. Did he mention the ancient chinese uh chakra system at all okay because the chakra system which founded the formation of acupuncture even though i don't

like acupuncture did focus on like centralized neuron paths paths and it did mention that there are multiple locus points on the body of which pain centralizes. So what he was talking about may actually be like the actual scientific interpretation of what the chakra system was trying to refer to. Interesting. I'll have to look into that. Interesting. Well, just to come quickly back on topic. So homeopathy, you would say, is that completely placebo if it does anything for anybody? Because what I've heard, not from a reliable source, so I kind of just put it in the shrug bucket, is that what you would buy at the grocery store, yeah, all of that stuff is if it does anything for you, it's just the placebo effect. But if you have an individual practitioner who knows what they're doing, quote unquote,

then that can actually produce an effect that could be replicated in scientific research, not just placebo effect. What are your thoughts? So I'll agree with what that source said. But before I get into that, I just want to say that homeopathy, if it's anything more than the placebo effect, it's an insult to all of dietary supplements. I hate homeopathy with a passion. Why? Because when you have something like mathematics, because mathematics is like the hardest of the hard sciences. And mathematics can literally predict the future if you have the right formula and apply it to the right situation. The issue is finding the right formula and apply it to the right situation. The issue is finding the right formula and applying it to the right situation,

which is a heck of a lot harder than you'd ever think it would be. But if you do that correctly, you can predict the future. That's how accurate mathematics is. Sociology, the softest of all sciences, it has one of my favorite sayings, which I learned from an actual PhD in sociology. If you think you know sociology, you're not a sociologist like there's just way too many unknown factors and biology is somewhere in the middle like if you can get a cellular system and you can predict even like 70 75 percent of what happens after drug therapy in that cell,

that's pretty good. There's no way you can predict 100%. There's always going to be some weird genetic monkey wrench born from stuff that we just don't understand about the cell. But we can get a pretty good prediction. So that's why biology has so many general rules of thumb and so few laws. But out of the laws, we do have one. The dose makes the poison. Basically, if you want a molecule to affect the body, the molecule needs to actually exist, and the molecule can affect more things

if there's more of that molecule. Homeopathy looks at this one rule we have and says, hey, let's reverse that. It literally takes the entire concept of pharmacy and says, lol, let's run in the opposite direction. And why is that? Just for anybody not familiar with the fundamental premise of homeopathy. Oh, I'm pretty sure homeopathy was just like a running gag between a bunch of guys saying, what's the stupidest thing we can make when they're like drinking? It's like, what if we just took pharmacy and reversed it? If they were to trick people, like that's the best explanation I can get. This involves then is using very, very small amounts of something that otherwise would be a problem. Yes. They believe that diluting a

molecule makes it stronger. And that is literally the opposite of the truth. I believe it's because the concept of hormesis, where a small dose of a toxin causes a positive effect, they took that, completely misinterpreted it, and then took it way too far because even when it comes to say like resveratrol and curcumin are both hormetic compounds they work via hormesis but we use like let's say in fortify 500 milligrams of curcumin because that is the hormetic dose like that is the dose of which the hormetic effects are strongest. If you dilute it even more, you don't get more hormetic effects. You get less. Even when it works via hormesis, there is an optimal dose.

You can't just keep on diluting something over and over and over again. But that's what homeopathy does. You can reduce your cost of goods a lot. Oh, yeah. It just increases the profit margin incredibly. So we've established that homeopathy is very profitable. Very profitable, very sketchy. And the only homeopathy that works is the stuff that sets this homeopathy when it actually

isn't. Which is when it really is just supplementation at that point. Yeah, exactly. But I remember seeing a homeopathic zinc lozenge with 15 milligrams of zinc. And I'm like, that's normal. That's just a supplement at that point. But anyways, what your source was saying, that it's better if you have a practitioner, that is technically true.

Because if homeopathy is only the placebo effect, a good practitioner with good social skills and good charisma charisma i guess is the best way to say it i think bedside manner is that the term perhaps although that i guess that's with doctors and sick people i don't know i have to actually yeah i like charisma because i can apply that to sure no no as it says bedside manner is just a doctor's approach or attitude yeah but anyone who uses homeopathy i refuse to call the doctor so charisma but they might have they might have a phd and then they say they're a doctor or they might be a chiropractor and they say they're yeah the only chiropractors i respect are those who are actually physiotherapists different discussion but uh basically yeah the whole

chiropractor stuff's like as long as they say like cracking your back like helps your back that's fine as soon as they say like it helps with the common cold. No. Yeah. I, you know, I actually haven't looked too much into chiropractic. Somebody I get asked about, I just haven't taken the time to really get into the literature. I go to a chiropractor every once in a while. If I'm in Florida, there's a guy I like to see. He's a nice guy and it feels kind of good. And that's it. I don't really put much more stock into it than that. And I have no problem with, I have friends who are chiropractors and as far as I know, they do a good job and they help people. So I have no problem with the work and with the field. What I don't like though, and it does seem to be chiropractors who do this the most,

and it does seem to be chiropractors who do this the most, is chiropractors who actually just try to mislead people into thinking they are medical doctors, they're MDs, because they know it's good marketing. They know that although the prestige of an MD has declined, and this has been shown in research, the last survey I saw in terms of like, on an individual level, who do you trust the most? My doctor is still number one. And so people still on the whole put a lot of give doctors a lot of credence. And so there are shady chiropractor marker guys and gals out there who know that and say, Oh, I'm Dr. So-and-so and they might even in their marketing pictures, I've seen them even wear the white coat and have the stethoscope. And they're really trying to make you think that they're an MD. That is not cool. And that often is chiropractors from what I've seen.

But as long as chiropractors stick to the whole back cracking and just making your body feel good, I'm totally okay with that. It's when they get into the uh unverifiable claims and be pretending to be someone that they're not as you just suggested but yeah like anyways uh have you ever looked into i don't want to get off on a tangent because it might make for a good podcast so if i'm asking have you ever looked into the whole muscle testing thing that chiropractors will use to see sometimes it's for to find the subluxations like okay where do we need to adjust and then other times it'll go as far as supplementation what supplements do you need how many do you need to take you know what i'm talking

about i vaguely do but i don't know much about that topic okay okay because like i've all the chiropractors i know were like kind of physiotherapists in a way. And all the supplements that they sold were quite literally just for osteoporotic women because that's who they were helping most. I see. So yeah, I have a pretty good experience with chiropractors. I go to a chiropractor now and then, and I've been to a few in particular who I really liked and it did feel good to get adjusted and i didn't put much more thought into it than that that's about it but anyways uh like back to the whole thing that i was saying earlier i like saying charisma because a lot of homeopaths

view as charlatans but if you have high charisma and you can convince people of something, you can maximize a placebo effect from any source. And that then opens the door to the justification that it's okay, right? Oh, well, I actually am helping people. Yeah, but I don't know. That's like a whole ethical rabbit hole. I know. The end justifies the means. I hate that saying so much.

Like, that's actually my... Do you mind if i go on a tangent there like yeah yeah well like because i was thinking like i mean i agree it's it's that is a very slippery slope and that line of thinking has been used to do a lot of very bad things throughout history and a very different discussion but i would say there are people in power today who i mean that's just a that's a rationalization it's just so easy it's so it's so cheap and it it can justify very evil actions that the person they will say until the end that it was for the best because like the way i view it is just when you think of any situation of where you say the end justifies the means,

it's only topics of grand design, such as politics, science, theocracy, theology, I should say, medicine, basically things that don't actually have an end. Something that does have an end would be, I go to the grocery store to get some cheese, because if I go to the grocery store to get some cheese, I just reach the end. But if I were to take an end justifies the means approach, I can't just say, oh, there's a traffic jam. Then I just cut through a park, run over three children. If the cops arrest me when I'm eating my cheese and I say, but bro, it's cheddar, they're not going to accept that. They're going to arrest me. Because in that case,

the end clearly doesn't justify the means. But should they, you know? I know. Or is that just... The cheese is the justification. I mean, it's just a social construct anyway. Yeah, the cheese is justification. But anyways,

so the only time you really say the end justifies the means are not for the minor issues of which there are an end, but the major issues of grand design of which there is no end. But couldn't you postulate an end? Couldn't you say, well, we're working toward, let's talk about, this would be in the realm of politics or just power and the development of civilization.

Say, hey, the end is this utopian state. And unfortunately, the only way to get there, the only viable way we can see to get there is to do things that some people would say are evil, but they just don't understand. They don't even have the intellectual or maybe the ethical capacity to understand that creation requires destruction and we are trying to minimize the destruction, but you have to destroy what's there to create something better. Yeah. But the thing is, whenever it comes to like stuff like this, at least when it comes to science, at least the closer you get to the end to the closer you realize it wasn't actually the end, but rather

there's just a checkpoint on the way to the end. So the closer you get to your end goal, you realize that that wasn't the end, that was just step one. And then you head to the next end and you realize that was just step two. And so you live your entire life aiming for this end of which doesn't actually exist. And so if you have the end justifies the means mentality and you never reach the end, where is the justification? There was none ever. But sometimes ends are reached, though. I mean, again, I don't want to get off on too long of a tangent.

This might make for an interesting and a separate episode. This is really just a philosophical discussion. With what I'm talking about, you could find in history quite a few examples of people who did achieve ends that were good. And they got there by doing things that many people it affected, you would say, yes, that was definitely a lot more good than bad, even though it did require doing some things that were questionable if you were to just be an absolutist in terms of morals. It is always good to do this. It is never good to do that and so forth you know yeah i do agree but what the situations that you bring up like i would have probably referred to those as the checkpoints because at the very least they were once thought to be ends so something was accomplished so the

checkpoint justifies the means i could agree with that okay all right to a degree it depends on nuances and all that stuff all the nitty-gritty that i really don't care for well you know just in case we have to join the new world order one day we have to have these things worked out for ourselves yeah oh yeah definitely that's going to be on the entry exam does the checkpoint justify the means the checkpoint justify the means anyway i like the tangent actually i like that. Anyway, I like the tangent, actually. I like the topic. It might be worth just doing an episode on that.

But to bring this back and to wrap up with the placebo effect, how did we even get to that point? I know we were talking about homeopathy and then chiropractic. Yeah, it was just the ethical component of. Ah, right, right, right. Of with homeopathy, right? Okay. Yeah, I understand that it really, if we're talking about, if we wanted to get into real science, it would be supplementation because that has good evidence behind it. But I am helping people,

therefore lying to them is okay. I'm with you in that I would disagree because I would say, well, why don't you just do something that's honest? Why don't you help people without lying to them? Have you thought about that? Because you can either help people by lying or help people by not lying. So you can either have two goods or one good and one bad that neutralize each other. It's like the choice is obvious. Yeah. And that would be a counter argument. Again, this isn't something I've thought too much about. So somebody who's more well-versed in philosophy might laugh at this, but that would be my instinctive response to the checkpoint justifies the means kind of thinking is, okay, yes, in theory, but are you telling me that that was the only way to get there? That you had to do all of these destructive things that you couldn't come up with any other means that was maybe less unpleasant for so many people.

Yeah, that's why I like the whole the means justify the ends because whether action being the most right that you can try. That kind of Jordan Peterson type of approach to living. And even if you fail at reaching the checkpoint, the life is still worth living. Totally. And before we head off into our weekend, let's quickly, because you mentioned acupuncture, and how much does the placebo effect factor into that? I'm not a huge fan of it. I mean, if it works, it works. What I can tell most of it is placebo, but at the same time, there does seem to be some benefit maybe because a lot of the acupuncture studies, reliable is not the best uh way to describe them they're really over the map i'd say the majority of them do say that it's you know not different from placebo which is what you would expect if the majority of the benefit is from placebo

yeah but even then uh the degree of from placebo and the degree of potentially actual benefits like that aren't placebo, it seems to change. And you mentioned earlier what Paul Ingram said about those locus points on the body where like pain centralizes. I think that might be related, but I don't really know too much about that because i only know about like the chakra system from traditional chinese medicine i didn't actually know that there is a modern day equivalent or potentially equivalent to that so you're gonna have to look into that and see if there is a connection between the two but and in and in paul's case he was just saying you can just rub these things you don't have to get someone to stick needles in them yeah like if you can rub them like by yourself then that

saves a lot of money i mean if you want to have needles stuck in you to like some like relaxing or who music and like incense floating in the air is someone just like just poke and you're wondering if like any of the needles happen to be poisoned with opioids like who knows like you could do that if you want but i don't know like i don't want to completely discount it out of hand but at the same time i'm not going to go around praising it in any way so i'm i'm keeping it on the back burner for now and i also do have to mention that a lot of pain scientists and physiotherapists that I follow, acupuncture is like their trigger word, where if you just

say acupuncture, they just come out of the woodworks like, oh, you said the bad word. I'm pretty sure I'm just going to defer to the experts on this one. Apparently, it's not good. I like it. It's like saying homeopathy three times while staring into the mirror i'll just appear with a knife it's like the bloody mary of supplements maybe that's what your afterlife is going to hold for you maybe you'll have a chance to actually uh

bloody frank yeah to haunt your enemies until you get bored of that. And then maybe you'll have to re-roll, restart. All right, man. Well, this was a great discussion. Very informative. Thanks for taking the time. And I look forward to our next, whatever it's going to be, we'll figure out something. Yeah. Looking forward to it as well. All right. Well, that's it for today's episode. I hope you found it interesting and helpful. And if you did, and you don't mind doing me a favor, could you please leave a quick review for the podcast on iTunes or wherever you are listening from? Because those reviews not only convince people that they should check out the show. They also increase the search visibility and help more

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