Radiolab - Placebo

Episode Date: May 17, 2007

With new research demonstrating the startling power of the placebo effect, this hour of Radiolab examines the chemical consequences of belief and imagination.

You're listening to Radio Lab. From New York Public Radio. Public Radio. W.N.Y.C. And NPR. I'm Chad, I'm Omrod. And I'm Robert Krollwich. And this is Radio Lab, season three.

Let me start with a story. Okay. 1893, an anthropologist Franz Boas goes to the woods of British Columbia. He has a giant wax cylinder recorder with him. And he records this guy singing a healing song. And who's this? This gentleman is an Indian from the Kwakudal tribe, and his name, we're told, is Kuselid.

Or Kessalit. I've always pronounced Kesselid. I don't know. I'm not quite sure how it would be pronounced in Kwokuta. It's Daniel Mormon. He's an anthropologist. He's written a lot about Kesselid because it's a neat story. And it goes like this.

The young Kesselid begins as a skeptic. He was skeptical about the activities of the The shaman, he thought they were tricking people in some way. The shaman are the village healers, very, very powerful men. They were scary men. And he'd see them doing these dramatic healing rituals. And he thought they were full of it. And so he decided to go undercover.

One day, Kessel approached some of these shaman and asks if he can apprentice with them. Yeah, there's three or four of them taking them out into the woods into a clearing or something, and they tell a bunch of things. And they taught him the songs. And he learned that stuff. And eventually, after he'd gained their trust a little, they taught him their best trick of all. The trick that's widespread in the world of shamanism, where you find variations on it all over the world. Here's what you do, they told him.

Get some feathers, some down feathers and just tuck it in your cheek, right? Just stick it in your mouth. Secretly. So that nobody knew that it was there. Then during the ritual, let's say the patient is there, they're on the ground, maybe their chest hurts, you lean down. Literally, get down and put your mouth on the patient's chest. And suck. And here's the last step.

sucking, you bite the inside of your cheek to get some blood in there, which mixes with the feathers. Then, at the pivotal point, you throw your head back and cough out the feathers, which were now bloody and nasty. So you end up with this bit of bloody down in the palm of your hand, which you would then say is the disease which you have sucked out of the body of the patient. Kessel had learned all this and thought, I knew it. Those liars! The problem was that part of the obligation of his apprenticeship, was that whenever anybody asked, he had to go and treat them for free. That was sort of part of the deal of being an apprentice. And somebody from a famous family called him to come and treat a daughter who was sick. Very sick, according to the written account. And so he went to see this family and he treated the girl and he went through the songs that he sang. And then he did the feather trick, which he knew was false. He put the feathers in his mouth, bit the inside of his cheek, pretended to suck, cough the whole thing out. And lo and behold, she was healed.

She was fine. She was... Fine, fine? Yeah, it was a great success. Wow, and what do he think? Well, he clearly indicates a kind of ambiguity. He knows that he was tricking her, but he also knows that she's better. Not convinced.

Kessler tries the trick again and again and again, and every time he does it, it works. So at the end of the story, he decides to become a healer. Does that mean that he ends up believing in the lie that he set out to disprove? I think that he realizes that truth and lies are not that fundamentally different as we might think they are. Today on Radio Lab, we look at that. The true healing power of lies, which in medicine we call the placebo effect. No, no, we don't. What do you mean? No, we don't.

Well, it's actually called placebo, plecabo. Who calls it that? Latin scholars, I think. I mean, it's a Latin word. Lecebo was originally a Latin word. Why, you call it the plecebo effect? I'm going to try and figure out how it works. I'm going to tell some stories, including one about a dramatically dressed gentleman.

He dressed entirely in purple or maybe it was lilac, who used a placebo effect to make the ladies feel real good. That's all coming up on Radio Lab. Dr. Benedetti? Yes. Can you hear me? I am Fabrizio Benedetti, but I cannot hear anything. We have a little trouble with the phone connection.

Fabricio Benedetti is a doctor at the Turin Medical Center in Italy, and he's one of the most expert. Experts on the placebo effect. Better? Yeah, now I can hear you. So we thought we'd start with him. He's been studying the placebo effect for about 15 years. Yes, I got interested in the placebo effect because I realized that sometimes the placebo group gets much better than the active treatment group.

Much, much better? Yeah, sometimes, sometimes. For what kind of stuff? Well, he saw it first in pain. Pain? Pain. Pain? Pain trials. Oh. And then he saw it in depression.

Depression. As in antidepressants, right? And then digestion. Immune response. All of these places where placebos were doing things, they just were not supposed to do. Yeah, it's really amazing. Particularly for some conditions like... And this one's a little surprising.

Parkinson's disease. Serious neurological disorder. People with Parkinson's have shakes, they have tremors. Dr. Benedetti treats a lot of these folks. And in the really bad cases, the only treatment that really seems to work. at all is surgery. So this patient, you open up the patient's skull and implant a little stimulator deep into their brain.

Deep into the brain in two brain regions. Essentially what that does is it hot wires the parts of the brain that aren't working. And when you do that, you turn the stimulator on, the shakes go away. It's a real treatment. Yes. So we can switch the stimulator on or off, and the patient does know that the stimulator is on or off. And that is where the trickery comes in.

In one experiment, he stood in front of his patient with the stimulator and said, Now we are going to switch your stimulator on. Except he didn't. Of course, of course. It is a sham turning on. He only pretended to turn it on, but that's the weird thing. It didn't matter. Pretending to turn it on work just as well as turning it on for real.

The tremors disappeared. Really? He even has a video of this where he's with a Parkinson's patient, and he says those words. Now we are going to switch your stimulator on. Which is a lie, by the way. Yeah, but it doesn't matter, because what you see on the video screen is a shaking hand go completely still. Yeah, that's correct.

In a few seconds, you see that there is dramatic improvement in motor performance, even though the stimulator is still off. Just from words. And this is an equivalency? The lie is as good as the medicine? For a while. What do you mean for a while? Coming out of the gate, a placebo seems to be 100% as effective as, say, a real Parkinson's drug.

But it lasts only about 25% the duration of the actual drug. Still, it's just words. Come on, words are cheap. Yeah, your words are cheaper than... Word overstatement. 25%? That is so different from 100%. I never said it was 100%.

You did, too. I didn't... Roll the tape back. What's wrong with you? The fact that it happens at all, that word... That's what we're talking about. Words can be as effective as surgery. Doesn't that want, doesn't that intrigue you? Don't you want to know how that works? Yes, actually. I do. How does it work? We have no idea. But for the first time, we can see it.

See what? Well, see it in action. See the placebo effect in action. Oh. Testing, testing. Dr. Benadetti referred us to a guy actually right here in New York. In New York, probably you have took it with Torwega. No. Should we? Yes. Tor Wager, are you?

Hi, Tor Wager. Hey, how are you? Tor Wager, he's a very good neuroimager. You should introduce yourself. Okay, I'm Tor Wager. I'm assistant professor of psychology at Columbia University. Here's what Tor Wager does. He puts subjects in the brain scanner, puts a hot pad on their arm, like I'm doing to you right now.

So that's very, yes. Right? We'll give them these pulses of heat. And then he'll give you some pain relief cream. This cream here? A cream. that we tell you is lydicane. We say, this is going to be really effective.

This is going to block pain. It's going to take away the pain. Really, it's just Vaseline. But you don't know that. I'm having a hard time playing this role. In any case, right as you're putting on this fake cream and feeling better, having a placebo effect, in other words, he takes a picture of your brain.

So, I have many things I can show you. Come on to our show it. He does. He shows me one on his computer. It's very pretty. Now we have a brain in front of us. A brain scan of a person right in the middle of being placebo.

meaning that they've just been given the placebo cream, and now they're expecting to feel better. Those expectations... The placebo expectations... First of all, they seem to start here... ...in your forehead. Kind of on the sides of your forehead above your temples. When you believe that you're going to feel better,

the belief seems to live kind of near your temples. But then, once that belief is there, it seems to turn on. Turn on this... This other part. The midbrain. He points to it on the screen. It's a little nugget deep in the center of the brain. What's important about this area is that it's one of the major centers for the production of opioids in the brain.

Oh, opioids, like opium. Yes. Yeah. Right. Like opium? Opium, as in. Chad? What?

The greatest pain killer known to man. There it was. Inside our heads. Isn't that strike you as weird, by the way, that stuff actually is inside our heads? I can't get over that. That these illicit substances are actually inside us. Right. Well, you know, there's kind of a nice thing.

story about that. And here is where Torb blows my mind right out my face. Because it explains that every drug out there in the world, every single one, even the ones you see on TV, are in a sense already inside our heads. Your brain must have its own internal chemical. The only reason those drugs work, he says, is because our brain has receptors for them. And why would it have those receptors? Because it can already make them in-house. Every pharmacological agent or drug that there is, you know, there is a chemical that's produced by your own brain that essentially does that thing. That's so weird.

It's like an internal pharmacy in there. It's just stocked full of drugs. And we just have to figure out how to unlock it in a way. We have a sort of, as you said, internal pharmacy, but we don't know why sometimes it does not work. What? What does that mean? Well, what he means is that the placebo effect,

though it can be incredibly powerful, it's rarely consistent. It's hard to produce. who's going to get a placebo effect under what circumstances. But just imagine if we could figure this out. We could have all the drugs we ever need without those nasty side effects. Oh, yes, absolutely, yes. We are working a lot with drug companies in this direction.

What Dr. Benedetti is looking at now, which could be huge for patients with chronic pain, is to take a toxic drug like morphine and gradually replace it with a placebo substitute. So say on Monday he would give you some morphine, and then on Tuesday, slip in a placebo. You give morphine again on Wednesday and a placebo on Thursday and so forth. In the long run, you can have a reduction of morphine by 50%. Aha. And perhaps one day, I'm sorry I can't contain my enthusiasm.

We won't need drugs at all. Maybe one day we'll have a little box that I can plug directly into my midbrain, and I can just spend all day hitting the joy button. Joy, joy, joy, joy. Joy, joy, joy. Joy, joy. Oh, sorry about that. Well, while we're waiting for your glorious drug-soaked future, you can do it much more simply by simply telling a story.

I'll tell you a story about telling stories. How about that? I have no idea what you're talking about. All right, well, let me start. It's a story I learned from Daniel Carr. Daniel B. Carr, MD. He told me about a guy who's really the father. of placebo research. His name is Henry. Henry, unangst. Unangst. Unangst. Unangst is his

original name. German, as Dr. Carr will tell you. Which, given the poor quality of my German, I would roughly scan as meaning anti-anxiety or perhaps anti-pain. This may be one of those cases where the name shapes the man. It may well be. It may well be. Because even though he ends up changing his name? To be sure. Henry Knowles Beecher. He does go into medicine to become a doctor. And then during World War II, he joined the army as a doctor and found himself to the great battle of Anzio,

where the Americans landed in Nazi Europe. And he was right there. He was on the beach. Bullets were flying. Soldiers were being killed, and some were being wounded. And since Beecher was the doctor, it was his job to treat them.

That's correct. The treatment at that time for pain, as it still is nowadays, was morphine. One problem, though. Beecher's division was cut off from supplies and reinforcements, and he began to run low on morphine. He had to figure out which soldiers needed it the most. And he's talking to them, and he's asking them about how much pain they're actually having. This is Scott Podoski, who's a doctor and a historian.

And he would go up to these patients and say to them... Soldier? Yes. As you lie there. As you lie there, are you having any pain? Are you having any pain? Quote unquote. So imagine, Jed, you're a soldier. You're lying there with shrapnel stuck in your gut.

These were severe injuries. And you haven't had any morphine for, I don't know. We've seen seven hours previously. Yeah, seven hours. So what would you say? Well, I'd say, give me some morphine. I'm in pain. Well, you want to know something?

The striking finding was that in 75% of them, they'd say... No. No. No, Doc. I'm okay. I don't need any morphine right now. Three quarters of them, said that. Wow. This didn't make a whole lot of sense to be sure because he knew about pain.

Before the war, he ran a clinic in Boston, so he would see people with bullet injuries and gun injuries, more or less the same kind of injuries he saw in the battlefield. But back in Boston, Doc. They really hurt. Did I have more morphine, please? Nurse. For some strange reason, says Daniel Kler. The intensity of the pain associated with being shot was lower in the battlefield than in civilian life. What could explain that?

You know, maybe soldiers are just, they're tough guys. They don't, they suck it up. They don't like... Well, no. No. Context. That was Beecher's very simple explanation. Context. Context. Meaning that the pain that you feel when you're hit by a bullet, it's not just about the bullet.

It's just as much about the story that comes with the bullet. So consider these two different stories. Story number one, you are a soldier and you've been shot. As the bullet passes through you, The first thing you think is... Oh, man, I'm shot. The second thing you think is... Wait a second. I'm alive.

If I can be evacuated from here, I'll have a period of recuperation. They'll take me to a hospital. There'll be nurses there. I may get a medal. And a pension. A bonus. I'll certainly be a claim. They'll send me home. Throw me a parade.

I'll be a hero. Now consider the civilian story. This time you're a regular guy, civilian in Boston. Maybe you own a shop. Can I help you, sir? This is a stick-up. Give me your money. Oh, my God, no.

And you've been shot. As the bullet passes through you, this time, the thoughts flashing to your head have nothing to do with glory. That's right. Instead, you think, yeah, I'm alive, but what's going to happen to me now? You wouldn't get a medal.

You were in trouble. How am I going to pay the doctor bills? Going to be out of commission. I'm going to lose my job. How do I pay the rent? And if your family was depending upon you, they suffered. Nothing good is going to come of this. One bullet, two, very.

very different stories. And it's the difference in the stories, said Dr. Beecher, that explains the difference in the experience of pain. Those stories you're saying are somehow filtering the pain even before it's felt? Yeah.

That even as the bullet enters the skin right away, within seconds thereafter, you spin yourself a story about what's going to happen to you next, not consciously, but way down deep in your head. And the story you tell, that makes all the difference. Scientists currently view

Our whole identity as something that we construct one fraction of a second to another. You are the unfolding of an ongoing narrative. But it's not just a narrative in words. It's a narrative that involves touch, color, odors. We use all those inputs to generate the next frame from the last frame. Well, if that's true, let me talk for a second about color. He just mentioned color, right? Daniel Mormon told me something really interesting

about color and pills. Cool colored pills, blue pills or purple pills, as placebos, make better sleeping tablets than yellow or red pills, which tend to wake people up. That's been shown? Oh yeah, yeah, yeah, yeah. Okay, take two pills that are the same. He says, color one blue, color the other red,

and the people that take the blue pill will sleep longer, they will sleep better than the people who took the red. This has been shown, he says, all over the world, except, and here's the cool part, except in Italy. Italy? Yep. In Italy, blue sleeping tablets have the paradoxical effect of being sleep-inducing for women but not for men.

What? How does that work? Well, I'm not really sure, but my speculation is that the Italian national football team is called Ajouri, which is blue. And so what blue evokes in an Italian man is the World Cup and soccer and screaming and hollering. And it's hardly. something that's likely to put them to sleep. Whereas by contrast, blue for Italian women?

The color of the Virgin. Oh. The Virgin is, of course, always presented in blue. And the Virgin is a very comforting and protective figure for women in Italian culture. Language and meaning

are the most crucial dimensions of our lives. This is Radio Lab. I'm Chad Epamrod. Robert Carlwich and I will continue in a moment. This is Jennifer from Tampa. Radio Lab is supported in part by the National Science Foundation and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at www.sloan.org.

This is Radio Lab. I'm Chad Abumran. And I'm Robert Crillwich. In this hour, we've been talking about the placebo effect. Yes, about the power of belief and suggestion. And thus far, we've looked at it from the perspective of the patient. Certainly the doctor has a role to play in all of this. And so I have a story to tell you. 5-4-3-2-1-0. It happens to be about a doctor.

Yeah, I'm Dr. Albert Mason. I was trained in medicine and guys' hospital. Back in the 1950s, Albert Mason was delivering babies at a hospital in London. He was a young guy and anesthesiologist. And he was looking for a new way to anesthetize his patients, the moms. Something may be safer than drugs. And one day, he ran across a board. about medical hypnosis.

Medical hypnosis. And I just read the technique and tried it out on some friends. And under what circumstances? Like, you would put a watch and have it swing back and forth, left and right? No, no, I just lay them down on a couch and say, now I want you to let your whole body go loose, let your arms go loose, let your legs go loose. And it worked on some people and not on others.

But the more he practiced, the better he got, you know, putting his friends under. to a trance state, getting them to remember stuff from their fifth birthday, and all sorts of games that we played as medical students. And so we took this little party trick into the delivery room and it worked. That's right. I delivered about 20 babies under hypnosis. And the moment you start to do hypnosis, you start to get a reputation as being somebody who has power. Well, I would think you'd get two reputations. The patients might think you have power and the doctors might think you're a quack. Well, both of those are true. But at that time, it was kind of fun.

Because the hospital administrators were kind of curious about this young doctor slash hypnotist. Maybe he was on to something. Who knows? So they started to send him all kinds of patients. Skin disorders, asthma. And he'd hypnotize them, which led to a weird little discovery. Of all things that hypnosis might help, the one that seemed to work the best was warts. Warts?

Warts? To my delight, I found that if you hypnotize them and told them that the warts, that the warts would go, they went in a certain number of cases. Let's fast forward a little bit. Dr. Mason is treating lots of these warts patients, and things are going pretty well. And one day, a young boy came to this hospital. He was wheeled in on a gurney, and the first thing I saw was his arm. I could have dropped through the floor, because this wasn't a dozen warts.

This was millions. This was the entire surface of the skin. It cracked and got infected, and his life was impossible. He couldn't go to school because he smelt. Now, I don't know if you've ever seen the photographs of this boy. Just check this out. Look at this picture here. Oh, my God.

He looks like he has a black hide over his whole body. It looked like an elephant skin. That's what it looked like. So they take this poor boy to surgery. The surgeon, a man called Jerry Moore, was trying to graft. healthy skin onto the hands. And when I saw this skin, I said to Mr. Moore, why don't you treat him by hypnosis? And he looked at me and he said, well, why don't you? And he walked out. Was he's, why don't you in despair or in contempt? I think a mixture of both. And by the way, when you

asked that question, you're the kid asking the senior practitioners. So I was cheeky. Yeah, you We're all cheeky. So there's Albert Mason, cheeky, alone with his boy with a million warts, and Albert asks him, do you mind if I hypnotize him? And this kid who was 15 said, okay. Didn't you have to tell the parents? Um, no. Couldn't have got away with it today, could I?

So I hypnotized this kid. I told him the warts on your right arm will shrivel up and die, and new skin will grow. And why did you choose the right arm? Oh, I had to start somewhere, and I sent him away. He came back in a week, and one arm was clear. Totally clear. I mean, imagine this.

The left arm is black and scaly, like, you know, elephant skin. And the right arm is totally normal. Totally normal looking? Yes. Well, here's the phone. Come on. Look, this knows a real farrow. This is verifiable.

It looked like a normal skin, but rather pinker than usual, slightly pink. slightly pink and soft and supple. Whoa. This is for real? Yes. It's like all those thousands and thousands of warts that covered the right arm. I guess they just fell off. And what were you thinking when you first saw it?

I was thinking, how wonderful. I was thinking, oh, wait till Mr. Moore sees this. So he takes the boy, he runs down the hall to the operating room. When Mr. Moore is in the middle of an operation, he takes the boy up to the big, you know, the glass window. And I held up both his arms. One black and scaly, the other, pink and raw. And Moore put down his scalpel.

He came out of the theater, and he looked and he said, my God, look at that. And I said, well, I told you, Warts could go. And he looked at me pityingly. He said, this isn't Warts. This is congenital ichthyozoform erythrodomia of bro. Well, now, for those of us who are, uninitiated, what is Romodermin? Naba-gabidabidacteosis.

It's a hopeless condition, never been known to change. The surgeon informed Albert Mason that he had just hypnotized away a condition that never once in medical history had been known to go away for any reason whatever. So he says, we're going to take him to the Royal Society of Medicine to show him to all the dermatologists in London. gentlemen, please make more seats. So Moore took me up there with the boy. Thank you, Dr. Moore, and to the Royal Society for this opportunity.

And I demonstrated, first of all, I demonstrated how to hypnotize him. Hypnosis is quite easily achieved. You simply lie the patient down and say, now I want you to let your whole body go loose, let your arms go loose, let your legs go loose. And then I showed his arm. Please, sir, if you don't mind, raise both arms. They were staggered.

In fact, the president, Gentlemen, this is absurd. He said that it's inconceivable that this gets well because... We all know that congenital ichthyosis is incurable. That was the exact word he used. Incurable. Incurable. Incurable.

Incurable. And the thing was, since all this took place at a hospital, every stage of it was documented. There are photographs every step along the way, before shots, after shots, close-ups, all available. two reporters, you can imagine what happened. It was picked up in every newspaper, Time magazine. Big media story. In fact, the first I heard about it, I was in bed one morning, a year after I'd sent the paper in for publication. And the phone rang, and a voice said, this is Wipsnade Zoo.

We have an elephant with a skin like a little boy. Can you cure him? And I thought, what the hell are you talking about? And then the phone started to ring and ring and ring. and hundreds of calls, hundreds of letters came in from all over the world. And I had people coming in with the most terrifying illnesses wanting to be cured. Especially people with that very rare skin condition. Congenital, Ixie, whatever it's called?

Yes. They flock to him from all over the world. And now here's where the story takes a turn. He would see these patients. He would hypnotize each one, one at a time, and then send them away hoping, of course, that they'd get better. And they would come back a week later. And none of the others ever got well.

At all? No. Not in any way. No improvement. I've spent the rest of my life trying to understand this phenomenon because I gave up anesthesia. Just a few years later, Albert Mason quit medicine and he decided to become a psychiatrist. He wanted to understand why he had the touch the first time and why after that it just didn't work. So the central question in your mind was,

not what happened to the kid, but what happened to me? That's right. That's right. And what do you think the answer to that is? Well, there is a condition called infantile omnipotence that we all suffer from when we're kids. We think we can do anything. Unconsciously, I knew this was incurable. Wait, wait, wait, wait, wait a second.

Because incurable would mean that it had never been cured. That's right. You had just created an exception. So, look, when you're 25 and the president of the Royal Society of Medicine tells you it's incurable, it has an effect. That's his best guess. He thinks that that word, incurable, changed him just a little bit. I lost my crazy confidence, even though I had the evidence, but it didn't work.

Confidence is a hard thing to measure. You can't put it on a scale. You can't weigh it, but you can sense it because it's conveyed in a million little ways how you stand, whether you look your patient in the eye, when you pause, where you pause, what you say, what you don't say. All these things are like signals. They say to the patient, they murmur to the patient, I can help you. I can do this. You know, you go to a doctor.

You've got this horrible rash all over you, and he says, oh, that's erythraithema multiforme. And you feel better immediately. because he's named it. Well, all he's said is many red spots in Latin. But the thing is that he knows what it is. And you feel that, oh, he knows, now I'll be okay. Because when you're feeling terrible, what you just want to do is hand over the authority for your situation

to someone else who's got information now. And who's going to tell you you're going to be fine. And maybe that comes from early childhood when it seems to us that our parents have that capacity. Harvard historian Anne Harrington. I have a two-year-old, and we're already now at the stage where, you know, he gets a little bump and he comes to me and holds the bit of his body out that's been hurt, and I kiss it, and it's okay.

And there is a way that mommy's kiss is kind of a placebo effect. Testing, testing. And now imagine that you're sick. You know, when you're sick, there's a strong impulse to come. kind of revert back to that way of interacting with people. Yeah, say something just to get it. Shubed Duck. That's Arabic for what do you want.

Hi, Chad. How are you? I'm good, Dad. How are you? I'm doing very well. This is my dad. Do you see how your voice goes on this thing? He's the guy I'm at bring my boo-boos to as a kid.

Tell me what you do. Actually, I still do. Like your title and that kind of thing. Because he happens to be a doctor. I'm the chairman of the Department of Surgery at Vanderbilt. Vanderbilt is in. Nashville. Tennessee. Where we grew up for much of our life.

Where you grew up for much of your life. Okay, so my dad had no idea why I wanted to follow him around the hospital. I didn't exactly lead with the whole placebo thing. The truth is, I feel okay about that, because this show isn't really about lying. It's about healing, a healing process, which doesn't happen in a vacuum. Patient, of course, has to believe in the cure, but the doctor has to create that belief. Okay, wait, you have to walk slower. I can't walk slowly.

How does he do that? Tell me where we're going now. We're going to the clinic. Be more specific. What happens at the clinic? I have patients scheduled to come to see me today. These days, my dad's hair is his white as his white doctor coat. But he still sees patients every Wednesday.

Today I have four patients. And that is why I'm here. 1 p.m. clinic begins. In the clinic. And as if to illustrate Anne Harrington's basic point. When you're sick, there's a strong influence. to kind of revert back to that way of interacting with people. As soon as my dad's first patient shows up, a hairstylist from Murphysboro, Tennessee,

when she walks down the busy hallway and sees him, as soon as she sees him, she bursts into tears. He gives her hug. Every time I see him, it's kind of like I have to be strong, and I feel like when I see him, I can let it down. because I know that he's going to hug me and make me feel better. I'm a single parent, and I own my own business, and I've always been in survival mode, and I've always had to be strong,

and so that's why this has been so hard for me. They go into a tiny exam room, which is quiet and super intimate compared to the hallway. Dad has Megan to sit on a table. Lift up. And he gently presses two fingers to her neck. Swaddle a little bit. There's a tiny gland in her neck that should be the size of a pea.

But over the past four years, it's gotten bigger. And bigger. Wide and two and a half inches in the other direction. Now it's the size of a golf ball and it presses against her airways. You know, at night sometimes I wake up and I'm, you know, and I think, oh God, should I call 911? And I keep asking him every week, are you sure I'm not going to choke? It's not going to choke me. It's not going to choke me.

It is not going to choke me. Just him reassuring me. It's not going to affect the airway. I try to remember the little things that he says to me when I'm, especially in the middle of the night, when I start feeling anxious or panicking. In the meantime, how do I deal with the anxiety that are surrounding this thing? Because I've got... Patients are anxious.

I'm having lots of anxiety, but I don't know... We're going to... ... scared of the unknown. Part of that is worrying about the future, I think, just because of the future, I think, just because of the... I think, just because I... It's nothing to worry, Megan. Well, I know, but I guess it's just because of my personal responsibilities. I'll work with you.

You got to put them at ease. There is nothing life-threatening today. You have to put them at ease. I'm going to give you a short-term plan and a longer term. If medicine were just science, then all of this talk would be just noise. Because the real business would then happen in the next room where there's this big machine ready to scan Megan's thyroid. But medicine isn't purely science.

Yeah, I mean... Which my dad admits. It's an art. It's communication. Which is why he and Megan talk and talk and talk and talk for over an hour. In a way, it's a kind of negotiation. She wants to know one thing. What if my thyroid has gotten bigger?

What if I have to have radiation? Well, I have to quit my job. He needs her to focus on anything but the what ifs. To stay focused on what they do know, which, unfortunately, is that they won't know anything for another day. They'll draw the blood today and... or not, I know it within 24 hours. Okay. I need to know the size of that thyroid plant.

Somehow, in the end, despite all the open questions, he gets there to relax. We're going to work together. We're going to work together. Well, you can't stop going out of town so much. It's really inconvenient for me. How much performance is in it? What do you mean performance?

How much of doctoring is having to play a certain role that the patient needs at that moment? It's just about every bit of it. So if I were to call it theater, would that offend you or no? It's not a theater. It is, I'm living that role. It's part of me. It's not part of a fake image that I'm projecting.

I think you know what I'm trying to get at. No? You call it theater. You can call it theater. I just mean that when you don't have the white coat on, and you're not like in doctor mode. You know, you don't have all the answers. You don't.

And I don't have all the answers then. But you seem to. No. That's what I really wanted to know. That magic pixie dust called certainty. How do you project that? Instantly to a patient, the moment you walk into a room, even when the patient hits you with questions like,

Doc, am I going to make it? It can seem kind of mystical, that aura. But then again, there are the props. You have to tell me what you're doing now. What is this? For instance, to rewind a moment, here we are before clinic in my dad's office, and he's just opened up his little coat closet. Putting my coat on. Then I usually, on the day of the clinic, I choose a clean white coat. Really?

Yeah. Do you have many to choose from? I have one, two, three, four, five. Five. Five blindingly white white coats. He flips through them, picks the whitest of the bunch, puts it on, and I swear to you, even now, when I'm older, supposedly wise to these kinds of these coats. kinds of things. It's like he changes somehow. Do you ever go to see patients without your white cut on? I don't like to look. It's almost like you're naked without it. You do seem taller

with it on. I do? Yeah. There is inherent power in the props, especially the coat, and if you have any doubt, the doctors don't know this, go to a med school, any med school on the day the new students arrive, and you'll probably find something like this. Excuse me, if we could all have a seat, we'll start the ceremony. The White Coat Ceremony. Thank you. It's as close to religious ritual as you can get in medicine, and in fact, the one that we attended at Columbia University in New York.

I asked the students to please stand with me. Included a chaplain. As you are able, let us pray together. Compassionate God, bless these new medical students of the Columbia University College of Physician Insurgents, and bless the white coats that they receive. today. May these white coats be for each student, a cloak of compassion, a clear statement of purpose, a sign of assurance, and a symbol of respect. The ceremony, we pray for the strength and for

at times has some almost spiritual component. It's quite moving, I think, I hope you'll find. That's Arnold and Sandra Gold. They began the white coat ceremony at Columbia almost 20 years ago. be with each student. And they were in the audience the day we were there, along with about 250 students in their families. First, each student is cloaked individually and called by name. Eric J. Arias, James, J. Atra. They then return to their seats,

and we see this visual transformation that occurs. This is a change that you can actually see. These people come into this room with their coats on their arm, and they're wearing blue and black and green and yellow. and that's who they are. And you see the room filling up in white, and they see the room filling up in white. Alexandra, Jay Borst.

And you know, in the old days, doctors wore black. It's true. A hundred years ago, doctors wore Gothic black coats, but then someone discovered germs and had the insight that germs live in dirt. And because you couldn't see dirt on black. Coats had to be white. They changed for antiseptic reasons.

And that is when a certain symbolism took hold. When you think about angels, they're never in red. They're never in black. Please turn around to face the audience, and I present to you the class of 2010. Radio Lab will continue in a moment. Hi, I'm Marley Duncan from Brooklyn, New York. Radio Lab is supported in part by the National Science Foundation and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at www. www. Sloan.org.

Bye! This is Radio Lab. I'm Chad Eppermott. And I'm Robert Krollwitch. Today we are talking about the placebo effect, the power of suggestion. We're looking at a lot of new research. I don't know what's new research. Well, it is new research, but the problem has been with us for centuries. Even at the very beginning of the age of reason,

Let me take you back. 18th century, the Enlightenment was in full swing. There was change in the air. Voltaire was denouncing the church. The Babel is mad. Ben Franklin was flying kite. Electricity. LeVoisier was inventing chemistry.

It was the beginning of modern times. Modern science, you might say, reason, inquiry. People were re-examining the big questions. How does the world work? What possibly could hold? everything together. And this was new. Well, you have to understand that in earlier historical moments,

the unification of the universe was not a problem because it was God that unified everything, and everything was a manifestation of God. That's Ed Cohen talking about God. He's a historian. But if God isn't the glue that holds the universe together... Then what does hold the world together? Enter Antoine Mesmer.

Who? Antoine Mesmer. Have you ever said, you mesmerize me, My darling, if I said that? I've said things like that. No, the word mesmer or mesmerization comes from Anton Mismore. He's a real historical figure. So he's part of our narrative.

Oh, get out of my way. I'll go to the rest of the story. So! In 1778, he moves to Paris, and he has a theory. He believed that the world was filled with a kind of fluid that moved through all living things. And he gave it his own kind of sexy name. Animal magnetism. Or, as they say in the French, magnetism, animal.

Right. And as this force flowed through all of life, occasionally it would get stuck, like in a traffic jam. It would bunch up. Right. And that is also, the bunching up can also be a cause of a problem. That's what he thought being sick was, blocking the flow. Our restrictions in the flow of animal magnetism in the organism. I mean, not that dissimilar to the way that we understand traditional Chinese medicine.

You know, like chi with the needles and the acupuncture. Mesmer thought this life force, when it got stuck, could be released with a, little help. From needles? No, no. This approach was a lot more theatrical. He created a kind of salon.

I actually think of it as a prototype for the idea of a happening in the 60s. That's the way I like to think of it. You know, it's sort of like everybody kind of came in and there was this like music playing. There was like dim lighting. And he would walk around in his lovely purple suit.

And he had a little... Purple? Yeah, I think he was a lilac, was I believe, actually, the shade that was reported. And then he would go over to a particular client. Usually it was a woman. Most of his clients were women.

He would... Madame. Sit across from them, and their knees would touch. Your magnetism, animal. It is... How do you say? Enpeche? Oh, no!

And then to unblock this flow, he would stare into her eyes. Stare. Right. And if he... If he unjammed you, how would you know? Oh, because you... She would have a healing crisis.

What was that? Simple, they would scream, they would vibrate. He had actually a padded room where the ladies could go and loosen their corsets and fling themselves about and bang their heads against the wall and do whatever they needed to do in order to kind of release the damned up energy. It was apparently quite dramatic. By the looks of it, they were real seizures, and people said they felt better after So words spread, and soon he had disciples, and then more disciples.

It had a lot of popularity, yes, it did. So he did what any businessman would do. He franchised it. He branched out, and I mean this literally. He magnetized trees. Trees had what? Mezmer, or sometimes his assistance, would take two magnetized iron rods, touch them to a tree in the forest, and that would transfer the magnetism to the tree.

The tree would then have the kind of therapeutic. powers that a mesmerist would have. How convenient. That's Anne Harrington, a Harvard historian. And this was quite efficient because then you could sort of have the trees do part of the work for you. So imagine if you will, lots and lots of people gathered around a tree, touching each other and the tree and allowing the flow to move through them, then they would all have fits together. And the problem was the doctors of the time, who used to have all these people as their patients, were now losing patients and money. So they protested to the king. The king established a commission.

And actually, one of the members of that commission was Benjamin Franklin, who at the time was the ambassador to France. And there were other important scientists on the team. Majot, Salin, Darcy, Le Voisier, guillotine was one of them. Is that the guillotine we know from the... Right. So we're talking here about a major, major league panel. These were big guys, big names.

And they devised a series of experiments to test for magnetic force. They weren't concerned whether or not animal magnetism worked. They were concerned whether or not animal magnetism existed. Because they figured, you know, it couldn't work, even though it may not exist. And one of the most dramatic tests that they devised is sometimes identified as the first placebo-controlled trial. In history, they were actually down on Benjamin Franklin's estate. This was just south of Paris. and Franklin himself conducted the experiment.

And it involved blindfolding kind of a young boy. Is it on too tightly? No. I was sort of 12, 13 years old. Can you see anything? No. Any light at all? No.

And he was told that... Now, here's the deal, young boy. One of these five oak trees... That one of the trees on the estate has been magnetized. ...by an actual mesmerist. We'll take you to one tree at a time. Your job is to tell us which one... One has been magnetized.

They said one of the trees been magnetized and we're blindfolded you and you tell us when, you know, you're up by the magnetic trees. Because patients insisted that they could feel the energy. And by the way, I believe them. I'm totally persuaded that the real experiences were happening. They brought the boy to one tree. This is tree number one. He began to kind of shake and they brought him to another. Now we stand before tree number two.

He began to sweat. And by the time they brought him to the third... And then the fourth... Here we are before tree number... He sort of collapsed in convulsions. Which is all very dramatic, except tree number one, tree number two, and number three, and number four... ...had never been magnetized. So this was seen as pretty definitive evidence that there was no magnetic force here.

But they also didn't think that the boy was sort of faking it. So what they concluded was that there is no magnetic force, but that all the effects, which they don't deny the reality of, were caused by the imagination. That was Harvard historian Anne Harrington and Rutgers historian, Ed Cohen. Our final stop in this hour comes from reporter Gregory Warner, who recently visited a tent revival, in upstate New York, little Adirondacks lakeside community, very rural,

to see a faith healing. Okay, so I get there and I'm a little bit late. I'm a little bit nervous. There's a lot of mosquitoes. People are restless. They're sitting in their chairs. The tent flaps are still up. The sun is kind of setting. And Steve, Steve Booza, is going on about some verses of scripture and people are really bored. And he says, don't worry, we're going to get to the healing pretty soon. The reading's important too. You know, that kind of thing, like a teacher like. So then he says, okay, now it's time for some healing. The flaps go down. and suddenly the space changes because what was before this kind of people milling in and out becomes this very focused chamber. And it begins. Unique ministry of any kind. Come on up here. This preacher, who is this guy?

That's Steve Buzza. He owns a construction company in Syracuse. Anything at all that you need? Physical healings, finances. So he's looking out to the crowd and then, voluntary. volunteer comes up. Hi. Hi.

Strawberry blonde hair, pink cardigan. What do you need? I need my backbone straightened. You need your backbone straightened? Tell me what's wrong. How old is she? She's in high school. It's in an S shape.

He diagnoses her. Scoliosis? Don't let this scare you now. I'm not trying to scare you. Scoliosis of the spine is 100% of the time demonic. It's not even physical. It's a demon. I'm standing next to Steve.

Do you believe it's going to be straightened right now? Give me your hands. So he spins her around. I break any generational first off of my sister right now in Jesus' name. You spirit of scoliosis, I break your power. And then all of a sudden. Leave now in Jesus' name back. Won't be straightened in Jesus' name.

Just kind of shoves her forward. Straighten right now in Jesus' name. In Jesus' name. Try it now. Move around. Do what you couldn't do before. Stand back and give yourself plenty of wrong. Move it, move it, move it.

Faith is what you couldn't do before. I really don't want to say that she was healed or that she wasn't healed. How does that feel to you? Better. Is she still pain there? No. Because she was just crying. If you can't go for 50% of this, is it 100% better.

But I did meet a woman who, I think something did happen with this other woman that I met. I need healing. I had an x-ray. Okay. And I said there was nothing wrong with it, when my bone sticks out. She comes up, an older woman in her 50s or 60s, and she just holds her hands out. And I'm a clean office, and it just hurts. Sometimes when it tried to grab something, it hurts.

Do you have carpal tunnel problems? Probably. Carpal tunnel, explain what that is? I mean, as far as I know, it's like an inflammation of the ligaments, and it's really, really painful. It's a repetitive stress injury. I want to show you something, though. Stand right, stand right here sideways. So what he does is he basically tells her to grip together her pinky in her thumb

and make a ring like an okay symbol. Now I'm going to take my smallest finger, my pinky. Then he sticks his finger in the ring. I want to try to see if I can pull my pinky through your hand. And he says, I'm going to try to break it and you try to stop me. And I want you to fight me now. I want to see how much strength you got there. You're ready?

He just pops it right open. You got no strength there at all there. She can't hold her grip. mean she got trouble in her carpal tunnel, which is right here. Give me those hands. Give me those hands. She gives him her hand, and he takes it in both of his. Carpal tunnel, I command you in Jesus' name for all swelling and inflammation.

And he starts rubbing with his thumbs. I command all the ligaments and tendons. I go back to the normal elasticity that's supposed to be in there. I command all pain to be gone out of this carpal tunnel region. I command the healing. I go into this entire arm and this carpal tunnel and all strength that come back there in Jesus' name. And then... Do it again.

He says, okay. Let's do the same demonstration right again. And he has to bring her pinky against her thumb. Now, make that grip. I'm going to take my big finger, and I'm going to fight you. And when he puts his finger in this time, watch what's going to happen. And pull. You ready?

He doesn't break her grip. And you can hear, he just drags her right across the stage. So it worked? It maybe did, at least temporarily. She went back to her seat. They gave her a blanket. She was really trembling. I went over to talk to her.

Can you describe what the experience was like for you? Actually, I didn't really feel anything at first. Because I'm just going by faith. Christian belief is that Christ died for our sins. The actual phrase is, which they always repeat, is... By the stripes of Jesus Christ, I'm healed. By his stripes, we were healed. By the stripes of Jesus, you were healed.

He healed me when he died on the cross. What does that mean? It means that you were healed, meaning he died on the... cross for our sins and also for our ailments. So we've already been healed? We've already been healed. We just have to access it and realize it by our connection and relationship to God. Okay, so what happened to Linda afterwards?

The carpal tunnel came back almost immediately, and I met with her in a coffee shop to talk about it. This is my belief from reading the Word of God. The devil, Satan, comes in, tries to talk you out of that healing. He'll say, you didn't really get healed. You know, those things come into your mind. And I believe that's just Satan. So you have to have strong faith to stand against that. Pain is Satan's way of testing her belief?

I think that's what she thinks. I talk to Satan. I tell him. You're a liar. The pain is part of the test. The word of God says you're a liar. And if the pain is there, she's not healed. She's seeing this bigger struggle, this bigger battle, where pain is just one more kind of obstacle. Not that there aren't times that I doubt.

I do. But I have to repent. I have to say, I'm sorry, God, I doubt it. Because I know you've healed me so many times and so many different things. So I know it's for real. It's not, you know, fake on my part, because I know. I think that's a crucial point.

I mean, if we think of it as a medical encounter, it's about pain and the body. But if we think of it as a spiritual encounter, the way she sees it, it's really a battle against doubt. Reporter Gregory Warner, thanks to him and to you for listening. We've got to go now. Don't forget to visit our website,

RadioLab.org, for more information on anything you heard. Also, you can sign up for our podcast at WNYC.org or on iTunes. And always, we'd love to hear what you think. Completely. Radio Lab at WNYC.org is the address. I'm Chad Abumrad. I'm Robert Crowley. And we're signing off.

Born, senior producer, Lulu Miller, assistant producer, production executive, Dean Capello, production support by Sarah Pellegrini, Scott Goldberg, Alaska Kevill, Sam Leavander, Aver Mitra, Ryan Scammel, and Jacob Weinberg. And special thanks to me, Jed's dad, Nagee, Boomrod. Hello, I'm Dr. Fabrizza Benedetti, and I'm Dr. Fabrizzi. I just wanted to say thank you to Nick Caputais, Mark Phillips, Sam Diggman, Joshua Kane, Ezekielsen, Mabel, and Charles Mitchell. Radio Lab is supported by a grant from the Alfred Peace Loan Foundation.

Hello, I'm Professor Anne Harrington. I just want to call and say thanks. Radio Lab is produced by WNYC, New York Public Radio, and distributed by NPR, National Public Radio.