Sawbones: A Marital Tour of Misguided Medicine - Sawbones: The Placebo Effect

Episode Date: August 13, 2018

If the pill you've been taking has been helping you, but it's really made of sugar, would you want to know? Those and other thrilling ethical questions await in our discussion of the placebo effect. Music: "Medicines" by The Taxpayers

Saabones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books! One, two, one, two, three, four! We came across a pharmacy with a toy and that's lost it out. We were shot through the broken glass and had ourselves a look around.

Some medicines, some medicines, the escalant macaque for the mouth. Wow! Hello, everybody. Welcome to Sobhones, a M a marital two of this guy did medicine. I am a coach. Just a back And I'm Sydney Macarine. We used to be on this great this great string The great combo of I believe 2017 When we Chained a bunch of episodes together. Do you remember this? Oh yeah. Our ideas kept, for episodes kept chaining to other ideas for many films would spring a new. And we broke that chain.

We broke the chain, but in a sense, we are taking a run unintentionally at an unplanned new chain. Uh-huh. I guess you can't really plan the chain. Otherwise, it's like, it's or it has to be organic. It's just a bit. It's just you plan. It has. Do you know, do you know, though, that and I will get to this in this episode, I already know next week's topic because I found it accidentally while researching this episode.

Combo. So the chain continues. The chain continues. But this week we're going to talk about something that came up, uh up a lot during our discussion of CBD oil as if you didn't listen to that. Could check that out and It is something that I think I think everybody is sort of familiar with, but it comes up so frequently in I mean nearly every every episode of saw bones. I mean, in some sense is about it. So it's cool that we're finally gonna talk about the placebo effect. That's right.

The placebo effect or the placebo response depends on if you're talking about. Effect. Well, it depends on if you're talking about. You say tomato. I say tomato. You say response. I say effect. Oh no. Let's call the whole thing off.

It depends on if you're talking about groups or you say potato, I say, potato. That's the same. Okay. Are you good there? You good with that? Yeah. You're good there. Okay. A lot of people have asked us to talk about this. And I mean, it makes sense because this, this topic really does relate to almost every single episode of Salbo. Yeah, in a sense So for all the emails we've gotten suggested not vaccines Yeah, not that but although placebo controlled trials have been used to Show whether or not vaccines have worked through history

But anyway, thank you to Thaddeus and Adrian and Jennifer and Elizabeth and John and Ethan and Drew and Jayny and Marie and Noah and Isaac and Emily and Gibberish and Arya and Res. That was the name. Fantastic. Lots of people have recommended this and they are right because the use of placebo especially in double-blind trials and drug trials where you don't know if what you're getting is real or not, have become necessary to evidence-based medicine.

Because if you're going to test two people to see like, does this medicine work? And you give one person the medicine and then you don't give the other person anything. That's a problem, right? Right. Because you can't control for the concept of placebo. Because one person got a pill, the other person didn't. The person who got the pill might be responding just because they got a pill, right? Right. So you have to give the other person a pill, too.

That will kind of pill. A sugar pill. Anyway, placebo has become necessary to do science. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure.

I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure.

I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. I'm not sure. Kind of like they were candy and I wanted I wanted to try some because they I heard they were sugar pills Anyway, well I saw sidebar number 80 pussybows as someone who took birth control for a while and you if you

Did many birth control pills do have sugar pills for the week that you're supposed to be on your period. Yeah They don't taste like anything am I allowed to are you talking about sugar to talk about sugar pills a lot more? I mean, I'll mention them. Okay, I'm going to continue my sidebar here. If you're going to give me something and you're going to sneak me in something, why can't it be, why do we have to be sugar? If I'm going to consume sugar, I want to know I'm doing it. It's like a big deal if I'm gonna consume sugar, I wanna know I'm doing it. It's like a big deal if I'm gonna eat sugar, I wanna know that I'm eating the sugar. Why can't it be like, I don't know, math pills or something? Or something like not dangerous substance in tiny amounts that, I mean, I don't know.

Over long New Yorker article pills. Like, at least, I'm gonna ingest something. Like, let it be something that's like Supposed to help might help me in some way. It used to be bread pills. We'll get into that. Oh Excellent. The origin of the word placebo comes from the Latin for eyeshadow please. Okay, that you can find that in scripture I believe it is Psalm 116 where they say plus Sebo Domino eyeshadow please the Lord All right.

But I although I read one author claiming that this is a Miss translation Okay, when it was translated from Greek and to Latin that it should have been Ambulabo Corom Domino. I shall I shall walk before the Lord. So the word placebo is like a mistake. I don't know. Anyway, it doesn't matter. placebo means I shall please. And that makes sense because it's a medicine that pleases you.

Because it makes you think you're taking whether whether or not it works. It pleases you. That's the concept. The the the word placebo in this sense was used first in the 14th century in reference to hired mourners at funerals. Okay So you would get people to come and mourn to make someone I guess look more beloved. Yeah and Along the and they would begin,

they would begin like openly sobbing and whaling around the ninth verse of Psalm 114, placebo domino. Gosh, I shall please the Lord. And so they were called placebos. And a singer of placebo was someone who would claim that they knew the person who had passed away. Even though they didn't really to try to get like in on the big dinner. Maybe like at the wake or whatever.

Yeah. Or maybe even to try to get money. So it was tied to deception. Okay. The concept of placebo even then was tied to decil, although it was not a deception of medicine, it was, hey, I'm your long lost nephew. Right. Can I have some dough? Please. The Catholic Church famously used placebo. And this is probably the closest like we see in the early uses of, I mean, because this is this will echo the way that it is used in medicinal trials later. People in the

16th century who were claiming possession, the Catholic Church wanted to try to figure out if they were really possessed or not, because there were people who were going around and making a lot of money off of fake exorcisms. They basically, they were people who were going around and making a lot of money off of fake exorcisms. They basically, they were people who maybe had no affiliation necessarily with the Catholic church and would go when someone was claiming possession and be like, oh, yeah, yeah, yeah, definitely possessed. And then do these fake exorcisms for a lot of money

and cure, heal, what a save, what a person, and then go about their business. And so the Catholic Church started to say, listen, one, that exorcism was fake. And two, I don't think that person was ever actually possessed. And so one of the ways they sought to prove that was by giving them fake, holy relics, the concept being that in a case of, and again, this is, you have to actually believe in possession for this whole situation that I am describing to you to work. You believe that possession can happen and that in that case, a person who is possessed by a demon or the devil would be harmed by a holy relic. If it was truly a holy, whatever, a rosary or a cross or whatever, if it was truly that,

then touching it would burn their skin or cause them pain or whatever, cause them great distress. And so the Catholic Church would send people out with these fake relics to hand them to people who are possessed and then see if they react it. Yeah. Yeah. And if they did, then you'd say, listen, you're not really possessed. This is something else because that was fake.

Okay. There's kind of a few levels there going at once. I think that happens in the exercise if I don't, if I'm remembering correctly. I think he uses fake holy water. I'm water. And I think she says it burn. So wait, it, it, it, it calls in the exorcist that she was just faking it the whole time. Well, I think if you've seen the exorcist, you, that's no, right? Like her head goes all the way around. Everybody. Yeah. But, no, but I mean, I think it was based on stories of possession that were questionable and clear. They're like a placebo chocolate cross at them. I don't

think it was a chocolate cross necessarily. Like look at the wrapper. It's not magic at all. Do they say magic? Holy, spiritually magical. So obviously we are not experts on ish on anything relating to religion. The idea grew from there, beginning to circulate through the medical community as well, the idea of using something that was not necessarily active in a way that we intended to, using a substance that as far as we knew was either inert or whatever it did, it had nothing to do with the problem, but nevertheless had some sort of positive effects on a patient.

And the question, even from the early uses of it was, is that okay? And we're gonna kind of go through like the turn of opinion on that because when it was first used, a lot of people just found out very practical. I will give you this pill and you feel better. So, case closed. But now with our current concept of medical ethics

that it's not that simple. So, placebo used to be just a standard part of medical practice. And part this was because we didn't really know what work or didn't work anyway, right? So a lot of times a doctor might be employing placebo without even knowing that the placebo effect was in, was all that was working.

You were giving a patient something that you honestly believed might help them, but it had absolutely no effect whatsoever. Right. So a true believer, you know, and so they didn't necessarily know they were using placebo. And you saw that a lot more before evidence based medicine because when I was somebody knew what they were doing. If a placebo, if you're controlling for placebo, wouldn't it but I'm talking about a time when medicine inherently was placebo because you know, it was like a tonic with like some opium in it or a bunch of sugar or some weeds, you know, or weed. Or weed. There are many people had like religious or

magical beliefs as to why disease happened. So if that's the kind of the perspective that you're coming from, it's easy to see how your faith in a treatment, your perception of the treatment could influence your response to it. I mean, if you if you already have some sort of magical belief, you know, bait as to why the disease happened in the first place. That makes sense. Yeah. And physicians, whether knowingly or unknowingly throughout history had been taking advantage of that, you know, whether they intended to be deceiving the patient or just they didn't they thought the medicine medicine worked too, or they had no idea and were doing their best. We've talked a lot about Pare, who was groundbreaking in many way, and Braw Pare, in the surgical field. But he also said in the 1500s that a physician's duty

was to cure occasionally, relieve often, console, always. And placebo is just a part of that. If you can't do anything else, you console your patient, giving them something that maybe doesn't work, but makes them feel better. Is that not providing consolation or not? I go back and forth on this, honestly.

I don't know. I don't know. I don't know. You know, I've talked about this enough times that I don't think I know. I don't think I have a strong feeling anymore. I used to, you've warmed me down. There are two realms that we're gonna continue to talk about placebo in.

In this way that I'm kind of referencing it already that physicians were giving patients medicines that either they did or didn't know, either they didn't know if they worked at all or they absolutely knew they didn't work at all and letting them just have whatever effect from it, you know, because that was their job to help the patient out even if they couldn't really. And then there's also the use of placebo in a study to, you know, to have like a control group, right? Placibo is used in the control group.

The ones who don't get the medication or don't get the treatment, but you don't want them to know they didn't because you're trying to control for a Placibo effect. And where did that come from? Because that's the whole other use of placebo. In 1752, James Lynn, who I think we talked about when we did the scurvy episode. I'm sure we did. Yeah. He published the the treatise of the scurvy after performing what was probably one of the first placebo controlled experiments, although he didn't call it that. That's probably what it was. So he and I think again

we may have talked about this in our scurvy episode, but he picked 12 sailors who already had scurvy. He divided them into groups of two and each group had one of six different treatments for 15 days. So one group got cider, another got sulfuric acid, another got vinegar, another got seawater, another got lemons in oranges, and the last one got garlic mustard and horse radish. Yum. Sounds good. Poedent.

Kind of an odd like one at the end there. Yeah. Just throw everything else that has any effect in there. If you were in the fifth group and you got lemons in oranges, you got better. Cider also seemed to make people a little bit better. Everybody else was not doing well, and they were in placebo groups, even though he didn't call on that. But that demonstrated kind of the, even if you think one thing works, you give everybody

something concept. Right. Right. You don't just, like, you don't get any medicine. Let's see what happens to you. You're everybody something. Right. Right. You don't just don't like you don't get any medicine. Let's see what happens to you. You're everybody something. Um, Jefferson Thomas Jefferson spoke of the rampant use of placebo in 1807. He talked about doctors as pious frauds. And he talked about a doctor who said that he prescribed more than anything else he prescribed. He gave out bread pills that were dyed various colors and powders made of hickory ash. What could a bread pill be?

Like a, like a squeeze drill tight? That's kind of what I was envisioning. Like a, like you take a school roll and you like squish the insides into a little, like a little, I don't know that I have that one. I don't care what medicine you got. Give me a school role any day. Even after it's been squished, especially after it's been squished, it's returned to its do like state. It's ready. Oh, it's perfect. Charlie likes to do. Charlie always saves me her toast crust. But first she likes to kind of, if she gets to them to give to me, she balls them up. But first she likes to kind of if she gets to them to give to me she balls them up

So not only is it just the crest of the toast. It's the bald up Which is crest of the time? I'll take But they you said things are things. Yeah, so things are gonna things are gonna change this this idea that giving somebody a bread pill It's still be considered pious, even in its fraudulence is about to change. Okay. Well, what happened? Well, I'm going to tell you about that Justin, but let's go to the building department.

You're kidding me. Let's go. The medicines, the medicines that I skilled at my cards for the mouth. So, as I mentioned, yeah, things are about to change. So, placebo at this point in history is a term that is being used almost for any common medication. Yeah, and it was referenced in part what I already mentioned, the fact that we really didn't know what worked and what didn't.

So there was a lot of stuff that people used a lot, a lot of tonics and elixirs and soothing syrups and things like that. The medical, on some level, I think doctors knew didn't really do anything. Right. And so they would call it placebo, but they didn't, you didn't know it to be fake,

but you kind of did. Head in your gut. And it got feeling. But, and that was, that was all the way up And you're good. Right. And it got feeling. Right. But and that was that was all the way up until double blind studies to prove this stuff became a thing. And then we start to see the word placebo being used in that context.

And this shift that starts to happen, I think it's important to understand like the what is happening in medicine at this moment that changes this? So initially doctors were very patient driven They focus the catered to each patient's needs You would go see somebody Take a long time probably at their home, right? Like do a house call take a long time to take their history do an exam Get to know them you would forge a bond with, take a long time to take their history, do an exam, get to know them,

you would forge a bond with them, like a real trust. You're their doctor. They are your patient. This is a sacred bond that you are forming. And so you are committed to making them feel better, to making them better, whatever that looks like. You're committed to doing that through any means necessary. And that relationship and the trust was almost as comforting

as just about anything that doctors had to offer at this point in time, because a lot of their therapeutic options were flawed. Yeah. That's the ideal. Right. Like bloodletting or mercury or weak. Yeah, we impact. We have or there's a whole podcast. Two episodes. Now, over time, this relationship, while I think you could say beautiful in many ways, and I mean, like the idea of a healer and their, their healing, their heal, yeah, I mean, it's a very, it's a beautiful relationship in the hospital.

It's a story of a doctor, a patch out of the junior, where they were healies everywhere in the hospital and they inspire the kids to get better. That's a great movie. Over time, this inevitably had to change as doctors began to cater to more and more patients and as medicine became institutionalized. Well, people, a lot more people go into doctors when they started being able to fix things.

Well, that's fair. And also, like the hospital began to become the dominant institution, you know, that that was where medicine happened and your and your doctors were trained there and so they began to lean less on like a patient focused, patient first kind of theory of medicine and more on like a laboratory focused theory of medicine. We learn what works in a lab and then we apply it to patients as opposed to learning what works based on your individual patient and their response to a medicine.

And this is good in a sense because this is evidence-based medicine. You don't treat patient A this way and patient B that way. You treat hypertension this way and you treat diabetes that way. Does that make sense? Absolutely. And that needed to happen because there were a lot of people who were doing a lot of dangerous stuff and it needed to happen so that everybody knew about the newest advances in medicine and was trained to use them so that all patients, no matter where they lived or what doctors they were seeing,

got appropriate treatment. But it also kind of eroded that bond. You no longer had that that deep connection necessarily to your physician. I mean, I'm not saying you can't, but it wasn't a given. You didn't have that faith in trusting them. And so the idea of just any old therapy. They were just reading out of a book like any creep kid. Well, they weren't individualizing that treatment to you as much. And so the idea that faith that it's going to work as well starts to go away to, you know, that makes for a sense. A medicine work now if science said it worked, not because the patient said they felt better

after they took it. And, and so the more distance between the patient and the doctor, the harder it is for just trust and comfort to heal the patient and the doctor, the harder it is for just trust and comfort to heal the patient. Richard Cabot, who was a physician who did some groundbreaking work in the field of hematology. Yes, very good, very good. Also helped to shift things. He was trained to use placebo as part of his practice, but by the time he was on his

own writing influential papers, he said, listen, deception is wrong. It doesn't matter the outcome. It doesn't matter if it works or not. Lying to your patient is always wrong. Stop. Even though I was trained to use placebo, I would advise against it. And this sounds like, well, who cares?

This is a big deal. To say this out loud and break it into paper and send it out to other doctors was a big deal at the time. Because everybody kind of accepted that you did that and you also don't say it because Hey, you're messing out the placebo fact to know there was a big there was also a big groundbreaking investigation on something called Perkins tractors. I have not heard this. These were the tractors, the metal prongs that were supposed to cure disease. And then there was this big trial with the, or this big test with the placebo down at the

time that proved that they didn't work. I don't want to say too much more about them other than this help to shift the balance on placebo because this is our episode for next week. Ah, right. Because this is a great story. Next week you'll learn more about Perkins Tractor. And then we first see the term, not just placebo, but was placebo effect

used in 1920 in a paper in the Lancet by TC Graves talking about some psychiatric medications that didn't seem to be biologically active, but nevertheless, he was seen in effect in his patients. And he began to talk about the concept of the placebo effect. They're not just a placebo,

but some natural effect that might occur from taking a medication, even if it didn't, you know, essentially do anything. So now, even as doctors, you're questioning the use of intentional placebo, evidence-based medicine was creating this growing demand for researchers to actually prove what did work, right?

Okay, so now you're saying we can't just use fake medicine, well, how the heck do we know what works? Well, we gotta do trials, and so there were a lot of researchers arguing we need to do things where we give done patients medicine and we don't give other patients medicine and we see what happens. And doctors were very reluctant to do that because that sounded unethical. So you have a medicine that you think might work. Let's give it to everybody. Yes, I kind of. But that makes

sense, right? You think it might work. What if you, what if somebody who doesn't get it dies and it did work? You harmed them. But the problem is you don't know it works. Yeah, but what if it does? What if it doesn't? But what if it does? You see the issue here. So there was a lot of debate as to whether or not this was okay. And the other argument that they were making was, do you really think this placebo effect is such a big, everybody's talking about this placebo effect, is that a real thing? Because if it's not real, it shouldn't matter.

You should be able to, like I should be able to say, hey, Justin, I'm gonna give you a pill, I'm not gonna give a pill to your buddy, and we'll see if it works for the same disease you have. And we'll just trust whether or not you get better, right? If there's no placebo effect, you don't need a control. You just, that's it, right? It works or it doesn't.

You give the medicine, or you don't even have to do a trial. You just give the medicine everybody and see if they get better. So the placebo effect had to be real for doctors to be okay with this. Yeah, understand. Okay. In comes Henry Beacher. He was a Harvard anesthesiologist and an ethicist and he, in 1955, gathered data from 15 different studies of 1082 patients with all these different kinds

of pain and from analyzing all these studies, he stated that a placebo analgesic, a fake pain pill, that a placebo analgesic of a fake pain pill is effective on average in 35.2% of cases. And depending on the patient in the pain that could range anywhere from as little as 4% of the patients to 86% of some patients are going to respond to a placebo. Okay, I'm sure Hank did some great work and his time You can't say that is it you can't say this But doing four percent and 86 percent you might as well say I have absolutely Yeah, they were very they were very very Clause of pain and patience They're very, very causative pain and patience. Four percent.

Four percent with this pain, 86% with that pain. That fact he just told me made me dumber. No, okay. No less after hearing it. Yeah, you, there were some things, pain that was the least intense, did not show as much of a responsible SIBO.

Whereas extremely intense pain like angina, like heart pain, heart muscle pain, that happens when your heart's not getting a function. That was very sensitive to placebo. Okay. If you thought a placebo would work, you were more likely for it to work. Okay.

You didn't think it was gonna work, it's less likely for it to work. And anyway, he wrote all this out, And there were a lot of different reasons for it. But this was very compelling. After he published this, a lot of doctors said, well, heck, if the placebo effect is really as big as Dr. Beacher is saying that it is, we got to do these studies. Yeah, we have to do double blind study. So this was revolutionary. This study, which demonstrated the breadth and depth of the placebo effect, is why so many people adopted

the double blind study, and why we have them probably as rampantly as we do today, they're the gold standard. He also published a study in 1961, I thought this was interesting, that suggested that surgeons that he called enthusiasts believe their patients chest pain and heart problems more than patients, than surgeons who were skeptics. Surgeons that were like pumped to be there?

Yeah, surgeons who were just like really like, they were like, this is gonna work, this is gonna work, don't worry, we got you. Their patients did better. like, this is going to work. This is going to work. Don't worry. We got we got you. Their patients did better. And this, uh, there was also the same year Walter Kennedy coined the term no SIBO. I just like to mention this. This is like a bad placebo. It's weird. You mentioned that to me or your researching two days ago. This morning, I watched an episode of Glasses, that opened with some John Hamm narration about new clothes. Really?

That is strange. Actually, I thought it was kind of interesting. They actually drew a connection between the idea of no seabirds and stuff like the dancing and other mass delusions. That's interesting. You can kind of, it's something that you think could cause you harm and your mind manifesting that harm

Even though it doesn't exist technically, I think it's kind of Whoops side of In essence, it is what the Catholic Church was doing with the fake holy relics Because people were reacting as if they caused them pain when they didn't so no secebo is something that shouldn't cause you pain, but you react as if it does. For a while, the word oba-calpe was used to sell placebo medicines. Backwards placebo backwards. But you'll find a lot of medicines that were called that.

Even into the 90s, it was usually just a sugar pill. It could be a little bit more clever. Being a doctor. In my own practice, I have, and this is not something that I certainly have done or that I know people doing now, but I've heard doctors like to tell tale of the old days things that used to happen in the old days. Things y'all used to really get away with. Right. So I've heard tale of knackle being used. You know knackle being used, you know, knackle is. Knackle is, that table is, is that salt? It's sodium chloride. It's saline solution, like that you, like the fluid, IV fluids, giving somebody a shot

of knackle. So we're gonna give you some knackle. Yeah. Or like just giving somebody a saline flush to flush their IV, which you need to do. So it's not like a harmful thing to do, but like saying that it's a medicine and the patient saying their pain was better, even though you didn't give him anything. Or like switching something to IV,

like somebody keeps asking for an IV pain medicine so you give him IV Tylenol and they say that they're all good. I got that stuff I needed. I've heard these things. We are not allowed to do this. This is not something that we do now. You get in big trouble. How does it? Yeah, we don't do that. I'm not saying there is no doctor anywhere who ever does it. I don't know. I can't vouch for everybody. All I know is we

don't do it. We're certainly not trained to do that. There's some general rules with placebo supposedly shots are more effective than pills for pain. You're going to use a placebo. Yeah. People tend to think a shop works better, but but but pills are more effective for sedation for like sleeping pills and that kind of thing. Blue pills work better for sleeping. Red pills work better for pain. Well, I know it. If a medicine is expensive, brand name, hard to get, it tends to have more effect. If your doctor is really excited about it, it tends to have more of an effect.

Now, this all sounds like it makes sense, right? At this point, we've accepted all this. So now we know this is how placebo happened, and this is why we used double-blind studies, and the placebo effect is real, blah, blah. Okay, here's the problem with all this. BeecherLide. That big study that I cited was re-evaluated in like 97 by some German scientists and found that most of his results were inaccurate and some of his conflusions were just straight

up like they conflicted with the data he presented. It's unclear if he misinterpreted, I mean, he was a good scientist. He was a good doctor or a good scientist, so it's unlikely that he just didn't get it. So it's unclear if he misinterpreted things or if he was trying to maybe exaggerate findings to push science in the direction of placebo-controlled double blind studies. Like, he knew something like this was necessary

to sway doctors and so he published it, even though maybe it wasn't quite that real. A 2001 systematic review of a bunch of different clinical trials showed that essentially there is no placebo effect, except occasionally with some subjective symptoms like pain, subjectively someone might report that it's better, but it's only to the extent that like if you're in pain and I give you a placebo, there's a chance that you might say your pain is less, but it doesn't eliminate pain, it doesn't cure things. The placebo effect, I'm not saying it doesn't exist,

but it is not nearly what science thought it was for many decades. Wow. Yeah, a lot of what we think, I'm not, yes, it can happen, but it is not the problem that we used to think it was. There are studies that have kind of looked into like brain activity and receptors to try to figure out why there might be some placebo effect in some causes.

And they've seen some things like endorphin release and dopamine release that could explain why you feel better even if nothing chemically should have made you feel better. But it is not nearly the influencer that we thought it was. And as I said, it is now considered unethical to give a patient a placebo knowingly in line of them, because it violates the... Outside of like a research.

Yeah, outside of a research setting, outside of a research setting. And when you enter a research setting, you sign papers that say, I know I might be getting a placebo. Yeah, that's fine. Let me know if I can chew it up. Give that to good sugar.

But no, but like if I were to walk into a patient's room and try to give him a medicine that I said was real and wasn't, that would be, I mean, that's unethical. That violates the principle of autonomy, which means you have the right to the information about your body into everything I'm gonna do to it and to consent to it or not.

And you wouldn't consent if I told you I'm going to give you something fake. Is that cool with you? How would I not be okay with that? So obviously we don't do that, but some have offered this and this is my final parting thought on this. If placebo effect Israel sometimes and if a placebo, let's say it's a sugar pill, something harmless, if it could help a patient is not giving it, harming them. If we could take advantage of the placebo effect, especially in situations like chronic pain where maybe

there isn't a great solution right now, if there's something that would help them, that wouldn't harm them, but wasn't really the post. No. I'm not proposing. I'm not saying that I believe this. I'm just telling you that these are the ethical requirements. Do you want me to actually tell you why I think my point? Sure.

And I agree with you. Let me say, I have straight up, I agree with you. I think patients should always know what we're doing to their bodies. I don't think we should ever be trying to deceive someone about their healthcare. I have a different reason to think. Okay. I think that we are all of us not just ourselves,

but we are members of this great human race of ours. And I think that if I get something that I think works for me, and I start telling people that this thing works, that I am actually not advancing human knowledge and the cause of the species. You look at the stuff that we do, and it is like the stuff that we talk about, and it is millennia of people saying, well this thing works for me it must work and

Like that is exactly what you're talking about and I don't want to be party to that And I think that even if I whether I do or don't want to be party to it I Think you owe me the option of Of deciding whether or not I want to be party to it And but the irony of course there is that in a lot of situations, if you give me that option, you have actually removed it for the placebo effect.

Because if you say like what this, like, you know, unless you've got one of those men in black, the lasers that erase my memory, then that should be sales. But that is my thingop. They're hiring their own, you know, truth seeker. They're a fact checker. Yeah. Great. Yeah. My vehicle start for you.

Start some people. And stuff. But I don't want to be. I don't want to be. I don't want to believe in a fake. Here. Even if it helps. You're not.

You're not a fan of. Goop. Them. Not a fan of goop. They're hiring. You know, truth seeker. They're a fact checker. Yeah. Great. Yeah. I'm being a cool start before you start some people, vitamins and stuff, but whatever.

Good luck in God's speed to whoever winds up in that position. Yeah. So don't doctors don't do this. This is not good anymore. Get friends studies. That's it. You got any sugar pills though? You know,

I. Honey, if you just want sugar, like we have sugar, not in pills, but we have a bag. Thank you for listening to our podcast Have you enjoyed yourself? Thank you to our sponsors and thank you to you for listening if you get a second you can tweet about the show We're at solbona's on Twitter. I'm at Justin McElroy MCEL R O Y and she is at Sydney McElroy S Y D in E E and uh false. We have an email too. We have an email solbons at maximumfund.org. What's maximum fun you ask? Well, just the finest podcast network this side of the

Mississippi. All of great shows that you'll love to enjoy like stop podcasting yourself. Just John Hodgman and so many others. We don't know. I'm going to bubble fiction series that we just wrapped that you would love. It's kind of like a post-apocalyptic buffy with the five. It's great. I'm going to be on a show next week. What? Quarter pointed. Oh yeah, that's right. That's right.

So my dad and my uncle Michael do like a, it's sort of like a legal sub-units. Legal sub-units, except for law, because he's a lawyer, my dad's not. Yeah. But my uncle is. And anyway, quarter pointed, and I'll be on there to talk about medical malpractice.

Awesome. Well, make sure to check that out. And thank you. It comes out Monday. We're checking us out. That's going to give first for us to tell next week. My name is Justin McHeroi. I'm Sydney May.

It is always dope trouble in your head. Alright! Maximumfund.org Comedy and Culture, Artistone Listener Supported you