Stuff You Should Know - SYSK Selects: How the Placebo Effect Works

Episode Date: January 18, 2020

For centuries, doctors have prescribed drugs they knew weren't real – but that still somehow worked. It wasn't until the 1980s that the placebo effect was studied. Learn all about how an inert substance can have a genuine impact on a patient's recovery, in this classic episode. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s.

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Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. Hey everybody, it's me, Josh, and for this week's SYS Case Selects, I've chosen an episode on Placebos. It's an episode chock full of facts of the podcast, and yet Chuck comes out with one of the all-time greats

right out of the gate. But don't stop listening then. The whole episode is amazingly wonderful, which is why I chose it. So enjoy it. Welcome to Stuff You Should Know, a production of iHeartRadio's How Stuff Works. ["How Stuff Works"]

Hey, and welcome to the podcast. I'm Josh Clark, and there's Charles W. Chuck Bryant, and there's Jerry. Jerry. The Placebo Deucer. Hmm, no. No, that was bad. Chuck.

Yes. Have you ever heard of the word Placebo Deucer? Yeah, I've heard of Placebo. You know what it means? I do. Tell everybody. I shall see. No, I will please.

I shall please, is what I meant. I shall see. We'll see about that. I shall please, is what I meant. In Latin? Yes. Right, so Placebo. Everybody's heard of a Placebo,

and very famously the Placebo Effect. Do you know anywhere that comes from? The Placebo Effect? No, the word Placebo. Oh, yeah. 14th century, it referred to hired mourners at funerals. What? They would hire mourners in place of family members,

and they would start their morning wailing with, not morning, but as in M-O-U-R, with Placebo Domino in Regione Vivorum, which means I shall please the Lord in the land of the living. But in that, it means Placebo, this article said it carries the connotation of substitution. Weird.

Yeah. That is fantastic stuff. I thought so. This is from Placebos and Placebo Effects and Medicine, colon, historical overview, by Tyssen, Capchuk, Kreen, and Clegen. Oh, Capchuk. That guy is high quality.

Oh, yeah? Yeah, a lot of skeptics take Capchuk. He's at Harvard. Let me tell you a little bit about Ted Capchuk. Okay. Of the Coney Island Capchuk? I just raised a lot of skeptics' hackles because some people see him as a huxer of fraud

or everything that's wrong with Placebos. These people would probably have a problem with us even talking seriously about the Placebo Effect in the first place. So I don't know that it's a really big deal that I just raised their hackles. But Ted Capchuk is a former... O's me 50 bucks.

Let me tell you about Capchuk. Now he's a former acupuncturist and he apparently had some sort of epiphany one day when he was treating somebody and they started to feel better before he'd even used the acupuncture. So he started wondering like, okay, what's going on here? And he started investigating the Placebo Effect.

And in short order, he ended up as an instructor at Harvard and became one of the leading researchers and into the Placebo Effect, which is a really strange journey because Harvard Medical School doesn't usually hire acupuncturists. And he had like kind of a rocky road at first. Like he didn't know what he was doing with clinical trials

and he got publicly called out in the New England Journal of Medicine. And over the years, over the decades, I think this was the 80s that he really started to look into it. He, like I said, became the foremost researcher in coming up with quality clinical trials for trying to get to the root

of what the Placebo Effect is and how to use it. What year was that, do you know? He's still doing it. Oh, but when was this when he started all that stuff at Harvard? He got called out in I think a 2001 issue of the New England Journal of Medicine, basically for not using a control group

in his Placebo study. So, you know, when you do a study, you have a Placebo group, which is your control group. And that basically is, I'm giving you real medicine, but I'm giving Jerry a sugar pill. And in a proper study, I don't know who's getting the sugar pill and who's getting the medicine.

It's called double blind. All right. So, if you're studying just the Placebo Effect, I should be giving you a Placebo and I should be giving Jerry no treatment whatsoever to truly... I thought you needed three people. One with the real treatment,

one with Placebo and one with no treatment. It's another way to do it. At the very least though, you need the Placebo group and somebody who's receiving no treatment. Gotcha. You see? Yeah, yeah.

If we're skinning cats. Well, if you're doing good science, researching into the Placebo Effect. But what's ironic is, is this whole double blind Placebo study came about because the Placebo Effect was first noticed by a Western practitioner by the name of Dr. Henry Beecher,

who in World War II supposedly saw a nurse give a shot of saline to a soldier because they'd run out of morphine. But the nurse told them it was morphine and the soldier responded to this shot of saline like it was morphine. And from that, Beecher was like, what is going on here?

Started to investigate the Placebo Effect and ended up proposing the double blind Placebo study to prove the efficacy of drugs. That goes back further than that, my friend. Let's hear it, man. Try 1785, the new medical dictionary. They described the Placebo as a commonplace method or medicine and then a short time later in 1811

in Quincy's lexicon, medicum. He defined the Placebo as an epithet given to any medicine adapted more to please than to benefit the patient. Like heroin. So they were on it back in the early 1800s, which is surprising.

Yeah. But I mean, like that's the basis of like snake oil and hucksterism, right? Yeah. Well, they called them bread pills back then because I guess it was probably some sort of like pill made of yeast is my guess. Okay.

And Thomas Jefferson in 1807 even recorded what he called the pious fraud. And he observed, quote, that one of the most successful physicians I've ever known has assured me that he used more bread pills, drops of colored water and powders of hickory ash than all other medicines put together. And people treated people with bread pills

in the early 1800s. It was a thing. And like they were way onto the Placebo effect and the fact that it seemed to work. And another dude named John Hagarth in the early 1800s actually started performing the first studies on Placebo's effect. And he said it went back to the Renaissance idea

that imagination was the major mediator between body and mind. Which is starting to be proven as possibly correct. Yeah, it's pretty interesting. And in the 1930s is when they started publishing papers on the Placebo and actually doing clinical trials. And they said one of their points in the 1930s would confidence aroused in a treatment,

the encouragement afforded by a new procedure even. Like just people getting treated in a new way, people would say, oh, well, this is gonna work. Right. And it maybe did work. And then we're up to the 40s where Beecher comes along, notices the Placebo effect himself, ultimately comes up with the double blind

Placebo based study. And what's ironic about that is the Placebo based double blind study ultimately has split back off into the study of Placebo again. Because there were so many trials where the Placebo was more effective than the drug, even though the drug worked, but the Placebo worked even better.

And finally in the 1990s, people were like, what is going on here? We need to study this thing in and of itself. Well, yeah, because one of the things I had no idea, I thought Placebos were only used in studies for efficacy rates. I did not know that there are doctors always have been and still are prescribing Placebos as medicine,

unknowingly, even though they're not supposed to, we'll get to that later. No, knowingly. No, unknowingly for the patient. Right. Even though they're supposed to tell the patient. Yeah. We'll get to that toward the end,

but I had no idea that they were prescribing Placebos to people. Yeah, and in their defense, a lot of times, doctors are carrying on a tradition where they don't have anything else to prescribe, but they can't, if they say that to their patient, their patients are going to go off and suffer. So at the very least,

they can use the last ditch attempt of saying. Psychological trickery. Take this. Yeah, and I'm not knocking it. I just was surprised to learn that that still happens. And I'm wondering if I've ever been given a Placebo, and it makes me feel dumb as a patient to say, like, yeah, man, whatever you gave me really helped.

And the doctor's like. Right, yeah. Because it's the same thing as that high school prank of like giving somebody non-alcoholic beer and telling you it's a real beer and watching them make a jerk out of themselves, getting drunk. It's exactly the same thing.

So let's talk about Placebo. We assume that everybody knows what Placebo is, but let's define it a little more clearly. The Placebo effect specifically is the very real phenomenon that people when given a pill or some sort of medical intervention that. Feel better?

Yes, they feel better even though what they've been given is not medicine and was not actually a real intervention. Yeah, and the Placebo is the pill itself that is the Placebo, and the effect is what you just described. Right, and it doesn't have to be a pill. It can be an injection. It can be fake surgery.

Yeah, there's true. And it doesn't even have to be pharmacologically inert. It can be a vitamin or like an aspirin, even though some argue that's not a true Placebo, but sometimes that's what the doctor will give you and call it, you know, medication. But they're very often things like a sugar pill. Yeah.

Like you said, pharmacologically inert. And astoundingly, depending on the size of the pill, the shape of the pill, the color of the pill, people will have different effects and responses to these things that are just sugar. So there's some really strange psychological things going on here. And at first, for a long time,

everybody just kind of assumed it was just psychology, that we were tricking ourselves into feeling better, or we hadn't really felt bad in the first place. Right. And we were being tricked into not feeling bad any longer or not thinking we were feeling bad any longer. Like an offshoot of a hypochondria, maybe. Very much so, yeah.

This article says they've been shown to work in about 30% of patients. And that was actually, that's based on Beecher's finding. It was like 35.2, I'd say. Yeah, that's what he found out in 1955. That's what they're still basing that on? Yeah, but there's been other studies that have gone back through Beecher's studies

and said, no, no, no, this is not that much. Other people have found up to 60% respond to it. Right, and basically one of the big questions is, is it a psychological effect, or are there actual physical responses that are going on? And there's been a lot of research lately that's pretty interesting, I think. Right, so like we were saying,

the initial idea was that it was all psychological, right? Yeah, like, well, I guess we can talk about the two effects, the subject expectancy effect, which is basically, if you know the result ahead of time in the pill you're gonna take, you're gonna end up feeling that result. Right, so this is, or 30%. That's what a blind study seeks to prevent

is a subject expectancy effect. And also the observer expectancy effect, which is what a double blind study seeks to prevent. Yeah, and that's important because it's, or different because it's all self-reported. Right. Which is always a little, you know, hanky. Right, so the other idea,

if it has a psychological basis, is that it's classical conditioning. Right. That we are raised from birth to think that if somebody gives you a pill, you're going to respond to it because it has medicine. Yeah, and that is not self-reported. That is actually seeing physical responses.

Right, and with classical conditioning, established very famously by Pavlov and his dogs, right? You are, you're having, you're responding physically to a psychological stimulus. Yes. Right? Yeah.

So you are getting a physiological response. So classical conditioning eventually kind of came to be the viewed as the more reasonable explanation for what was going on. Right. Because study after study after study has shown that we are having a physical reaction to these inert placebos.

Yeah, one of them in 2002 from UCLA's Neuropsychiatric Institute. They had a couple of groups of patients and a lot of the placebo studies are for mental conditions. Not all of them, but a lot of them are. Or in like the clinical trials. Yeah, yeah.

Yeah. Exactly. So this one was for antidepressants. And they had two groups that got experimental drugs, like real drugs. And then the third was given the placebo. They spent a few weeks on these pills and monitored their brain activity

with the old EEG wonder machine. And well, that's not the wonder machine. The MRI is the wonder machine. It's a wonder machine, not the wonder machine. Right. And the patients on the placebo reported positive effects and showed greater increase of brain activity than those who had responded to the drug.

You know, I remember that it was... The study? Yeah, it totally undermined people's faith in antidepressants. Because it was on the other end of like the whole 90s where everybody was on antidepressants. And this study came out and was like, people were saying like,

did these things even work? Right. It was kind of taken the opposite way, rather than, wow, the placebo effect is really something. It was, wow, antidepressants are fraudulent. Right, right, right. Well, I wonder what they were trying to... It was a placebo study though, right?

Yeah. So it kind of backfired or did they even care? No, I think they very much cared because when compared to placebo, the whole point of a drug trial is to show that this drug is more effective than placebo. It's more effective than the imagination. Right, right, right.

And if it's not, then that means that drug shouldn't be brought to market. Even though now the thinking is more like, that's not necessarily true because we're coming to understand the placebo effect can be very powerful, especially depending on the individual too. Yeah, for sure.

The interesting thing about that study is when the EEG lit up, the activity was in different parts of the brain. I think the placebo patient said the prefrontal cortex was lighting up. And basically that says that the brain isn't being fooled. It's just doing something different. Yeah, they responded better to the treatment

than the people who responded to the drug. So some people did respond to the drug, but different parts of their brain were activated by the drug than the people who responded well to the placebo. That's right. Even though they felt better. That's mind boggling. It is.

So they reached the same conclusion but using a totally different region of their brain and they actually felt better. That wasn't the first study to prove that there is a physiological response to placebos. Or last. There was a dental study from the 70s that I think was the first

that showed that if you blocked endorphins, which are nature's pain relievers, you can also block the placebo effect. So the people weren't responding to the placebo like you would expect them to, a pain reliever placebo, because they weren't able to release their natural pain relievers. Yeah, and that's backed up, I guess,

by this 2004 study from University of Michigan, Go-Wolverines, they basically demonstrated that it is related to endorphins specifically. So I guess that backs up that study because if you can block them. So here's the thing. It's not, that study was related to endorphins specifically. Other studies have found that it can be related

to how much a person expresses dopamine specifically. So there's this idea that there's a genetic basis to our predisposition to placebos. But I think that it's depending on the drug or the effect that you're trying to induce using the placebo effect, because think about it. If you are somebody who naturally produces more endorphins than somebody else, you're going to naturally

produce more endorphins when it's triggered by a placebo than somebody who doesn't produce more endorphins naturally. So there's a genetic basis to it, I guess, but I think the genetic basis is that the individual must be predispositioned to be able to have that genetic response to the drug or the placebo and have that, I guess, response to it. Yeah, and like you said, it's all so personal

because they found that it is even affected by a person's personal experience with past pills. The color of the pill, the shape and size of the pill, will have a different reaction because the person had maybe took another little blue pill for something else. Sure, and actually blue pills in particular are known to have sedative effects as placebos. Red pills are known to have stimulating

and pain relieving effects as placebo. That's odd that they made Viagra blue. Yeah, like inevitably marketed it as the little blue pill. Right, interesting, sedative effect? Yes, they don't think so. No, so Chuck, we'll... Not that I'd know. Well, we've got more stuff about all this coming up.

I don't know what we're gonna talk about next. It's a grab bag right now. ["Grab Bag"] ["Grab Bag"] ["Grab Bag"] Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to

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something that I had never heard of, which I think is super interesting. Oh, I know. The nocebo effect. It's awesome. It is super cool. And that is when, well, there's a couple of things. That is when you are taking a placebo

and you experience maybe the effects of the pill, which is great, and the side effects of that pill that you think might be, you're supposed to have. Right. So you're actually experiencing side effects that shouldn't be there. Right. Because it's a sugar pill.

There are clinical trials too, because when you're carrying out a clinical trial, you have to warn the patients. Yeah. This drug may give you these terrible side effects. And so they started noticing like people who were on placebo were still experiencing the side effects. Like physical reactions, like hives.

Yeah. And itching in things. Right. So there is a negative side to placebo as well. And nocebo means I shall harm. Like placebo means I shall please. Oh, yeah. And they found that, and this is definitely backed up

by the idea that it's classical conditioning. They found that people who have gone through chemotherapy can become nauseated when they enter a room that's painted the same color as the room where they received chemo before. Yeah, that makes sense. Yeah. So there's all sorts of ways that the nocebo effect

can pop up, but it's pretty mind-boggling as well. Yeah. And nocebo doesn't even have to be just with a placebo. Yeah. So nocebo doesn't experience side effects that aren't on the list of a real drug because of what we were talking about, because it looked like another pill you might have had before.

Yeah. Man, the brain. Powerful stuff. So going back to Capchuk, who I'm just kind of a fan of. Yeah, even though he owes you 50. Yeah. I think if you're into like long form articles, which I love. Yeah.

Go to Harvard Magazine and search for the placebo phenomenon. I'll tell you about him and his work. It's really interesting stuff. But he was saying that kind of in line with the idea that the color of the pill or the shape of the pill will have an effect either on the nocebo or the placebo effect. Right. He was saying that it seems like the basis of the placebo effect

is what's called ritual. Yeah. And ritual is it involves everything from like the physician's bedside manner to how expensive the patient thinks the pill is. Yeah. To how effective the patient thinks the pill is. And he did a study where he carried out what was called schmaltzy, like a schmaltzy care, to where he was just lavishing attention

on the patient and telling him how spadly he felt that they were going through this. Right. But this pill is really effective with your condition. And apparently, not just this study, but other studies show that there's a positive correlation between the ritual and response to the placebo effect. So the more you think that this drug is expensive,

that this drug is effective, that this physician cares about you, the greater of a placebo response you're going to have. Yeah. Have you ever been accused of being a hypochondriac by anyone? No. That's got to be very demeaning. It is, because it happened to me. Oh, yeah.

I went to the emergency room in New York, as you know. When we were up there recently for our trip, I went to the ER. Oh, yeah, yeah. Man, that was something. It was something. And it was a result of, it was throwing up in nausea from, I learned from anti-inflammatory pills I was taking at the time for something else.

I had nothing to do with being sick. Right. And they figured that out, but they kept, you know, this guy, I called him Nurse Jackie. He was just like Nurse Jackie, except he was a dude. He kept coming by and treating me with things and giving me the IV drip. And I was like, dude, I'm not feeling better. And I'm not a hypochondriac in any way.

I didn't go to the doctor for like 18 years straight. Right. And I could tell he was looking at me like, oh, I got one of these guys. You were med-seeking. Yeah. And I was like, no, no. And I could tell I could sense it. And so he finally gave me this thing to drink that knocked me out,

woke up like 20 minutes later and felt better. Wow. What was it? I can't remember. It was something to... Gatorade? No. It was like three different things.

It was like a cocktail of stomach pleasing things. And what's the stuff that numbs you? Numb my throat. And I can't remember. Lidocaine, I think. Oh, okay. And it worked, huh? Yeah, it worked.

I woke up and I felt better. I said, you know, I don't feel so nauseous now. And they were checking me out. And I reached up and I felt behind my ear for some reason. And it felt like a golf ball behind my ear. And it had popped up in the last 20 minutes. Wow. And so I was literally leaving.

I was like, oh, wait a minute. I got this thing behind my ear all of a sudden. And this guy looked at me like... And he called the doctor over and she was like, yeah, it's very swollen at your lymph node. But he wasn't there for that. So he came back over. He was like, hey, what'd she say?

I said, well, she said it's a swollen lymph. And he said that you're a hypochondriac. And I was so mad at Nurse Jackie. Yeah. I was like, dude, look at it. It's huge. I'm not making this up. And I started defending myself like, I never go to doctors.

And I'm not one of those people. And he was just, he was like, I was just kidding. I was just kidding. I was just kidding. Yeah, but it totally made me feel like a jerk. Yeah. I mean, imagine if like you, if that happened to you a lot too. I mean, that just...

Well, that means you're a hypochondriac. No, it definitely made me felt... And I know he was kidding, but it made me feel really bad. Like I'm in there just... What's the syndrome? Munchausen. Is that it? Yeah.

Yeah. We did an episode on that too. Yeah. Anyway, sorry about that. Yeah. Well, I'm sorry that that happened to you. Thanks. I mean, that is BS.

But you mentioned the IV. Yeah. I guarantee you that was just saline. And that's a placebo in itself. No. I mean, they told me that. I mean, they didn't say like, this is the wonder bag. Right.

But there's basically no reason to give you saline solution. Well, to hydrate me, I guess, if I'd been throwing up. Oh, yeah. Okay. But yeah, I guess you're right, though, to see something dripping into your arm. Like, surely that's got to be doing something. Yeah. Well, one interesting thing is, back to placebos, there have been studies that have shown that

if you don't tell the patient what they're supposed to do, that they don't work as well. Yeah. They even found that with drugs that they know for a fact work. Yeah. If you don't tell them, it won't work. Yeah, they did a placebo based trial with a painkiller. And the painkiller proved more effective than placebo. And then they did another trial with the same painkiller.

Didn't tell anybody what it was. Yeah. And it didn't work. Interesting. And then conversely, this is the one that gets me. Yeah. The study where they, it's so crazy. I know where you're going.

They used an injection that they put into patients' jaws in the study. Yeah, that sounds awful. Which is mean to induce pain. Like that was the point. They were trying to induce pain in somebody's jaw using harmless but painful jaw injections. Yeah. And they would inject saline into the jaw to keep the patient's self-reported pain level steady throughout the study.

Yeah. And then they used another injection and gave them saline, but told them this was a pain reliever. And everybody's pain across the board dropped as a result in the study. Unbelievable. Placebo effect. I can just sit around and rattle off studies all day. It's pretty interesting. What do you think about Obacalp?

Yeah, it seems, kids are dumb. You could just call it placebo anyway. I think it's unnecessary. Well, Obacalp is placebo spelled backwards, obviously. And that in 2008 was, I guess, sort of invented, or not invented, but coined and packaged by a mother, I think Australian named Gin Butner. Is she Australian? I don't know.

I think so. Is that an Australian last name? I don't think there's such a thing. And so that's basically placebos for kids. It's marketed. You can buy a bottle of Obacalp. And it's for when your kid isn't feeling good, but you know your kid's not sick, that kind of thing.

Right. And so you give the kid the pill and it makes them feel better. And some people have problems with this and say, you're teaching your child that you get relief from pills only when they don't necessarily need to be taking pills all the time. And proponents say, you know what, it's the same thing as putting a bandage or kissing a boo-boo. It's, like you said, these are dumb little kids. Well, I remember growing up with the children's aspirin, the orange aspirin.

I'm pretty sure those were just sugar pills. You think? I ate a whole bottle of them once and I was fine. Well, but those were vitamins. It was children's aspirin. Oh, oh, oh. And they were orange flavored. Yeah.

I totally remember those. Yeah. I think those were probably placebo. I remember the taste like I can still sense that. They're good. They were delicious. I ate a whole bottle of them once because I was a little fat kid. You didn't eat and get sick?

No. You didn't take pills? I think so. Because I even remember I was old enough thinking like, I probably shouldn't have eaten that whole bottle of those things because it's medicine. And washed it down with a Scotch. And I was right. And I was fine afterward.

Well, they do have legit baby aspirin now though. Do they? I'm starting to doubt everything. So starting to talk about doubt, there are plenty of criticisms of all this and we'll talk about them right after this. On the podcast, Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're going to use Hey Dude as our jumping off point, but we are going to unpack and

dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars, friends and non-stop references to the best decade ever. Do you remember going to Blockbuster? Do you remember Nintendo 64? Do you remember getting frosted tips? Was that a cereal?

No, it was hair. Do you remember AOL instant messenger and the dial-up sound like poltergeist? So leave a code on your best friend's beeper, because you'll want to be there when the nostalgia starts flowing. Each episode will rival the feeling of taking out the cartridge from your Game Boy, blowing on it and popping it back in as we take you back to the 90s. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts.

Hey, I'm Lance Bass, host of the new iHeart podcast Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when questions arise or times get tough or you're at the end of the road. Ah, okay, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. This I promise you.

Oh, God. Seriously, I swear. And you won't have to send an SOS because I'll be there for you. Oh, man. And so my husband, Michael, um, hey, that's me. Yep, we know that Michael and a different hot, sexy teen crush boy band are each week to guide you through life step by step, not another one, kids, relationships, life in general can get messy.

You may be thinking, this is the story of my life. Just stop now. And so tell everybody, yeah, everybody about my new podcast and make sure to listen. So we'll never, ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the I Heart Radio app, Apple podcast or wherever you listen to podcasts. So Chuck, I'm big time into the placebo effect. I can tell.

I'm big time into the placebo effect. There are people who are not. That's true. There, uh, it raises plenty of skepticism, which again is one of the reasons why my head is off to Ted Kapchuk because he has responded to the criticism. He's adjusted his methodology. He's doing really good science in the investigation of the placebo effect. I like that guy still skeptics say there are a lot of things that you can use to explain

away the placebo effect. For example, it's possible the person was actually a hypochondriac. Yeah. They weren't actually sick in the first place. Yeah. It's possible that some people get better with no treatment. Yeah. It's possible that some diseases do treat themselves and just get better over the course

of time. Yeah. And if, if you overlay a placebo effect or a placebo and, and you put that over the same course of time, it's going to look like it was the placebo that did it when really it just healed itself. Yeah. Which is why critics call for studies where there is one group that is not given any medication whatsoever.

Right. Exactly. Which makes sense. So one of the other criticisms though is that if a doctor is saying, and there are like you said plenty of doctors who do this, there were studies that found that a 2007 study from the University of Chicago found 45% of 200 doctors surveyed in the Chicago area had prescribed placebos before. Yeah.

At some point during their career. And in 2008, they did a little more robust one, 600 doctors all across the U.S. and half of them said that they had prescribed placebos. So this is like, this is still going on. It's a thing. It's pretty widespread. Yeah. And the criticism is, well, that means doctors are lying to their patients.

They're using deception to practice medicine and that's unethical. So the AMA came out with a guideline that's kind of flies in the face of the placebo effect or the idea that if you give somebody a placebo and tell them it's a placebo, that it shouldn't work, which is not necessarily true. Yeah. In 2006, the AMA came out and said, quote, physicians may use placebos for diagnosis or treatment only if a patient is informed and agrees to it, to me, that means it's not a placebo.

I mean, I guess it is, but if you know it is, I don't get it. Like what's the point of a doctor coming in and saying, I'm going to give you the sugar pill. Right. Would you like a prescription for sugar pills? And you say, yes, I would. Supposedly there are studies that show the placebo effect is still possible. Still works.

Yeah. Sometimes. I mean, across the board, pretty much everyone believes that if the placebo effect is a real thing. The cat's out of the bag. It is part of the imagination. Yeah. And that you do kind of have to fool the person into thinking that it's a real thing.

The expectation coupled with imagination provides the placebo effect. Yeah. And this article points out too, we're not just saying these doctors are lying liars. Maybe one tech that a doctor can take is to say, I have something that I think can help, but I don't exactly know what the deal is with it or how it works, but I'll give it to you if you want to try it. And you know how people are. A lot of people are like, sure, I'll try anything.

Right. Exactly. That's not really deception because if the doctor's prescribing a placebo, he or she obviously does believe in the placebo effect. So here she does think it could work, but doesn't know how. Or if it really does work in 30% of the population, then you've got a 70% chance of striking out anyway with this course of treatment. Right.

So your bacteria started to begin with. Yeah. And again, that falls into the what's the point category. Now again, we should say that a lot of physicians who do prescribed placebos aren't just doing it to toy with their patients. They're doing it because they think that their patient will suffer more without it or they just don't have anything that could be used to address the patient's problem. They can't find anything medically wrong with the patient, but just saying that the patient's

not going to help. So here's a sugar pill. The other attack that a doctor can take to Chuck is to say, hey, new patient, welcome to my practice. Let me tell you about the placebo effect. And in the course of me treating you sometime during your lifetime, I may find that a placebo will be the best thing to use. Are you okay with me doing that to you at some point possibly?

Basically like signing up for my own personal long-term study as a doctor. But wouldn't you from that point on be like, you just gave me the placebo to each other. It's a placebo. Yeah. I know it's a placebo. I wouldn't know which way it was up. I don't know how to feel. That's the drug.

Better, worse, side effects, none. And the other attack doctors can take is to knock off early and go hit the golf course. They do that one a lot. On TV, that's an old bit. Troupe. It's like, yeah, cops in their doughnuts. Is it? Doctors in golf?

Yeah. I think that one's pretty accurate. I mean, in Caddyshack, the doctor was Dr. Beeper. Yeah. He was the one who just got mad all the time, right? No, that was Judge Smales. Dr. Beeper was, he was just one of the guys, one of the foursome. Okay.

That I think he played. Was it Buck Henry? Was he the doctor? No. I can picture the guy. It's Buck Henry, right? Is that who you're picturing? No, I don't think so.

We'll figure this out offline. How about that? Yeah. All right. If you want to know more about the placebo effect and believe us, there is plenty more to know about it. You can type those two words in the search bar at HowStuffWorks.com. Since I said that, it's time for Listener Mail.

I'm going to call this Australian last name. This is, he says, dear Josh, Chuck, and Jerry, and anyone else I should thank, and I think we never mentioned other people that support us. Didn't we already talk about an Australian last name? Yeah, that was the joke. Oh, okay. It's called a callback. Gotcha.

I just felt like deja vu. Listener Mail though made me realize that we don't thank other folks a lot besides Jerry and like Noel and Matt, but let's do that now. Okay. Like Rebecca. Mm-hmm. Rebecca is, what's her official title? I don't even know what titles are around that.

Producer, web producer maybe? Yeah. I mean, she handles our website and makes everything look great. And Sherry, even though we do our own social media, Sherry does social media for HowStuffWorks. Yeah, and she like throws to us a lot. Throws to us and helps us out a lot. And Joe, our buddy Joe, is a huge help. And that's kind of the crack staff.

I mean, we're answering our own emails and we're doing a lot of our own stuff, but it doesn't mean we don't have help. You know what I'm saying? There's tons of help. So you know, I just want to say thanks to those people. That is very nice of you, Chuck. Thanks everybody. I figured six years in, seven years in, we might as well shout out some of our help.

So this is from Alex and he said to thank anyone else he doesn't know about. And he's from Perth, Western Australia, which is nothing like Eastern Australia. I'm a 19 year old aspiring electrician, trapped in the depths of Western Australia's mining downturn. Due to layoffs in the mining sector, I've been unable to find an apprenticeship and I would have lost hope if it weren't for you guys. I was just after New Year's, it was just after New Year's January 6th, 2014, when I came across the magical production called Stuff You Should Know, at the time of this writing,

it is May 10th. And I have finished the epic adventure of 600 episodes plus. That's in a very short time, my friend. Yeah, it is. It's been an amazing journey and I want to thank you for pulling me through the hard days of resume writing and delivering long days of waiting previously were mind numbing, but have since been filled with interesting, insightful, and overall incredible, enjoyable content.

My favorites, Gene Pattons, Lobotomies, and the masterfully dictated Halloween episodes. We like those too. Those are some of my favorites. A little Christmas, I think, is the best. So cue the existential crisis after you guys forming such an integral part of my life over the past five months. I don't know how I'm going to acclimate myself to just two a week. And we hear that a lot from people who mainline the show.

Yeah, there's like a withdrawal period. Yeah, and I've done that with TV shows, you know? I do that with Fresh Air. You mainline it and then you're like, I need it. Yeah. Yeah. I would just like to sincerely say thank you to both of you and Jerry and anyone else for pulling me through these times and hope the future contains a stable job for myself,

more content for yourselves to pass on to the stuff you should know Army and an ever-growing fan base that you can both woo with your dulcet tones and enlightening information. Yours faithfully, that is Alex Giddings from Peth. Thanks, Alex. Yeah, Alex. Yeah. Yeah. Thank you very much.

I hope you get a job, buddy. Yeah, for sure. If you're in Perth and you're looking for an electrician, contact Alex. He's shockingly good. Nice chuck. So terrible. We're ending on that one. If you want to get in touch with us, you can tweet to us at S-Y-S-K podcast.

You can join us on facebook.com slash stuff you should know. You can send us an email to stuffpodcast at howstuffworks.com. And as always, join us at our home on the web, stuffyoushouldknow.com. Stuff You Should Know is a production of iHeartRadio's How Stuff Works. For more podcasts from iHeartRadio, visit the iHeartRadio app. All podcasts are wherever you listen to your favorite shows. On the podcast, Hey Dude, the 90s called David Lacher and Christine Taylor, stars of the cult classic show Hey Dude, bring you back to the days of slip dresses and choker necklaces.

We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called on the iHeartRadio app, apple podcasts or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation?

If you do, you've come to the right place because I'm here to help and a different hot sexy teen crush boy bander each week to guide you through life. Tell everybody, everybody about my new podcast and make sure to listen so we'll never ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the iHeartRadio app, apple podcast or wherever you listen to podcasts.