The Jordan Harbinger Show - 716: Jo Marchant | Placebos and the Science of Mind over Body

Episode Date: August 25, 2022

Jo Marchant (@JoMarchant) is an award-winning journalist, speaker, and author of The Human Cosmos, The Shadow King, and the New York Times bestseller Cure: A Journey into the Science of Mind over Body. [Note: This is a previously broadcast episode from the vault that we felt deserved a fresh pass through your earholes!] What We Discuss with Jo Marchant: How to understand the power of placebos. How your immune system can be trained. Why stress kills and how to beat it. The importance of social relationships and how to boost them. Does believing in God make you live longer? And so much more… Full show notes and resources can be found here: jordanharbinger.com/716 Sign up for Six-Minute Networking -- our free networking and relationship development mini course -- at jordanharbinger.com/course! Did you hear our conversation with Desmond Shum, the former CCP insider and former husband of disappeared Chinese billionaire “Whitney” Duan Weihong? Catch up with episode 684: Desmond Shum | Wealth, Power, Corruption, and Vengeance in China here! Like this show? Please leave us a review here -- even one sentence helps! Consider including your Twitter handle so we can thank you personally!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This episode is sponsored in part by Conspiruality Podcast. You know how I'm always talking about critical thinking and spotting manipulation? Well, there's a podcast that's all about dismantling new age cults, wellness grifters, and conspiracy med yogis, basically the wild overlap of spirituality and misinformation. It's called the Conspiruality Podcast. The hosts, a journalist, cult researcher, and a philosophical skeptic, dive deep into how this stuff spreads, from Project 2025 and the Heritage Foundation's dystopian vision of the future to how former leftists get pulled into far-right conspiracies.

An interesting episode to checkout is called Speaking Truth to Goop, where Jen Gunter breaks down the pseudoscience behind the wellness industry in a way that is super entertaining and eye-opening. It's sharp, funny, and makes you a lot harder to fool, which, if you listen to this show, you know I'm all about that. From exploring cults to analyzing our cultural and political landscape, the Conspiratuality Podcast will help you stay informed against misinformation and resist fear tactics.

Find Conspirality on Apple Podcasts, Spotify, and wherever you get your podcasts. Coming up next on the Jordan Harbinger Show. There is another type of placebo effect, which relies not on your conscious expectation, but more of an unconscious learning process, where if you take a drug several times, your body learns the physiological response to that drug,

and then if you take a placebo, your body automatically triggers that same physiological response. Welcome to the show. I'm Jordan Harbinger. On the Jordan Harbinger show, we decode the stories, secrets and skills, the world's most fascinating people. We have in-depth conversations with scientists and entrepreneurs, spies and psychologists, even the occasional former cult member, investigative journalist, economic hitman, or astronaut. And each episode turns our guest's wisdom into practical advice that you can use to build a deeper understanding of how the world works and become a better thinker.

If you're new to the show or you want to tell your friends about it, and I love it when you tell your friends about it, I suggest our episode starter packs. These are collections of our favorite episodes organized by topic, and they'll help new listeners get a taste of everything that we do here on the show. Topics like persuasion and influence, negotiation and communication, abnormal psychology, investing in financial crimes, technology and futureism, and more. Just visit jordanharbinger.com slash start or search for us in your Spotify app to get started. Today, one from the vault from a couple years back that I particularly enjoyed.

We're talking with Joe Marchant, author of Cure, a journey, into the science of mind over body. Now, we're talking about the placebo effect. There's nothing magical here. A lot of people like to equate magic with the mind over matter and all that stuff. No, this is a, it's kind of like a kiss and make it all better kind of thing. Is that real? How do regular emotional states influence our health? What can the mind really do? How and why it works? And more importantly, perhaps, what are the limitations of the placebo effect? We see a lot of pseudoscience lately about the placebo effect. It cured me of this. It helped me with this other thing. whatever, cancer. Some of it's real, some of it just is not, and it's very dangerous to confuse the two.

Last but not least, how can we use these latest findings in our own lives and harness our very own placebo effect? I hope you all enjoy this one from the vault with Dr. Joe Marchant. So, Joe, tell us what you do in one sentence. I'm a science journalist and author. What I really like about this is you're not just a writer. You've got a PhD in genetics and medical microbiology. And so you write about things that you actually know about. This isn't kind of like, oh, I'm going to write about stuff and then exaggerate a lot of it so it's more interesting. Yeah, I'm a scientist by training. So seeing the evidence is really important to me and being rigorous

is really important to me. I do sometimes delve into subjects that I wasn't an expert on before. And I think that that helps me to kind of bring together different points of view rather than following anyone agenda, but the actual sort of methodology of the science and the reliance on evidence I feel question about. In the book, Cure, you talk a lot about several different topics, one of which is the placebo effect. And I found this super interesting because I always thought the placebo effect was what happens when you get kind of unsophisticated people, you give them sugar pills and they imagine results and everyone quietly snickers behind their back and says that the real drug that we were testing is a bunch of malarkey because the placebo effect did the same thing.

But what your book is saying or what it seems to be saying is that not only is placebo effect, just as real as most effects from any other real, quote unquote, real drug, it's actually not only more useful in many cases, but more natural, safer, and sometimes the only thing that actually works. Yeah, that's a very good description you just gave actually of the kind of conventional view of placebos, that if somebody gets better after getting a fake treatment, then either they would have got better anyway or they've somehow been fooled into thinking that they feel better even if nothing's actually changed. But yeah, the really interesting thing that's coming out of the research now, including brain scanning and those kinds of studies,

is that when somebody responds to placebo, you see these measurable biological effects happening in their brains that are identical in many cases to the changes that you get with drugs. So when someone responds to a placebo painkiller, neuroscientists can see the release of endorphins in the brain, which is exactly the same pathway that opioid drugs, things like morphine, work through Parkinson's patients. When they respond to placebo, they get a release of dopamine, mean in the brain, which is the neurotransmitter that they're lacking. So again, it's the same pathway as the drug. And so again and again, researchers are finding. We don't imagine the improvement that we see after taking a placebo. It's actually a real biological change.

This is big news because, or at least in my opinion, because people often think things that happen in the mind are often sort of magical or woo-woo or maybe not even real. And somehow science can't explain it. Or if science can't explain it, it's usually explained by, yes, what happening is you're a moron and you believe stupid things and this is ridiculous and get real and take this new drug or this other drug or just get ready to die a slow painful death. And this notion is both behind quacky claims of miracle cures as well as on the far other side of this argument, the skeptics arguments that thoughts can't influence health and anybody who believes so is full of crap or easily diluted. Yeah, the quack claims, I think underlying that is this idea that we've got this

mysterious, magical force of the mind that doesn't need to obey scientific rules and therefore it can pretty much cure anything. And I think the skeptics are like, well, the mind couldn't possibly cure anything. Again, they've got this idea of it as some sort of ephemeral thing. But yeah, for me, the scientific view is that the mind and the body are entwined. And if you have a change in the body, you have a change in the mind. If you have a change in the mind, you have a change in the body. So the mind is working through defined biological pathways that we can study scientifically. And often these sort of natural biological pathways that are happening in the brain and the body, these are the same pathways that we take advantage of when we're using drugs as well.

So there's nothing kind of magical about it. It's just the way that we've evolved, essentially. So let's talk more about the power of placebos. I mean, it seems like conventional thinking, going back to what we'd said earlier, is that if a treatment works no better than placebo, it just doesn't work. And that's not really the case anymore, or at least that's what you're arguing is no longer the case or has never been the case. Well, if such treatment works no better, rather than placebo in a trial, it tells you that that treatment isn't working necessarily the way you think it's working. So if you take acupuncture, for example, or homeopathy, and you can test those against placebo or fake versions of themselves, and there's no difference, then it tells you

that those needles aren't really doing anything or that homeopathic remedy isn't doing anything. But that doesn't mean that it isn't working because placebo responses themselves aren't all the same. Some can be larger than others. And they can be actually larger than the responses you'd get was conventional treatment. So there's a very interesting trial in more than a thousand patients with chronic low back pain. So a really big trial. There was no difference in that trial between acupuncture and placebo acupuncture. So this is a kind of fake acupuncture where the needles go in the wrong places and they don't properly penetrate the skin. So scientists would usually say, oh, well then it's worthless. It doesn't work. Throw it out. But in this trial,

there was a third group. The third group got the conventional treatment, including the drugs, the pain killers. That group did barely half as well as either of the groups. The got the acupuncture. So a placebo-controlled trial tells you something about the way in which a treatment is working. But just because something is no better than placebo doesn't mean that can't actually be helping patients quite significantly. So I think we have to change our attitude a little bit to the way that we interpret these trials and to how we think about what it means for a medicine to work or to not work. Right. So this almost shows more about what scientists maybe don't know about how the body works and how the brain works to respond to, say, pain versus this just not being a

real thing, right? This is just not being a real cure or being quackery. Yeah, like we need placebo control trials to tell us whether drugs are working through direct bychemical effects, and that's fine. But what we're doing at the moment is throwing out everything else, because everything else is in the placebo group. But actually, particularly when it comes to symptoms that we experience, things like chronic pain, particularly, but also nausea, fatigue, depression, all of these things that have to do with quality of life. The brain plays an incredibly important role. Our minds, our attitude, is really important. And so we're throwing out all of the very things that could be helping us. There's a lot of research now that's going into, well, how can we use these placebo effects to help people with those

symptoms? When it comes to health and conventional science and medicine, why do you think that we tend to ignore or downplay the effect of the mind on the body? Why do that when we're looking for results? I think there's quite a lot of things going on there. I mean, one is just, I think there's a lot of prejudice in science that anything to do with the mind, subjective things are kind of flaky and not very scientific. And possibly that goes back to Descartes, even the philosopher in the 17th century, who kind of divided stuff into objective, physical, measurable things that could be studied scientifically. And then the subjective thoughts, beliefs, you know, the stuff of the minds that he thought could not be studied scientifically. And no neuroscientist, there was really,

respected today would really argue that we have such a split. You know, every different sort of mental state or thought that we might have is reflected by a physical change in the brain. But I think there's still a hangover from that that scientists don't think that anything that's subjective, like pain, for example, is really very scientific. I think it's also to do with where the money comes from in trials because the vast majority of clinical trials are funded by drug companies. And so you wouldn't really expect them to be carrying out trials in mind-body therapies

or anything that's going to reduce their reliance on drugs. But if you're going to base your medicine on evidence, then the evidence you end up basing it on, it's going to depend on what trials you do, and that depends on who's paying for them. So it's kind of a self-fulfilling prophecy, if you like, that we end up with most of our medical care based on physical treatments and drugs that you can sell.

So basically, if I'm a drug company and I'm paying for the trial, I don't want to prove that sugar pills that convince you to do things can heal you. I want to prove that this chemical that I've worked on that cost me hundreds of millions of dollars to research, is the only option that you have. So prove that. I don't want to prove the other. In fact, I probably want to argue against those other things, but the best way to do that is simply to drown it out or make sure that it doesn't get any oxygen. Yeah, and I don't think we can necessarily blame them for that. You know, that's just the job that they do. Their drug companies, you know, I don't think we

should be relying on drug companies to tell us everything we need to know about what's effective medical care. I think we need to find maybe other funding streams or other ways of doing this. So it's not a case of I think drug companies are evil and we should blame them for the whole thing. I just think that it's a really bad idea to rely on them for all of the evidence that underlies our medical system. Right. It's kind of like relying on a coal company to say, by the way, have you guys seen solar energy? We could totally improve on this and we would have no need for all this oil that we keep drilling. There's no incentive for them to do that. Yeah, or letting all of your research for sort of good nutrition come from companies that make sugar.

You know, it just doesn't make sense. Yeah. Whether it's nefarious or not, the hashtag capitalism here. says, look, look where the incentives lie. And the other thing that tends to push mainstream opinion away from any kind of alternative healing, and I mean alternative healing, and I'm taking a wide swath of this, because I don't want placebo effect to get mixed up with snake oil, literally or figuratively. And I think the new generation, people my age now often would not be surprised that our emotional state might be important in warding off disease.

Depressed people get sick more, people who are happier, live longer. I mean, this is not news for an ever-growing segment of the population. And the idea that our minds have quote-unquote healing powers, it's seen as so flaky because of the snake oil that we've seen in the past. Yeah, I think we absolutely have to have a scientific approach. So I don't think we can just say, oh, the mind's great. The mind can cure everything because it doesn't cure everything. There's streets of limitations on what the mind can do.

Sometimes it can have a very surprisingly dramatic effect. other times it doesn't have any effect at all. So we need to know when it works, in which situations can we try to harness that. So we don't want to get it mixed up with snake or I think we absolutely have to base it on the scientific trial. And I think the science that you write about in the book acknowledges the role of the mind and health and thereby hopefully, as you write,

rescues it from the clutches of pseudoscience, which is I think kind of what we're trying to do here a little bit today. Tell us what the placebo effect can do. And then let's talk about what it cannot do. Because that dividing line where the limitations exist is kind of where the rational and sane of us get off in the snake oil salesman we're talking about here continue to go down the path of this can cure everything. Don't go to the doctor.

You know, cure your cancer with this drink I made out of a pomegranate or whatever the hell these guys are selling. Yeah. So one thing to know about the placebo effect is there's not just one placebo effect. There are many placebo effects. So depending on the circumstances, you can get different biological changes happening in the body, so depending on how you believe your condition is going to change. And there's two main ways in which placebo's work. One is through conscious expectation. So yeah, this knowledge or

belief in a treatment that you're taking. And that works best for symptoms that we're consciously aware of. So things like pain, nausea, fatigue, itching, wheezing. It can include objective visible changes, things like rashes and swellings, which was a real surprise to me. I haven't realize that before I started looking at all of this. But generally things that you're consciously aware of. So your just belief or expectation in a pill doesn't seem to have much effect on, say, the immune system or your cholesterol levels or your blood sugar. So things that we're not consciously aware of. And, you know, taking a placebo is not going to be able to suddenly magically produce a chemical that your body isn't normally capable of making. So,

you know, insulin and a patient with diabetes, for example. It's not going to help sort of save your body when it's overwhelmed. You know, it's not going to shrink a tumor. It's not going to banish a serious infection. So it's mostly to do with quality of life, pain, depression, nausea, fatigue, those kinds of things. There is another type of placebo effect, which relies not on your conscious expectation, but more of an unconscious learning process where if you take a drug, several times your body learns the physiological response to that drug. And then if you take a placebo, your body automatically triggers that same physiological response. It's a little bit like if I asked you to imagine biting into a lemon

and sinking your teeth into that lemon and sucking down that juice. And if you've eaten a lemon before, you might start to feel a tingling at the back of your mouth where your saliva glands switching on. They're producing extra saliva in preparation for that lemon juice.

And that's not something that you've kind of consciously done. It's just an automatic response that your body has learned to lemon juice. And the same thing happens with other drugs. And this kind of learned response, that can reach further into the body if you like, that does affect immune responses, hormone levels, a much wider sort of range of basic physiology, the basic processes of disease, if you like. And so what we need to try and do if we want

to harness placebo responses is trying to use those together in a clever way. So you could have presciboes for depression or pain, for example. And there are Charles now suggesting that actually honest perceivos work too, that just taking a placebo might give you a significant response. Whereas if you want to take an immunosuppressant, if you're a kidney transplant patients, there are studies going on in this right now, you might have a regime where you give somebody a drug several times so that they learn the response and then you can use a placebo to get the same clinical effect without the drug dose so you're reducing the side effects of those drugs. You're listening to The Jordan Harbinger Show with our guest, Joe Marchant. We'll be right back.

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guest on the show already subscribe and contribute to the course. So come join us. You'll be in smart company where you belong. Now back to Dr. Joe Marchant. Right, so we're looking at certain types of drugs or placebo, I should say, that release endorphins that block pain. And this is just a biological machination inside your brain that happens. It's you push the A button and B comes out, right? Endorphins are released when this happens versus or in addition to what sounds like a Pavlovian response where you've trained your body to release certain. types of the immune system that you just mentioned to ramp things up when XYZ substance is inside our body. So can we do something like I take this red pill that tastes a certain

way and it actually has something that boosts my immune system? Then I take it again a few days later, except it doesn't have that substance in it, but it looks and tastes the same. Do I start to then feel similar effects? Exactly. That is very, very similar to the trails that are actually being carried out. They're actually using a green drink rather than a red pill. But Yeah, it's exactly what you're suggesting. So you could either take a pill that boosted the immune system or actually what they're using are pills that suppress the immune system because for patients with autoimmune disease, for example, or organ transplant,

you know, there are a lot of people who need to take immunosuppressants and they have horrible side effects. So the idea is you train the body to respond to the drug and then you can get the same response with your placebo. So they're getting the immunosuppression they need without the toxicity of those drugs. And it's something that you could probably do. I mean, it works with pain as well. Parkinson's disease is another one where it's being looked at, that you could have a blister pack of

pills and you don't know which ones are the presciboes, which ones are the drugs. It's just mixed up together. The idea is you end up with the exact same clinical effect, but with a much lower drug dose. So the placebo effect isn't just one effect. It's a melting pot of responses from what it sounds like. Yes. I mean, essentially the brain is controlling all the time lots of different aspects of physiology. So, you know, the symptoms that we experience, things like pain and fatigue, Those are created and controlled by the brain. The brain produces different neurotransmitters, things like endorphins, things like dopamine, prostaglandins, cannabinoids, all of these chemicals that are being produced by the brain that kind of pushing our symptoms up and down, regulating

how we feel in response to the environment. And that can be in response to physical signals, like, you know, results of infection and injury. But also our psychological state, you know, the information that we're perceiving about our surroundings, our mental state at any particular time, that's also pushing those symptoms up and down. So these thoughts and beliefs and emotions, whether you're stressed, whether you're worried about something, whether you feel safe and cared for. All of this is causing different neurotransmitters in the brain to be released,

which is changing the levels of those symptoms that we experience. And then when it comes to other aspects of physiology like the immune system, again, the brain is in constant two-way communication with the immune system, determining how the system should be regulated depending on our environment. With the immune system, it seems that our conscious thoughts don't seem to play such a big role, but these learning processes do. So again, it's understanding how is the brain interacting with these different things, whether it's pain, whether it's immune responses, what are the mechanisms?

And then we can develop ways of sort of cleverly pushing things in the way that we want them to go without sometimes the use of drugs. So is the placebo effect then limited to the maybe natural tools that the body and brain have available? because it sounds like our body's doing all the work, really. Yeah, absolutely. That is the main limitation that you can only work within the natural limits of the body's physiology. Obviously, if you've got a drug, you can give much higher doses of something that the body could

ever make. So you can have more powerful effects. But then you also get into the realm of problems with side effects, tolerance, addiction. So you can have bigger effects, but there's also much greater dangers. And so generally, if we have an effective medical treatment, then I don't think it makes sense to suddenly switch to placibos because obviously we get placebo effects when we take real drugs as well. You've got all of those same expectations, all of that's happening. So what you'd want to do is take the effect of drug and then you've got the active biochemical effect of that

drug and you've got placebo effect. So that's great. But there are lots of conditions where conventional drugs don't work very well and where placebo responses are large and where actually there are quite significant downsides to taking drugs, so things like side effects and addiction. And so examples of those kinds of cases are chronic pain is a very good one. Most of the painkillers we have are not actually very effective for chronic pain, but you've got huge problems with addiction. And we know that presciboes are very effective in pain. Depression is another one.

In all but the most severe cases of depression, there's practically no difference between antidepressants and placebos, but the drugs have significant downsides. So in these kinds of cases, researchers are saying, actually, it might be worth offering people placebo before progressing, if necessary, to the active drug. Yes, this is interesting because it sounds like not only are the limitations totally appropriate because our brain and body can do so much for us, but it sounds like some of the most severe

things that humans find themselves afflicted, such as chronic pain or depression and things like that, are actually better served by solutions that don't involve harsh drugs with harsh side effects. Yeah, I think so particularly chronic conditions. So even in acute pain, you can use the mind to give people extra pain relief on top of the drugs that they're being given. So in acute burns patients, for example, researchers are developing virtual reality worlds that can kind of compel patients' attention to reduce their pain. And that's used with drugs. So you can use the two together to kind of get more pain relief overall than you would have been able to.

But in chronic conditions, actually it seems that it's often people are in pain and there's no obvious physical injury or perhaps they had an injury and it's healed. but they're still in pain. And here it really does seem to be the brain that's kind of perpetuating that pain that they're in. This is one reason why giving people those drugs long term actually isn't very effective. So in these cases,

it really does make sense to start looking for other approaches. Taking a placebo is one approach. You know, it was always thought that that's not ethical because you have to think that a placebo is real for it to work. The doctor has to lie to you. But now in trials, they're finding out that actually honest placebo

is where you know it's a placebo work too. So that's one option. But then there are also lots of other ways that we can use that knowledge about the importance of the brain to develop other techniques, whether that's improving care in medicine. That's something we haven't talked about yet, that studies of placebo effects are showing that the sort of quality of the interaction with the practitioner, that human care that you get is very important for triggering large placebo effects. So just giving people better care, regardless of the actual treatment, would be important. We can use alternative medicines as a way of harnessing placebo effects. Some people suggest that. or we can develop these completely new techniques like the virtual reality I mentioned.

Taking some placebo pills as one option, but there are lots of other ways of triggering placebo effects, even things like cognitive behavioural therapy or mindfulness meditation, which is shown to be very effective for chronic pain, for example. It's just a way really of changing your own attitude and triggering your own placebo effects, if you like. You've mentioned that showing people additional care and things like that. It helps to utilize the placebo effect. So basically, kind of reducing this down to absurdity, it sounds like kiss it and make it all better

in terms of a kid falling down and scraping his knee is actually kind of legit. Yeah, I mean, I have two young children, and I really like knowing now that if they fall over and hurt themselves, they kiss it better, that's actually doing something biological. I know that that is having a concrete effect to reduce their pain. You know, I'm a mum. I would have kissed them better anyway, but I quite like knowing that that is the case. But even among adults, there's some very interesting research coming out of Harvard University, for example, where they're trying to really tease apart what are the active ingredients of these placebo effects? You know, can we isolate them and maybe incorporate them into conventional medicine. And so I can give you just a couple of quick examples. There was one study in patients with irritable bowel syndrome where one group got no treatment. One group got sham acupuncture from a practitioner who was sort of polite but cold, didn't really talk to the patients. And one group got sham acupuncture from a practitioner who was warm and empathic and like asked them lots of personal questions and listen to the

answers and touch them on the arm. And that group got hugely more relief from their symptoms than the group that got the same sham acupuncture but with a cold but polite practitioner. That group also did better than the no treatment group. So there was something about the needles that triggered a placebo effect. But then that interaction with the practitioner was very important. There was one other study in acid reflux disease where the researchers looked at the difference between a homeopathic. remedy and a placebo, there was no difference between the two. But they also looked at the difference between a standard 18-minute consultation with the doctor and then a longer 42-minute consultation with the doctor, the sort of long, personalised consultation that you might have with a homeopathic

therapist. In that first group with a shorter consultation, 17% of them said their symptoms were at least halved. In the group with a long consultation, that proportion jumped up to 75%. So I think we all know that being cared for kind of helps and makes you feel better. But it's just how dramatic that difference can be. For me, that was really surprising that, you know, acid reflux disease is not usually thought of us. It's not a psychosomatic condition. It has a real physical cause and can be very distressing for people. But just having that change in the consultation, regardless of the actual treatment they were getting, made a huge difference to their outcomes. So you end up with things that formerly took really hazardous drugs to control. And we end up with essentially,

zero side effect benefits from placebo. But on the other side of that same coin, since it is limited to what the brain and body can do, what are some examples, actually, things that we can't change? I mean, I'm thinking cholesterol or blood sugar, are those things that we can help with placebo, or is that just, hey, look, this is the machinery, we can't ignore it? Yeah, so there's no evidence, as far as I know that placebo statins is going to change your cholesterol level, for example. that doesn't seem to be controlled by the brain. I think blood sugar levels as well. So the brain can only change things where it's got a pathway or a mechanism for doing it,

if you like. And generally the brain is controlling physiology through the autonomic nervous system, which leads to lots of different sort of organs and pathways in the body, including the cardiovascular system, the digestive system, the immune system. So all of these things in theory, the brain can change and regulate. and then we can use the mind to sort of feed into that. We can't necessarily will these changes consciously. You can't just suddenly say, oh, heart beat faster now, please.

But if we're scared, you know, that thought can trigger that change. So that's one limitation is that you can't just will these things to happen. You can't will your immune system to change in a certain way. You can't wish your pain away. But we can find clever ways to use the mind, like visualising the lemon that I mentioned earlier, like the percebos with the immunosuppressants, we can find ways of influence. influencing these things. But yeah, things like cholesterol and blood sugar and just cancer, for example, you can use the mind certainly to improve quality of life and help with pain and nausea and fatigue

and that kind of thing. But there's very little evidence for a strong placebo effect when it comes to actually shrinking that tumour. So this is not a case of throwing out physical treatments. We still need physical treatments. There are lots of things that drugs can do that the mind cannot do. But I think we've gone too far the other way. We're in a situation where we're using drugs for everything regardless, and we're using much higher doses than we need to. So by incorporating the power of the mind back into medicine, I think that would help us to just reduce that reliance on drugs and physical treatment that's going to be better for everybody all round. Right. It reminds me of, is it Chris Rock, who has that bit, it's like, they got drugs for

everything. Are you hot? Are you cold? Are you too skinny? Are you too fat? It's something like that. Yeah, we're using drugs for everything. And when I was a kid, which was a long time ago, but not that long ago, I mean, in the 90s, that was when I remembered drug commercials coming on TV. They've gotten more and more ridiculous as the years have gone by and now watching them, having not entirely my whole life grown up with them, but having watched way too much TV and being able to pay close attention, it's just kind of ridiculous some of the things that you end up getting drugs for. Ask your doctor about this. Everybody has that. But then if you listen to the side effects, which the VO guy, the voiceover guy does really, really quickly and the same monotone,

It's like, who wants to risk leaky, you know, insert the blank here because they wake up at night sometimes when they're not supposed to. I mean, it's just complete lunacy to me. And I'm not anti-drug. I'm a little bit more anti-drug probably than the average person, but I'm not crazy with it. And I'm certainly not someone who goes to do natural cures all the time, especially if there's no science behind it. But I love the balance that you took with the placebos. of course, just because the benefits mediated by placebos are mostly subjective,

you argue that they still have potential value for medicine, and that leads to the question that why aren't practitioners using more of this? I think it might be partly just because the evidence base, so far, a lot of the studies are fairly small, or we have the kind of

the basic science to understand the mechanisms in an experimental setting, but those trials that you need to really translate that into medicine aren't always there, and I think that It's partly a political issue where people who are giving out the grants find it hard to get their heads around this kind of work. A lot of the researchers I spoke to said they find it really hard to get funding for the work that they're doing. Yeah, the funding that we mentioned for the clinical trials where most of these are carried out by drug companies.

So there's just a lot of obstacles against doing the work that needs to be done to really translate this into medical care. I think the upside is that a lot of this we can look at as individuals. You know, I certainly feel that I can incorporate a lot of this into my own life in terms of, you know, the way that I view my own symptoms now, I would say has changed. So I still listen to the symptoms if I'm in pain or I'm tired or, you know, feeling ill or whatever. I don't have to be controlled by it. I don't have that anxiety of, oh, no, I'm in pain and it's going to get worse. And, you know, I've been able to realize that when we experience symptoms like pain, it's not always an accurate reflection of the injury or the damage, if you like. it can be vastly amplified by our anxieties.

So I think that's kind of empowering, really, to know that my mental state can control that or, you know, through distraction or mindfulness or other techniques, we can reduce the pain. We don't have to be ruled by it. This is the Jordan Harbinger show with our guest, Joe Marchant. We'll be right back. Thank you so much for listening to and supporting the show.

I love the fact that I get to have these conversations with slash for you and your support of our advertisers keeps the lights on around here To get all of the deals you hear on the show, all the discount codes, all the little URLs, they're all in one page. Jordan Harbinger.com slash deals is where you can find it. You can also search for the sponsors using the search box on the website as well. So please consider supporting those who support us.

Now for the rest of my conversation with Joe Marchant. If the placebo effect is regulated by the mind, does this mean that in different types of minds, for example, different cultures, we see different placebo effects, different degrees of it maybe? Yes, absolutely. There are big cultural effects. Pacebo effects aren't anything to do with the placebo itself. You know, take a sugar pill. There's nothing in it. It's inert. They can't do anything. What triggers the placebo effect is your response to that treatment. So what it means to you. And obviously, that can be different between different people, different situations and different cultures. So one really nice example is that red or pink pills tend to trigger particularly large placebo effects to the pain,

whereas blue pills tend to have more of a calming effect they're good for treating anxiety or helping you to sleep, except among Italian men. I don't know if you can guess why. I'm afraid to. They think that it's because blue is the color of their national football team. So for Italian men, the color blue is exciting and arousing rather than relaxing. So it's just to make the point that it's the meaning that it has for you as an individual

rather than anything inherent about the placebo itself. And because of that, people are going to respond. on differently to different presciboes depending on how you feel about them. So somebody who, you know, has a lot of faith in conventional medicine, for example, may well have a sort of very strong placebo effect for drugs that prescribe, whether it's for chronic pain or depression, you know, you might do very well on that. Whereas if you're the kind of person who's actually quite skeptical of drugs and worried about side effects and you much prefer the idea of alternative therapies or psychotherapy or whatever, you're probably not going to do very well on an antidepressant or a painkiller. You're probably

going to do better on the therapies that you feel more comfortable with. So particularly for these conditions where most of the response to the treatment is actually placebo effect, it's worth shopping around and thinking about what appeals to you. What do you have high expectations for? You know, the trials show that the people who are feeling engaged with their treatment and have high expectations for it, who do better, who have these strong placebo effects. Another thing I would say is that this social interaction with the practitioner is so important. So again, it's worth finding a doctor or a medical practitioner that you at least respect and trust rather than somebody that you feel that you don't get on well with. And different kinds of

medical practitioner are probably going to appeal to different people. You know, some people want a very authoritative physician who's just going to tell them what the matter is and tell them what they're going to do about it. Other people want to have more of a sort of equal dialogue. So again, it's finding what suits you and it's going to make you feel the most confident about how your condition is going to improve. One thing that I thought was super interesting was that that we're experiencing the placebo effect with any drug. Even quote-unquote real drugs, you still have the placebo effect happening. We discussed that with things like antidepressants and pain meds, but I still don't quite understand why. Even if people know it's a placebo,

it can still work. How is that possible? Why does that happen? This is really interesting, isn't it? Because the absolute dogma about placebos until about five years ago was that you have to think it's a real treatment. You have to be fooled for it to work. And therefore, for doctors to prescribe it, they'd have to lie to patients, that would be unethical. So one's been like, well, placebo effects is all very nice, but we can't use it in medicine. And then, just in the last few years, all these trials have come out showing that you can give people a placebo and tell them it's a placebo, and they still feel better, which seems really crazy to start off with.

So there was a trial in 2010 was the first one, I think, in irritable bowel syndrome. They gave patients sugar pills, told them they were sugar pills, and they did significantly better than the people in the trial who didn't get the sugar pills. That's now been shown in ADHD, in migraine headaches, in depression, and in chronic low back pain. And there are a lot more trials now in the pipeline as well. There are several possible reasons for this. One is that in some of these trials, they weren't just given the pill. The patients were given kind of like a little seminar on educating them on placebo responses and how they work and why a placebo might help them.

So similar to some of the stuff that I've been talking to you about. So it may be that it wasn't just the pill. that it's just believing in the placebo effect, if you like, is a bit like believing in a drug. You've got that expectation that the placebo is going to help you. That could be enough. It could just be there's something about being in a trial and receiving that medical care and attention and having that attention paid you by these top scientists and being looked after. That regardless of the treatment, even if it's a placebo and you know it's a placebo,

that human care is enough to reduce symptoms. Or it might be more to do with these automatic learned responses. telling you about. So if people have taken, say, painkillers in the past, their bodies learn the appropriate response. And then when they go into a trial and get a placebo, that response is triggered. Because the thing about these automatic learned responses is that they happen regardless of what you know about the placebo. It just happens anyway. It's probably actually a mixture of all those things. But the upshot is that it's just really transforming people's view about placebo from a kind of, yeah, all very nice, but we can't use it, into, oh, wow, this is something that we

could really start to use and harness in medicine. I feel like different cultures have their different placebos. In fact, my girlfriend, her family's Chinese. She's Chinese as well. One day I had a headache. I was, I was at their house and her mom's like, oh, I'll make you some tea that'll make the headache go away. And my first thought was, tea doesn't make headaches go away. What's wrong? Why do you prescribe tea for everything? Are you thirsty? Have some tea. You're not thirsty? Have some tea. Headache? Tired? here's some tea. And I drank the tea and she said, so your headache went away, huh? I was like, well, not yet. And then after a while it did. And of course, I'm like, well, of course my headache could have just gone away on its own. But I thought, what's the harm? I just read your book, by the way. And I thought, what's the harm in just believing that tea cure's headaches? I don't take Tylenol or painkillers anyway. I might as well have something else that, in air quotes, cures my headaches. So sure, tea cures my headaches. Why not?

So I never get headaches because I just drink tea, which I do all day anyway. And it's just something like, I've kind of thought, why not just program myself with this useful belief system? It's a little bit flaky because there's probably not a whole lot of actual mechanism going on here. But on the same token, I'm okay with it because otherwise I would just suffer through the headache and not care because I don't like taking things like Tylenol. And I was laughing at myself because I'm the last person who does this kind of woo-woo thing, but I thought, why not?

Why not go for it? I can't say whether or not it works, but I can say with a certain degree of certainty that there's hundreds of millions, if not more, Chinese people who believe that tea cures pretty much everything. Well, I agree with you. I think why not? I don't really agree with believing in these crazy alternative therapies that crystals are healing you or these kind of paranormal, I don't know, all these angels or past life regression, you know, these slightly mad things, because I think that's dangerous. That can lead you into rejecting perhaps conventional medicine when you needed it. But in terms of the mind, I don't think there's any harm in just working out what sort of beliefs and attitudes are helpful for you.

And we know, we know from study after study after study that if the expectation is hugely important in pain, if you believe that your pain is going to reduce, it will reduce. That's programmed into us. It's part of an evolutionary response, really, that if you're stressed or worried or anxious about an injury, your pain will go up because it's a warning signal. If you feel cared for and, you know, you believe that you've received effective medical treatment, your pain will come down because that's a signal for your brain that the crisis is over, it can ease off on that warning signal. So it's just programmed into us. So yeah, why not? Tea, whatever. Just find an attitude, an activity, a belief that works. I think we can all take

responsibility for harnessing that. We don't have to be passive recipients of pills. You know, we can engage in our own mental state and our own physical condition. And this is something I found very humorous. Studies show also that the more placebo costs, the better it works. showing probably because we believe that expensive treatments are more effective. And I thought to myself, we also see this with food, consumer products, technology, clothing. Maybe those aren't as measurable because they're not medical results, but I think almost anybody can agree with this. Anything that's marked up as more expensive and becomes, quote unquote, a luxury is somehow

a cut above, whether it's your iPhone or the latest computer that you've got, a type of car that you have, clothing that you have, but especially, and maybe this is just a California thing, food. Isn't that why Instagram started? People were posting pictures of their food on social media, and they thought, why not? It's a billion-dollar idea. They were right. We've got this sort of programming in our brain hardwired. The more resources something requires, the better it is, or the better it theoretically must be. Yeah, absolutely. I mean, we think of placebo effects to do with medicines, but it's actually every aspect of our conscious experience is being affected by our attitudes and our beliefs and our emotions and our expectations. We do construct our own

reality to a certain extent. I mean, obviously within limits, it's based on certain information that's coming into us, but how things taste, how things look even, depends on our sort of previous expectations. There was this picture of a dress and then people couldn't decide if it was white and gold or if it was blue and black, but it was exact same dress, but for some people that looks white and gold, for some people that looks blue and black. So that's where in vision, researchers are realizing that, you know, we play a huge part in constructing what we see in the world around us. It's the same with taste. It's the same as what we hear. So absolutely, in terms of price or other aspects of what we expect something to be, that can be a sort of self-fulfilling

prophecy. Or if you're on a holiday and you have a certain wine and it tastes amazing and you buy a case and you bring it home and you taste it at home and it's really not that great. So it's all to do with our sort of attitude at the time. So yeah, it's not just medical symptoms like pain. It's everything that we experience. We saw this in the book with the different types of pills. You take two pills, they work better. You take a big pill. It works better. You take a pill that's certain color works better. So the more dramatic the treatment, the bigger the placebo effect. And of course, the problem therein that you mentioned in the book was, well, oops, now we've got to have fake surgery in order to get the placebo effect from surgery. Yeah. So you kind of would think, wouldn't

you that more surgeries are kind of proper treatment. So you probably wouldn't have placebo effects in surgery, but actually in trials, there has the biggest placebo effects of all. So there was a big analysis recently of a whole load of different surgical techniques that were, you know, all thought to be really promising. And then half of them, the real surgery was no better than the fake surgery. This is for conditions from osteoarthritis to angina. I mean, it was just incredible, really, that surgeons have been doing a lot of these techniques. Traditionally, they don't test their surgical procedures in placebo-controlled trials because it was always thought that fake surgery wasn't very ethical. So they just kind of go ahead and do it and see people getting better.

And it's only in the last few years that we're realizing how much of that was actually placebo effects. And then it's a dilemma then, because what did you do? If a surgery is really helping people, but it's only working through a placebo. Do you stop doing that and take that benefit away from those people? I mean, it's a difficult one. You talk a lot in the book about stress, bad stress and turning it into good stress. Let's learn how to do this and take advantage of some of our brain power to limit stress. Because as we know, cortisol ages us, stress ages us. Literally, at a genetic level, this takes effect. If you could, explain that and then maybe give us some ways we can help manage it. Okay, so I mean, most people are familiar with stress or the fight or flight response. So we know that if we're anxious or afraid or nervous, this fight or flight response kicks in and it's meant to help us respond in emergencies. So your pupils will dilate, your heart beats faster, your blood pressure goes up. Blood is diverted from your gut to your limbs and brain. Glucose is released into the bloodstream to fuel your next move. So a whole load of changes are happening across your body, which is great in an emergency, not great if it's switched on all the time. If you're

stress all the time. That just creates wear and tear on the body. That increased blood pressure, increases the risk of heart disease, for example. Another thing that fight or flight does, it triggers a branch of the immune system called inflammation, which is the body's first line of defence against infection and injury. Again, if this is switched on long term, that's very damaging. It exacerbates autoimmune disease, makes us more susceptible to infection, everything from the common cold to HIV. It's been implicated in cancer. Yes, like you say, stress ages us. It increases is the rate of cellular aging of cells. So not good.

And so one thing I do in the book is I look at the evidence-based ways to reduce stress. So, you know, what does the trial evidence say? What works and what doesn't work? Mindfulness meditation is one of the best studied, for example. There are now hundreds of trials suggesting that that does reduce stress. It also reduces chronic pain and anxiety and fatigue. Social connection is another one. Your sort of best possible protection against stress is to have strong social relationships.

and that feeds through into life expectancy. So people who have strong social relationships who feel sort of integrated and part of a social group, they don't get sick and they live longer. That's one of the strongest findings that we have in behavioural science. But what I found really intriguing,

so there were some studies done on ways of not reducing stress, but just changing how we respond to stress because fight or flight isn't all the same. There's a difference, for example, if you imagine yourself at top of the ski slope and you see this sort of steep run going down beneath you, depending on whether you're an experienced skier or not, you might feel joy and exhilaration or you might feel absolute terror.

And those do different things to your body, whether you feel confident in a situation and it's a challenge that you think you can meet or whether you think that you're going to be crushed and you don't have the resources to deal with the situation. Those have very different effects. If you're feeling confident, psychologists like to call it sort of challenge stage rather than a threat state, in a challenge state, you perform better, and it's also much better for your long-term health as well. And so just one very quick way to change yourself from a challenge state into a threat state is how you think about your body's response to stress. So if you've got something

stressful coming up, whether it's an exam or you've got to do some public speaking and you notice that your heart's pumping, what researchers did in this study was they said to people who were about to sit an exam or do a stressful test, they said if you notice signs of anxiety or stress or arousal and your body like your palms are sweating or your heart's beating, remember that that is your body working to help you. That is going to help you perform better because if your heart's beating, that's going to push oxygenated blood around your body, more oxygen to your brain and to your muscles, that's great. You're going to perform better. Just telling people that so that they saw those signs of stress more positively switched people from a threat state into a challenge state so that it was a

healthier response for them. So this was in graduates. Made it a fake exam in the lab. They scored better in that fake exam. And not only that, when they did the real exam, three months later, they scored higher in that exam as well. So just that one piece of information, see those signs of sort of arousal in your body, beating heart or whatever, as positive, completely changed how they responded to that stress and it improves their performance. Seeing the situation differently changes your physiological response to it. That's excellent. We can do that at the regular. I think, regardless of whether or not it's an exam or any kind of situation, if we reframe that as, as our body getting ready versus us getting ready to have a negative reaction because we're not

ready for this or we're underprepared or we're going to get our butts kicked, it definitely can be a game changer, especially if we believe it. It's just taking back some control. And if I could give you one other quick example of reframing that has to do with pain. So this was a study where volunteers were told they were either going to be subjected to a low level of pain or a medium level of pain or another group was going to be subjected either to a medium level of pain or a high level of pain. In that first group, if they got a medium level of pain, so that was kind of the worst out of the two levels of pain they were expecting, they rated that as quite painful, moderately painful, and areas of the brain lit up that are associated with processing pain.

In the second group, if they got that medium pain, so exactly the same level of pain, but in the second group, they thought it was either going to be medium or high, so now it's the best case scenario. It's the lower of the two levels of pain they're expecting. They rated that pain as pleasant and parts of their brain lit up that are associated with reward. So just by reframing it, seeing what you're getting as either a best case scenario or a worst case scenario, completely changed what people were experiencing from being painful to being pleasant. So it's just an example of showing how important your attitude is, how you see what's happening to you, can either give you a painful experience or a pleasant one. Joe, thank you so much.

Thank you so much for having me. I really enjoyed it. You're about to hear a preview of the Jordan Harbinger show with Desmond Schum, a Chinese billionaire who did business in the highest circles of the Chinese Communist Party. A red heralded aristocrats. They are by bloodline. So when you're born, you're born in a different session of hospital from the rest of the country. No money can buy you into their session. So they'll go to a different private school, kindergarten, different primary school,

different secondary school. They have farms dedicated only grow for them. And then the car they ride in have a separate license plate. We're driving the bike lane. We're driving the bus lane. It's the loyalty and the aristocrats of the medieval times. Your wife, she gets an exit ban from China. And then she disappears.

And this is the part that is just Twilight Zone bizarre. You've been calling her for four years. Her mom's been calling her every day for four years. You write this book. Suddenly, she calls you on the phone from the number that had been dead for four years. What the hell is going on? About a year and a half after her disappearance,

I was in London talking to this friend. We were having coffee together. He looked me in the eyes. He said, you know, they will never let her out. And then he said, like a matter of family, if they let her out, they're going to give her a shutdown, a spy, she will come out as a zombie. Really?

The state can do something like that. and they will do something like that. You were friendly with many people in Xi Jinping's inner circle. How do you assess his character? He sees himself as an emperor to rejuvenate the dynasty. That's what he wants to do. That is the, I think for everybody, including Chinese in China, that's the most dangerous thing,

because he is re-engineering the entire country in every dimension where he is going to end. That's the most dangerous thing. To hear how it all came crashing down, his wife vanished and his escape abroad, check out episode 684 of the Jordan Harbinger Show. I love conversations like this. This is what I'm talking about when I talk about me just loving the heck out of science. Placebo effect, always, always interesting for me.

And the reason I wanted to do this show, I remember a few years back when I really wanted to do this episode of the show because I'm fascinated with the mind can do for the body. But I'm also just very alarmed by people selling placebo-ish cures for things. We know now that it's limited, essentially, to pain, and you can't have a placebo effect that cures an actual ailment other than pain. And not knowing that is very problematic, because you see these cures online or these people talking on TV, look at this, it cures this, it cures that, and that is just not true. It's dangerous, and it can dissuade people from getting actual real medical treatment,

and that's probably what's most insidious and most dangerous about all of this. You give your money to a con man, instead of getting actual treatment. cancer treatment, for example, that can kill you. So this type of thing is sort of near and dear to my heart. I do really want to educate people on these things, so I appreciate Dr. Joel Marchant's time here. Big thank you to her for coming on the show. Links to the book and everything else mentioned on the show. We'll be in the show notes at Jordan Harbinger.com. Books are always at Jordan Harbinger.com slash books. Please use our website links if you buy the book. It does help support the show. The links work overseas. They're Amazon links. They work with audio books.

Anywhere and anything you get through those links does help. I know people are like, oh, I I live in Japan. I can't do it. Yes, you can and please do. Transcripts are in the show notes, videos are on YouTube, advertisers, deals and discount codes, every way to support the show. Is it Jordan Harbinger.com slash deals. Please consider supporting those who support this show. I'm at Jordan Harbinger on both Twitter and Instagram or connect with me right there on LinkedIn. I'm teaching you how to connect with great people and manage relationships using the same software systems and tiny habits that I use every single day. That's our six-minute networking course. That course is free over at Jordan Harbinger.com slash course, teaching you how to dig the well

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