January 28, 2025 • 39 mins
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Fascinating interplay between placebos and nocebos: what they are, why they matter, and how they shape your health decisions. Understanding these effects can help you save money, avoid disappointment, and make better-informed choices.
Key Points:
- Placebos and Nocebos Defined:
- A placebo is an inert treatment leading to perceived improvement.
- A nocebo occurs when negative expectations cause symptoms, even without an active trigger.
- Personal Stories:
- My N-of-1 trial with creatine showed measurable improvements in muscle mass, confirming results beyond placebo effects.
- A friend’s experience with plantar fasciitis improvement through chiropractic care raised questions about the placebo effect.
- Taking a "statin holiday" revealed potential nocebo-related muscle soreness, which I’m further testing.
- Historical Context:
- Early mentions of placebos include 16th-century sham exorcisms, where false holy relics exposed imagined reactions.
- The first placebo-controlled trial in 1863 tested rheumatism treatments, showing equal results between opium creams and inert plant-based ointments.
- Scientific Insights:
- Pain Relief: A study using laser pain tests demonstrated reduced pain with a placebo cream compared to control groups (study link).
- Depression: Research on placebo antidepressants revealed that labeled placebos activated opioid receptors in the brain, mimicking real treatments (study link).
- Sham Surgeries: A study on knee arthroscopy found no difference between real and placebo procedures over two years, reshaping how such surgeries are viewed (study link).
- Sports Performance: Athletes showed enhanced cycling performance when they believed they received enriched oxygen, demonstrating the power of belief in physical exertion (study link).
- Everyday Medicine:
- A UK survey found that 77% of doctors regularly use “impure placebos” such as unnecessary supplements or low-dose prescriptions to reassure patients (study link).
Takeaways:
- Question Health Claims: Evaluate whether improvements from treatments or products might stem from placebo effects, not actual efficacy.
- Test for Yourself: Apply N-of-1 experiments to discern the true impact of treatments, incorporating blind tests where possible.
- Stay Skeptical: Avoid falling for placebo-driven marketing claims and expensive remedies that may lack scientific backing.
Let me know your thoughts or questions by visiting drbobbylivelongandwell.com. Let’s keep exploring how to live long and well!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
18th century French philosopher, voltaire said the
art of medicine consists inamusing the patient while nature
cures the disease.
This was one of the firstdiscussions of the placebo
effect, a very common andimportant phenomenon where we
(00:24):
believe a treatment will workand, lo and behold, it does,
even if that treatment hasnothing active in it.
This concept is critical to notbeing led in a false direction
of what does or does not workfor you.
(00:45):
Hi, I'm Dr Bobby Du Bois andwelcome to Live Long and Well, a
podcast where we will talkabout what you can do to live as
long as possible and with asmuch energy and vigor that you
(01:08):
wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironmantriathlete and have published
several hundred scientificstudies.
(01:30):
I'm honored to be your guide.
Welcome my listeners to episode28.
Is it the remedy, a placebo, orjust time?
And how can you tell thedifference?
So a placebo is giving aharmless or inert compound and
(01:56):
sometimes the patient feelsbetter.
It's also used in clinicaltrials as a comparison between
the active agent and, in thiscase, the placebo.
Now related to the placeboeffect is something very similar
, but you may not have heardabout it, and that's the nocebo
(02:16):
effect.
When you take something, amedication or something like
that, and you think it mightcause a side effect, well, it's
a self-fulfilling prophecy andin many cases you do, and it's
not an active agent causing it,it's your mind that's perceiving
it.
Statins have had a lot ofattention on this, with muscle
(02:39):
soreness and muscle weakness,and we'll talk a little bit in a
few minutes about my scenariowith this.
I believe talking about placebosis a logical follow-on.
So last episode we talked aboutthe N of 1 trial, where you
figure out what does or doesn'twork for you.
And of course, when you trysomething to improve your sleep,
(03:02):
to reduce your blood pressure,whatever it might be, there
could be a placebo effect builtinto it.
So with the end of one trial,we start it, then we stop it,
then we try it again, then westop it and eventually we get a
sense of whether it works or notand that sort of minimizes the
placebo problem.
(03:22):
But you know, we'll talk aboutthis in more detail in just a
few minutes.
So my plan for today is partone explain how powerful are
placebos and the nocebos?
Part two why does the placeboeffect happen?
What are the things that makeit a very, very real phenomenon?
(03:45):
And part three what are yousupposed to do with this
information?
Moving forward and hopefullywe'll have some very tangible
practical steps for you.
This is surprisingly animportant topic.
It isn't just an esoteric.
Well, isn't this interesting?
Dr Bobby, of course, is a nerdand he loves this stuff, which
(04:05):
is all true, but it's somethingthat affects you on a day-to-day
basis and it's how you react towhat you might hear from a
friend or read in a newspaperand how you experience your life
.
So I hope by the end of this,you realize it is something very
, very important.
Now, the way you incorporatethe concepts of a placebo may
(04:33):
well relate to your health type.
Again, our health types tell ushow we acquire information,
what we do with that information, how we make decisions, how we
react to things that arise thatmay be problematic in our health
.
If you haven't taken the healthtype quiz, please go to my
website.
You can also sign up for mynewsletter if you wish to do
(04:56):
that, and again, my website isdrbobblivelongandwellcom.
Well, it's that time for eachepisode where I have to tell you
my personal story and why do Iwant to talk about this?
As you, my listeners, mightwonder why do I pick certain
(05:16):
topics?
Well, of course I pick certaintopics because I think they're
intrinsically important and thatyou might want to hear about
them and I might have a take.
That's quite a bit different,like alcohol or how many glasses
of water a day to drink, orwhether your coffee in the
morning is a good idea or a badidea, but I also get fascinated
by topics because they'rerelevant to me.
(05:38):
I shared in the end of oneepisode my desire to build
muscle strength as I'm gettingolder and build muscle, and I
wondered about creatine.
And as I was doing it, I wasthinking well, you know, if I'm
feeling stronger after I havetried creatine for a period of
(06:01):
time, maybe it's just a placeboand that's what's going on.
So when I was testing out thecreatine, I put in a pretty
rigorous N of 1 trial and Imeasured my actual muscle mass,
the number of pounds of muscle Ihave, using a DEXA scan and I
did show that in fact, for meanyways, it worked.
(06:22):
So there's some ways aroundjust thinking.
Maybe it's a scan and I didshow that in fact for me anyways
, it worked.
So there's some ways aroundjust thinking maybe it's a
placebo.
I was having coffee the otherday with my buddy, tim, and he
told me a placebo effect and infact he used the word maybe this
is a placebo.
So he's had a plantar fasciitis, which is a pretty painful
(06:43):
condition when you walk or runor whatever on your feet, and he
had tried some ice and variousother things and he decided he
would go to his chiropractor.
This chiropractor said well,look, the heel of your foot is a
bunch of bones and I thinkmaybe I can realign those bones
and you will feel better.
(07:03):
Maybe I can realign those bonesand you will feel better.
So he went to the chiropractor.
The chiropractor did themanipulation of his foot and he
got better, or he felt he wassomewhat improved.
And he said to me Bobby, Idon't know whether this is just
a placebo, should I go to mychiropractor more often?
And I said that's a reallygreat question.
(07:25):
Now he also said anothervignette which wasn't a placebo
story but it was a nocebo study.
So here's what he told me.
He says you know, I'm thinkingof going to visit my
grandchildren and normally, youknow I would take an airplane
airplane.
But invariably when I get backfrom my trip I end up with a
(07:47):
cold, and I know those airplanesare supposed to do well with
circulating through filters, butI think I'm catching a cold on
the airplane and next time I'mgoing to drive.
So in essence, he goes in anairplane, he thinks he's going
to get sick and he does get sick.
And I pointed out to him.
(08:09):
I said, tim, you know it'spossible, it's the airplane.
I doubt it, but it's possible.
But when you go to visit yourgrandchildren you're visiting a
bunch of germ factories.
You know the kids that you'rewith your grandkids, of course,
go to school and they bring homeevery virus known to man and
you may well just be pickingthat up from your grandkids.
(08:30):
It has nothing to do withwhether you drove a car there or
you flew on an airplane.
He says, well, that's a reallygood point.
So maybe we'll do some testingin his future to figure out
what's really going on.
To figure out what's reallygoing on.
And finally, on a personal noteas well for me, I have noticed
(08:55):
for a fair bit of time that mymuscles have been quite sore and
maybe a little more fatiguedthan I would think they should
be Now.
I work out regularly and so Ifigured well, it's just because
I work out a lot.
But I'm also on a statin, on aLipitor, a generic version of
Lipitor to bring my cholesteroldown to a nice low level.
And I started wondering maybemy muscle soreness and also my
(09:21):
pace running and my amount ofpower on the bike has been
falling.
It's like, well, you know, Icould be just getting older, or
maybe it's related to the statinand maybe it's really causing
some muscle discomfort andmuscle weakness.
So in chatting with my physician, we decided I would go on a
(09:42):
statin holiday, meaning I wouldstop the statin for a number of
weeks and see if I feel better,and then we will re-challenge
with perhaps a different statinand see how I do.
Well, it's been about five, sixdays and I ran on the treadmill
and I felt a whole lot betterand I went on the peloton bike
(10:03):
and I felt like, wow, I'm doingstronger than I previously did.
So maybe it really was due tothe statins causing weakness.
But then of course I said tomyself, you know, maybe it's
just the nocebo effect, in thiscase, now the reversing of it,
the placebo effect.
I stopped a drug that I thoughtmight cause the discomfort and
(10:27):
the weakness and, lo and behold,I'm feeling better.
So at the moment I don't know.
I will keep you posted.
I will ultimately re-challengewith a statin and see if the
symptoms come back.
And so I too are facing noceboand placebo effects in my life.
And I suspect, if you thinkabout your life, what you
(10:50):
experience and what you read andhear from people, there's a
bunch of placebo, nocebo thingshappening for you, perhaps in
your life.
Well, it is an interesting nerdtopic, but why should you care?
And there are really fourreasons why this plays out in a
very important way in your life.
(11:12):
The first is I'd like to saveyou money.
There's a lot of marketingcampaigns out there and they
make claims of really strongbenefits.
Maybe it's whole bodycryotherapy booths or special
supplements that you should take, or this new thing, this water
(11:33):
bottle that you can carry withyou that has hydrogen gas
bubbling through it.
All of these things cost a fairbit of money.
So, by understanding that a lotof the marketing hype is built
around placebo, somebody triesthese wonderful things, they
have a testimonial, it goes onsocial media and all of a sudden
(11:55):
, people think there's actuallyrigorous science supporting them
when in fact there really isn't.
So that's the first reason whyyou should care.
Reason number two I want to helpyou avoid disappointment.
What do I mean by that?
Well, if you get a false beliefthat something's helping you,
(12:15):
like I've stopped the statinsand my muscle strength is going
to get better and I'm going torun faster I might be
disappointed in a month when Irealized.
You know, it was just a placeboeffect.
It was just how I wasapproaching it.
It wasn't actually that thedrug was causing me to get
better or worse.
So I want to help you avoidthat disappointment.
(12:37):
Third, I want you to be able toread headlines better, so that
when you hear about somethingthat sounds just too good to be
true, that you can ask yourselflots of questions, one of which
would be is this really aplacebo effect?
I'm hearing about and I want tohelp you reduce the fear of a
(12:58):
potential nocebo effect.
So I hear from family members.
You know, every time the pollencount is high, I get a headache
, or when I havegluten-containing foods, I feel
bad.
Now, this could be a realeffect of the gluten and the
pollen, but it's also possiblethat it's a placebo or a nocebo
(13:20):
effect, where you think thatwhen pollens are high that it
causes you discomfort, and, loand behold, it does.
So keep listening.
Hopefully I'll give you sometips about how to explore this
and figure out what's real andperhaps what's not.
Well, I love to delve into thehistory of every topic because I
(13:41):
think it gives us someperspective on kind of how to
think about things of everytopic, because I think it gives
us some perspective on kind ofhow to think about things.
Now, this is a bittongue-in-cheek, but I believe
the first report on the placeboeffect was in the Bible, in the
book of Judges.
Now you may be wondering, drBobby, we know you're nota
(14:02):
reverend or a rabbi, so what'syour knowledge of the Bible?
Well, I don't have too muchknowledge of the Bible, but
there is this story of Samsonand Delilah, and remember,
samson had long hair and heattributed his superhuman
strength to his long hair.
Now, was this a placebo?
Was it not a placebo?
(14:22):
Who knows, depends upon how youinterpret the Bible.
Now, delilah decided forwhatever reason and I don't know
all the details that she wasmad at him and she, one night,
when he was asleep, cut off hishair and, lo and behold, his
superhuman strength went away.
(14:43):
Now, was that a placebo effect?
He thought the hair caused himthis great strength.
He lost the hair.
He lost that.
Well, later in the story, godgives him back his strength.
Was that another placebo effectthat God says your strength is
back now, and lo and behold, itwas, or was it a placebo effect?
(15:05):
Anyhow, that's an interestingkind of story, and maybe it's a
placebo, maybe it's not.
Well, the awareness of theconcept of a placebo has been
around for 500 years or more.
There was someone writing inthe 1500s, ambroise Perret, and
he said something which reallyencapsulates a lot of how we
(15:30):
think about the placebo effectand how we care for our patients
.
So what did he say?
He said the physician's dutywas to cure occasionally,
relieve often and console always.
Similarly, in the 18th century,the French philosopher Voltaire
(15:52):
said the art of medicineconsists in amusing the patient,
while nature cures the disease.
So there's this sense thatailments will get better on
their own, and our job as adoctor is really just to nurture
you along that path, whether ornot we have a treatment that
(16:14):
really works or not.
I think it really does speak tothe placebo effect.
Now, in the 18th century theplacebo word actually became
part of medical jargon and itwas defined as any medicine
adapted more to please than tobenefit the patient.
(16:35):
So the characteristics were toplease the patient and accede to
their demands and requests.
Well, these were just mentionsof the concept, but there
actually goes back hundreds ofyears where people tested the
concept.
Again, I'm not an expert onCatholic history, but apparently
(16:56):
in the 16th century theCatholic church was concerned
about reports of exorcisms whereI guess the devil or demons
would be released from the body,and apparently the way this was
done back then was to give aholy relic to this possessed
(17:18):
person.
And if they violently reactedwith contortions and seizures,
they thought, oh wow, this isreally the devil or whatever
leaving.
So in the 16th century theycame up with false relics, just
simple wood objects that reallyweren't relics.
(17:39):
And if in fact the patient hadthis violent contortions, they
thought it was a false andpurely imagination of what was
going on.
And then in 1799, a scientistnamed a physician, named John
Haygarth, tried a sham approach.
(18:01):
So back in that day people hadrubantism, what we might call
arthritis today and they thoughtwell, we have this thing called
a Perkins tractor.
Now it's not a tractor like Idrive on the ranch, it's what
looks like a Harry Potter wandand it was made out of very rare
(18:22):
metals and you would touch itto the painful swollen spot and
it would draw out the bad energy.
So John Hagar said I'm not surethis thing is real.
So he made a wooden tractorlike a wand and painted it to
look like it was with that raremetal and he would touch it to
(18:43):
the patient and draw out thethings.
And what he found is that thedummy one worked as well as the
real one.
So that was kind of the firstkind of sham approach to what
really was a placebo effect.
The true firstplacebo-controlled trial
(19:03):
happened in 1863 at Dr AustinFlint, and he was again trying
to deal with rheumatism,arthritis, painful joints, and
he attempted to give peopleeither creams that had opium in
it, which might actually relievediscomfort, or a similar
(19:24):
ointment with some inert plantthat wasn't herbal, that wasn't
going to change anything, andwhat he found was, lo and behold
, the placebo ointment did justas well.
Well, let's turn from historyto some science and walk you
(19:45):
through some examples, first ofthe placebo effect and then of
the nocebo effect and howpowerful it can be and preview
of coming attractions in a fewminutes.
Doctors use this concept in ourpractices and I'll explain to
you what I mean by that.
So four different examples.
(20:05):
The first is pain relief.
So there's a certain type ofexperiment where you shine a
laser on somebody's hand, causesit to heat up, it causes
discomfort in the hand.
So what they did was theybasically came up with a cream
that they put on the patient'sskin and they said this cream
(20:30):
for the placebo group.
They said, well, this cream mayprovide some anesthetic relief.
And then in the control group,they just told them it was an
inert cream, they were justputting it on, it wasn't really
going to affect their discomfort.
But lo and behold, the groupthat had the cream, thinking it
(20:50):
was actually a topicalanesthetic, felt much better
with the pain, meaning the painwasn't as difficult for them or
as strong for them as it was.
For the control group, again,the placebo was just that there
was really nothing in the cream.
Secondly and this is afascinating study, not only just
for the symptom changes butwhat they found on PET scans so
(21:14):
depression.
They took 35 people with knowndepression and they had two
different placebo groups.
In fact, all of them were infact placebo groups and they
said for one of them, this isgoing to be a fast-acting
antidepressant.
And the other group?
They said, well, this is just aplacebo and there's nothing
(21:36):
active in it.
Well, the ones that were toldthis is a fast-acting
antidepressant felt bettercompared to the ones that were
told no, no, it's just a pilland there's really not going to
do much for you.
Now where this gets reallyintriguing is they did PET scans
and they found that in theplacebo group where they told
(21:59):
them this was an antidepressant,they found that a certain type
of opioid receptor was moreactive in the brain.
So something was going on inthe brain.
In the people who thought theywere getting an active
antidepressant, certain areaslit up compared to the people
who didn't.
Now what made it even moreexciting was that when they
(22:20):
really gave them antidepressants, the people who started to feel
better, it was the same part ofthe brain that lit up with the
placebo.
So the placebo effect isn'tjust hocus pocus, it's really
doing something potentially inour brains.
Now the third study is a classicstudy that goes back about 20
(22:42):
years and it was a shamprocedure.
Now, what do I mean by that?
So at the time, people who hadsome arthritic complaints in
their knee might undergo kneearthroscopy and when they would
go in there they would lavagethe joint.
They would take out the brokenpieces of cartilage and they
(23:04):
would wash the joint and thenthe patient might feel better.
So they did a study, which isremarkable.
So half the people got the realdebridement and lavage, the
cleaning of the joint, and theother group had anesthesia.
But all they did was they had alittle cut on the knee to make
(23:27):
it look like they had the actualprocedure, but they didn't.
And they followed these peoplefor two years and, lo and behold
, there was no differencebetween either group.
They both had improvements,both the ones that had the
actual lavage and the placebogroup.
And nowadays you don't see alot of this procedure because
(23:50):
this study pretty much showed itwas a placebo effect.
Well, in sports this happens too.
They've done studies of cyclingperformance.
Get people on a bike, see howhard they can go, see how long
they can go before they getcompletely exhausted.
So in one interesting study.
And all of these studies allhave links in the show notes.
(24:12):
So by all means, go and readthem for yourself.
So one group is told we'regiving you enriched oxygen or a
placebo.
You're not getting enrichedoxygen, and in each case,
nothing was different.
But the people thought, oh, I'mgetting more oxygen, I'm going
to feel better, I'm going to dobetter on the bike.
Lo and behold, they didSimilarly when you were giving
(24:36):
people certain capsules redversus white with certain touted
benefits cycling performanceimproved.
Well, those are four examples.
But this isn't just scientificexperiments.
In fact, this happens regularlyin medical practice.
Now, this was a study in the UKand they asked doctors how
(25:00):
often do you use placebos?
And what they found was theyinterviewed about 800 physicians
.
There is that 12% of them useda pure placebo, a sugar pill.
They gave it to the patient andhoped that the patient might
feel better.
Now, there's some ethicalquestions about this, but that's
(25:22):
what we learned from the survey.
But then when they asked himwell, do you every year use not
a sugar pill, what's called apure placebo, but an impure
placebo?
Now, that's a supplement that'sknown not to work.
So I might give you apeppermint pill for your sore
throat, or I might give you atiny, tiny dose of something
(25:44):
that isn't really going toaffect you medically.
Or I might say well, I know youhave a virus causing your cold,
but I'm going to give youantibiotics anyways.
Or you might have triedibuprofen at home, but I'm going
to give you a prescriptionversion and see if you get
(26:05):
better.
And this happened a lot.
77% of the doctors whoresponded said they use it on a
weekly basis.
So probably not when you go toyour doctor do you get a sugar
pill, because generally you goto the drugstore and they're not
giving you sugar pills.
But you may well be givensomething that the doctor is
like eh, it's not going to hurt.
(26:26):
I don't think it's going tohelp, but it might make you feel
better.
So placebo effect does happen.
Now I have been mentioning thenocebo effect, so let me show
you, share with you information,that this is equally powerful.
So there was an important studycalled the Samson study, where
(26:47):
they took people who were havingproblems with muscle soreness
and weakness from their statins,their Lipitor or Torvastatin or
something like that, just likethe story I've been telling you.
So they did an interestingstudy where they gave these
people 12 pill bottles.
Four of them had a statin, fourof them had a placebo, but they
(27:11):
thought it was a statin, andfour were empty.
So the patient knew that theyweren't on that statin and they
used a symptom score and theybasically the more symptoms,
meaning the more muscle weaknessand soreness, the higher the
score on this visual analogscale.
What did they find?
So when people were actually onthe statin?
(27:35):
So the four bottles thatactually had statins in it, they
had a score of 16, meaning theyhad some symptoms, or some
people had some symptoms.
But when they looked at theplacebo month, the ones where
they took pills, where thepatients thought it was a statin
, lo and behold, there was nodifference in between the real
statin.
Lo and behold, there was nodifference between the real
(27:56):
statin and the fake statin.
The fake statin people hadsymptoms too.
So also, sometimes people stoptaking their medicines because
they say, oh, these side effectsare really bad.
Well, there was no differencein the rate of discontinuation
between the people who got theplacebo and people who got the
statins.
(28:16):
Continuation, between thepeople who got the placebo and
people who got the statins.
Well, the final nocebo one is areally fun one.
There is a phenomenon when youocclude a blood vessel, so let's
say you're getting your bloodpressure measured, so it cuts
off the blood in your armtemporarily, then they release
it and then they measure yourblood pressure.
(28:37):
But if you did that for alittle bit longer and released
it, the blood rushes into yourarm or rushes in into your leg.
This is called flow-mediateddilation.
It's actually a measure of howgood your arteries are and how
flexible they are, and you wantto see a lot of blood flow going
into your arm or leg afteryou've occluded it for a little
(29:01):
while.
So this is a measure ofgoodness of your blood vessels
or how happy they are inresponse to this.
So they gave a series of peoplea milkshake and they had
everybody got the milkshake butone half of the people.
They were told this is amilkshake.
It they had.
Everybody got the milkshake butone half of the people.
They were told this is amilkshake.
It has high calories, has a lotof fat in it.
(29:23):
The second group was the samemilkshake, but they said no, no,
no, this is healthy, it doesn'thave a lot of calories and we
want to give this to you as partof this study.
And lo and behold that whenthey told people that it was an
unhealthy milkshake, that flowwas reduced, the flexibility was
(29:47):
reduced, but when they toldpeople, no, no, it's all very
healthy, it wasn't.
So it was fascinating thatpeople who thought it was bad
for them had a response thatsuggested it was bad for them.
The people who thought it wastotally fine and healthy did not
have that.
Similarly, a lot of peoplethink they have gluten
(30:10):
sensitivity and that they reallyshouldn't have foods with
gluten.
Here's a fascinating study.
You might want to look at it ifit's something that concerns
you.
They took 165 people and it wasa randomized trial with double
blind, so they basically hadfour different groups and they
(30:31):
gave them a meal or a series ofmeals.
In one case they said, okay,this has gluten in it.
And here you go, here's yourmeal, tell us how you feel.
The next group they said no, no, it doesn't have any gluten in
it, when in fact it actually did.
And what low and polledhappened was that when people
(30:55):
thought it was gluten, they feltworse Right from the gluten.
Then they did the reverse,where they didn't give them
gluten, it was a meal withoutgluten, but half the people they
said there's gluten in here,and half the people they said no
, no, no, there's no gluten.
Lo and behold again, the onesthat were told there was gluten
(31:18):
in the meal felt worse Again.
This is something that might bevery important and something to
test for you.
Clearly, celiac disease is areal deal and people have
changes in their intestines, butfor many other people perhaps
it could be a nocebo effect.
There's also something called anopen placebo.
(31:42):
People might think, oh, howunethical to give somebody a
placebo.
Well, there are examples, lotsof examples, where people got
better and they told them it wasa placebo and what they found
was substantial improvements.
Now how they explained it is.
They said yeah, it's a sugarpill, it doesn't have any active
(32:03):
ingredient.
But in other patients we foundit to be very powerful and it
helped them.
And if you have a positiveattitude about taking the
placebo, it can be helpful andyou really need to take this
pill every day faithfully.
Lo and behold, people knew itwas placebo and they felt better
(32:23):
.
Lo and behold, people knew itwas placebo and they felt better
.
Now let's shift gears to thenext part and ask the question
why does the placebo or noceboeffect occur?
Well, part of it is the powerof positive thinking.
In the 1950s, there was a bookby Norman Vincent Peale of that
(32:46):
name.
We all want to feel we haveagency, that we're not feeling
well, we do something and we'regoing to feel better.
It's very powerful, the role ofthe mind.
So that's one aspect.
But there's some importantstatistics that are also part of
this equation.
One is called regression to themean.
That means if something isreally bad or really good, if
(33:10):
you just wait, you don't doanything, you just wait, it's
likely to go back to normal.
Somebody who hits five, six,seven basketball shots from a
long distance, inevitably weknow it's going to go back to
normal.
If they normally get one forthree and now they've hit six in
a row, we know that that islikely to go away.
(33:33):
And again, if they triedsomething like now I'm wearing
different socks and all of asudden my jump shots aren't
going very well, I blame it onthe socks.
Well, that's called aregression to the mean.
Stock market very high likelyto come back down.
Stock market very low likely tocome up.
(33:54):
Secondly, you may have a chronicissue that undulates, that
comes and goes, it gets betteror worse, your pain from
arthritis, asthma, low back pain, and if you do something and
miraculously, you feel better.
It could also have been thatthe illness was going to kind of
(34:19):
run its course, or at leastthat timing or good timing.
So you get a flu shot andinevitably you get a cold the
day or two later and you blameit on the flu shot.
Well, it could have just been acold that you got by seeing
your grandkids as an example, or, as we talked about with my
(34:41):
friend Tim, the airplane rideand blaming the cold on the
airplane.
Again might have been due tothe airplane, but it could have
just been bad timing.
And then the last kind ofscientific element is called the
Hawthorne effect.
Now, hawthorne was an electriccompany in, of all places,
hawthorne, illinois and this wasdone quite a long time ago.
(35:04):
And what they found was theydid an experiment where they
wanted to see if productivitywould get better if they raised
the lights.
The lighting increased theintensity of the lights in the
workroom.
Lo and behold, productivityimproved.
Then they tested the oppositethey reduced the intensity of
(35:25):
the light.
Lo and behold, productivityimproved.
And what this means is that oneof the phenomenon that can
happen is when you knowsomeone's watching or measuring,
it changes your behavior.
So that's another piece of thepuzzle that may cause this very
(35:45):
real effect of nocebo or placebo.
Well, it's time to wrap up.
Another episode is coming to aclose.
So what do we do with thisinformation?
It is around us all day.
Every day, we will run acrossconcepts like the placebo and
the nocebo.
(36:06):
It isn't just ancient history,like Samson and Delilah, or the
things they said about thedoctor's role in the 1500s.
Yes, hundreds of years agopeople were selling snake oil
and people were using leeches,and people thought that was
wonderful and they got better.
But today it's just the same.
(36:27):
It's just a different product,whether it's special greens from
the garden in packets andcapsules, whether it's red light
therapy will get rid of yourfatigue and have you live longer
or vitality vitamins or a lotof interest in fasting.
(36:49):
Well, if you fast or if you doa detox, we're going to get this
bad stuff out of you.
People feel better and theywere like, oh, it worked, but
again, maybe it was the placeboeffect.
Also, in your life, day to day,you may read about maybe a new
surgery or a new treatmentthat's really helping people.
(37:10):
Well, take a close look.
A lot of these studies, or atleast some of them have what's
called a pre-post design.
They measure somebody'ssymptoms, they do something and
they measure their symptomsagain, without a placebo
comparison and, lo and behold,maybe the surgery seems to help
people.
Ask yourself the question didthey do a placebo, and could
(37:32):
that have been what's going onIn your own life?
If you're not sure if it's aplacebo, just like I'm doing do
your own N of 1 assessment, tryit, stop it, try it, stop it.
And, as we talked about in theN of 1 episode, maybe you can
even have your own real placeboby having your partner buy
(37:57):
magnesium.
If you're testing magnesium,and then a pill that wouldn't
help muscle cramps or sleep,like vitamin E, and that person
will give you the pills and youreally won't know what's what.
And then a pill that wouldn'thelp muscle cramps or sleep,
like vitamin E, and that personwill give you the pills and you
really won't know what's what.
So, to finalize, keep your eyesopen for the phenomenon.
Ask yourself might this greatimprovement I'm hearing about or
(38:19):
experiencing be a placebo?
And, most importantly, let meknow what you think.
Does this make sense?
Is it too nerdy?
Please send me a note throughmy website,
(38:48):
drbobbylivelongandwellcom, orreply within the podcast episode
itself.
I love to hear from you and, tothe extent I can, I will
absolutely respond.
So until next time, placebo ornot, nocebo or not, I hope you
can live long and well.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
(39:10):
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
That's doctor, as in D-R Bobby,live long and wellcom.
18th century French philosopher, voltaire said the
art of medicine consists inamusing the patient while nature
cures the disease.
This was one of the firstdiscussions of the placebo
effect, a very common andimportant phenomenon where we
(00:24):
believe a treatment will workand, lo and behold, it does,
even if that treatment hasnothing active in it.
This concept is critical to notbeing led in a false direction
of what does or does not workfor you.
(00:45):
Hi, I'm Dr Bobby Du Bois andwelcome to Live Long and Well, a
podcast where we will talkabout what you can do to live as
long as possible and with asmuch energy and vigor that you
(01:08):
wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironmantriathlete and have published
several hundred scientificstudies.
(01:30):
I'm honored to be your guide.
Welcome my listeners to episode28.
Is it the remedy, a placebo, orjust time?
And how can you tell thedifference?
So a placebo is giving aharmless or inert compound and
(01:56):
sometimes the patient feelsbetter.
It's also used in clinicaltrials as a comparison between
the active agent and, in thiscase, the placebo.
Now related to the placeboeffect is something very similar
, but you may not have heardabout it, and that's the nocebo
(02:16):
effect.
When you take something, amedication or something like
that, and you think it mightcause a side effect, well, it's
a self-fulfilling prophecy andin many cases you do, and it's
not an active agent causing it,it's your mind that's perceiving
it.
Statins have had a lot ofattention on this, with muscle
(02:39):
soreness and muscle weakness,and we'll talk a little bit in a
few minutes about my scenariowith this.
I believe talking about placebosis a logical follow-on.
So last episode we talked aboutthe N of 1 trial, where you
figure out what does or doesn'twork for you.
And of course, when you trysomething to improve your sleep,
(03:02):
to reduce your blood pressure,whatever it might be, there
could be a placebo effect builtinto it.
So with the end of one trial,we start it, then we stop it,
then we try it again, then westop it and eventually we get a
sense of whether it works or notand that sort of minimizes the
placebo problem.
(03:22):
But you know, we'll talk aboutthis in more detail in just a
few minutes.
So my plan for today is partone explain how powerful are
placebos and the nocebos?
Part two why does the placeboeffect happen?
What are the things that makeit a very, very real phenomenon?
(03:45):
And part three what are yousupposed to do with this
information?
Moving forward and hopefullywe'll have some very tangible
practical steps for you.
This is surprisingly animportant topic.
It isn't just an esoteric.
Well, isn't this interesting?
Dr Bobby, of course, is a nerdand he loves this stuff, which
(04:05):
is all true, but it's somethingthat affects you on a day-to-day
basis and it's how you react towhat you might hear from a
friend or read in a newspaperand how you experience your life
.
So I hope by the end of this,you realize it is something very
, very important.
Now, the way you incorporatethe concepts of a placebo may
(04:33):
well relate to your health type.
Again, our health types tell ushow we acquire information,
what we do with that information, how we make decisions, how we
react to things that arise thatmay be problematic in our health
.
If you haven't taken the healthtype quiz, please go to my
website.
You can also sign up for mynewsletter if you wish to do
(04:56):
that, and again, my website isdrbobblivelongandwellcom.
Well, it's that time for eachepisode where I have to tell you
my personal story and why do Iwant to talk about this?
As you, my listeners, mightwonder why do I pick certain
(05:16):
topics?
Well, of course I pick certaintopics because I think they're
intrinsically important and thatyou might want to hear about
them and I might have a take.
That's quite a bit different,like alcohol or how many glasses
of water a day to drink, orwhether your coffee in the
morning is a good idea or a badidea, but I also get fascinated
by topics because they'rerelevant to me.
(05:38):
I shared in the end of oneepisode my desire to build
muscle strength as I'm gettingolder and build muscle, and I
wondered about creatine.
And as I was doing it, I wasthinking well, you know, if I'm
feeling stronger after I havetried creatine for a period of
(06:01):
time, maybe it's just a placeboand that's what's going on.
So when I was testing out thecreatine, I put in a pretty
rigorous N of 1 trial and Imeasured my actual muscle mass,
the number of pounds of muscle Ihave, using a DEXA scan and I
did show that in fact, for meanyways, it worked.
(06:22):
So there's some ways aroundjust thinking.
Maybe it's a scan and I didshow that in fact for me anyways
, it worked.
So there's some ways aroundjust thinking maybe it's a
placebo.
I was having coffee the otherday with my buddy, tim, and he
told me a placebo effect and infact he used the word maybe this
is a placebo.
So he's had a plantar fasciitis, which is a pretty painful
(06:43):
condition when you walk or runor whatever on your feet, and he
had tried some ice and variousother things and he decided he
would go to his chiropractor.
This chiropractor said well,look, the heel of your foot is a
bunch of bones and I thinkmaybe I can realign those bones
and you will feel better.
(07:03):
Maybe I can realign those bonesand you will feel better.
So he went to the chiropractor.
The chiropractor did themanipulation of his foot and he
got better, or he felt he wassomewhat improved.
And he said to me Bobby, Idon't know whether this is just
a placebo, should I go to mychiropractor more often?
And I said that's a reallygreat question.
(07:25):
Now he also said anothervignette which wasn't a placebo
story but it was a nocebo study.
So here's what he told me.
He says you know, I'm thinkingof going to visit my
grandchildren and normally, youknow I would take an airplane
airplane.
But invariably when I get backfrom my trip I end up with a
(07:47):
cold, and I know those airplanesare supposed to do well with
circulating through filters, butI think I'm catching a cold on
the airplane and next time I'mgoing to drive.
So in essence, he goes in anairplane, he thinks he's going
to get sick and he does get sick.
And I pointed out to him.
(08:09):
I said, tim, you know it'spossible, it's the airplane.
I doubt it, but it's possible.
But when you go to visit yourgrandchildren you're visiting a
bunch of germ factories.
You know the kids that you'rewith your grandkids, of course,
go to school and they bring homeevery virus known to man and
you may well just be pickingthat up from your grandkids.
(08:30):
It has nothing to do withwhether you drove a car there or
you flew on an airplane.
He says, well, that's a reallygood point.
So maybe we'll do some testingin his future to figure out
what's really going on.
To figure out what's reallygoing on.
And finally, on a personal noteas well for me, I have noticed
(08:55):
for a fair bit of time that mymuscles have been quite sore and
maybe a little more fatiguedthan I would think they should
be Now.
I work out regularly and so Ifigured well, it's just because
I work out a lot.
But I'm also on a statin, on aLipitor, a generic version of
Lipitor to bring my cholesteroldown to a nice low level.
And I started wondering maybemy muscle soreness and also my
(09:21):
pace running and my amount ofpower on the bike has been
falling.
It's like, well, you know, Icould be just getting older, or
maybe it's related to the statinand maybe it's really causing
some muscle discomfort andmuscle weakness.
So in chatting with my physician, we decided I would go on a
(09:42):
statin holiday, meaning I wouldstop the statin for a number of
weeks and see if I feel better,and then we will re-challenge
with perhaps a different statinand see how I do.
Well, it's been about five, sixdays and I ran on the treadmill
and I felt a whole lot betterand I went on the peloton bike
(10:03):
and I felt like, wow, I'm doingstronger than I previously did.
So maybe it really was due tothe statins causing weakness.
But then of course I said tomyself, you know, maybe it's
just the nocebo effect, in thiscase, now the reversing of it,
the placebo effect.
I stopped a drug that I thoughtmight cause the discomfort and
(10:27):
the weakness and, lo and behold,I'm feeling better.
So at the moment I don't know.
I will keep you posted.
I will ultimately re-challengewith a statin and see if the
symptoms come back.
And so I too are facing noceboand placebo effects in my life.
And I suspect, if you thinkabout your life, what you
(10:50):
experience and what you read andhear from people, there's a
bunch of placebo, nocebo thingshappening for you, perhaps in
your life.
Well, it is an interesting nerdtopic, but why should you care?
And there are really fourreasons why this plays out in a
very important way in your life.
(11:12):
The first is I'd like to saveyou money.
There's a lot of marketingcampaigns out there and they
make claims of really strongbenefits.
Maybe it's whole bodycryotherapy booths or special
supplements that you should take, or this new thing, this water
(11:33):
bottle that you can carry withyou that has hydrogen gas
bubbling through it.
All of these things cost a fairbit of money.
So, by understanding that a lotof the marketing hype is built
around placebo, somebody triesthese wonderful things, they
have a testimonial, it goes onsocial media and all of a sudden
(11:55):
, people think there's actuallyrigorous science supporting them
when in fact there really isn't.
So that's the first reason whyyou should care.
Reason number two I want to helpyou avoid disappointment.
What do I mean by that?
Well, if you get a false beliefthat something's helping you,
(12:15):
like I've stopped the statinsand my muscle strength is going
to get better and I'm going torun faster I might be
disappointed in a month when Irealized.
You know, it was just a placeboeffect.
It was just how I wasapproaching it.
It wasn't actually that thedrug was causing me to get
better or worse.
So I want to help you avoidthat disappointment.
(12:37):
Third, I want you to be able toread headlines better, so that
when you hear about somethingthat sounds just too good to be
true, that you can ask yourselflots of questions, one of which
would be is this really aplacebo effect?
I'm hearing about and I want tohelp you reduce the fear of a
(12:58):
potential nocebo effect.
So I hear from family members.
You know, every time the pollencount is high, I get a headache
, or when I havegluten-containing foods, I feel
bad.
Now, this could be a realeffect of the gluten and the
pollen, but it's also possiblethat it's a placebo or a nocebo
(13:20):
effect, where you think thatwhen pollens are high that it
causes you discomfort, and, loand behold, it does.
So keep listening.
Hopefully I'll give you sometips about how to explore this
and figure out what's real andperhaps what's not.
Well, I love to delve into thehistory of every topic because I
(13:41):
think it gives us someperspective on kind of how to
think about things of everytopic, because I think it gives
us some perspective on kind ofhow to think about things.
Now, this is a bittongue-in-cheek, but I believe
the first report on the placeboeffect was in the Bible, in the
book of Judges.
Now you may be wondering, drBobby, we know you're nota
(14:02):
reverend or a rabbi, so what'syour knowledge of the Bible?
Well, I don't have too muchknowledge of the Bible, but
there is this story of Samsonand Delilah, and remember,
samson had long hair and heattributed his superhuman
strength to his long hair.
Now, was this a placebo?
Was it not a placebo?
(14:22):
Who knows, depends upon how youinterpret the Bible.
Now, delilah decided forwhatever reason and I don't know
all the details that she wasmad at him and she, one night,
when he was asleep, cut off hishair and, lo and behold, his
superhuman strength went away.
(14:43):
Now, was that a placebo effect?
He thought the hair caused himthis great strength.
He lost the hair.
He lost that.
Well, later in the story, godgives him back his strength.
Was that another placebo effectthat God says your strength is
back now, and lo and behold, itwas, or was it a placebo effect?
(15:05):
Anyhow, that's an interestingkind of story, and maybe it's a
placebo, maybe it's not.
Well, the awareness of theconcept of a placebo has been
around for 500 years or more.
There was someone writing inthe 1500s, ambroise Perret, and
he said something which reallyencapsulates a lot of how we
(15:30):
think about the placebo effectand how we care for our patients
.
So what did he say?
He said the physician's dutywas to cure occasionally,
relieve often and console always.
Similarly, in the 18th century,the French philosopher Voltaire
(15:52):
said the art of medicineconsists in amusing the patient,
while nature cures the disease.
So there's this sense thatailments will get better on
their own, and our job as adoctor is really just to nurture
you along that path, whether ornot we have a treatment that
(16:14):
really works or not.
I think it really does speak tothe placebo effect.
Now, in the 18th century theplacebo word actually became
part of medical jargon and itwas defined as any medicine
adapted more to please than tobenefit the patient.
(16:35):
So the characteristics were toplease the patient and accede to
their demands and requests.
Well, these were just mentionsof the concept, but there
actually goes back hundreds ofyears where people tested the
concept.
Again, I'm not an expert onCatholic history, but apparently
(16:56):
in the 16th century theCatholic church was concerned
about reports of exorcisms whereI guess the devil or demons
would be released from the body,and apparently the way this was
done back then was to give aholy relic to this possessed
(17:18):
person.
And if they violently reactedwith contortions and seizures,
they thought, oh wow, this isreally the devil or whatever
leaving.
So in the 16th century theycame up with false relics, just
simple wood objects that reallyweren't relics.
(17:39):
And if in fact the patient hadthis violent contortions, they
thought it was a false andpurely imagination of what was
going on.
And then in 1799, a scientistnamed a physician, named John
Haygarth, tried a sham approach.
(18:01):
So back in that day people hadrubantism, what we might call
arthritis today and they thoughtwell, we have this thing called
a Perkins tractor.
Now it's not a tractor like Idrive on the ranch, it's what
looks like a Harry Potter wandand it was made out of very rare
(18:22):
metals and you would touch itto the painful swollen spot and
it would draw out the bad energy.
So John Hagar said I'm not surethis thing is real.
So he made a wooden tractorlike a wand and painted it to
look like it was with that raremetal and he would touch it to
(18:43):
the patient and draw out thethings.
And what he found is that thedummy one worked as well as the
real one.
So that was kind of the firstkind of sham approach to what
really was a placebo effect.
The true firstplacebo-controlled trial
(19:03):
happened in 1863 at Dr AustinFlint, and he was again trying
to deal with rheumatism,arthritis, painful joints, and
he attempted to give peopleeither creams that had opium in
it, which might actually relievediscomfort, or a similar
(19:24):
ointment with some inert plantthat wasn't herbal, that wasn't
going to change anything, andwhat he found was, lo and behold
, the placebo ointment did justas well.
Well, let's turn from historyto some science and walk you
(19:45):
through some examples, first ofthe placebo effect and then of
the nocebo effect and howpowerful it can be and preview
of coming attractions in a fewminutes.
Doctors use this concept in ourpractices and I'll explain to
you what I mean by that.
So four different examples.
(20:05):
The first is pain relief.
So there's a certain type ofexperiment where you shine a
laser on somebody's hand, causesit to heat up, it causes
discomfort in the hand.
So what they did was theybasically came up with a cream
that they put on the patient'sskin and they said this cream
(20:30):
for the placebo group.
They said, well, this cream mayprovide some anesthetic relief.
And then in the control group,they just told them it was an
inert cream, they were justputting it on, it wasn't really
going to affect their discomfort.
But lo and behold, the groupthat had the cream, thinking it
(20:50):
was actually a topicalanesthetic, felt much better
with the pain, meaning the painwasn't as difficult for them or
as strong for them as it was.
For the control group, again,the placebo was just that there
was really nothing in the cream.
Secondly and this is afascinating study, not only just
for the symptom changes butwhat they found on PET scans so
(21:14):
depression.
They took 35 people with knowndepression and they had two
different placebo groups.
In fact, all of them were infact placebo groups and they
said for one of them, this isgoing to be a fast-acting
antidepressant.
And the other group?
They said, well, this is just aplacebo and there's nothing
(21:36):
active in it.
Well, the ones that were toldthis is a fast-acting
antidepressant felt bettercompared to the ones that were
told no, no, it's just a pilland there's really not going to
do much for you.
Now where this gets reallyintriguing is they did PET scans
and they found that in theplacebo group where they told
(21:59):
them this was an antidepressant,they found that a certain type
of opioid receptor was moreactive in the brain.
So something was going on inthe brain.
In the people who thought theywere getting an active
antidepressant, certain areaslit up compared to the people
who didn't.
Now what made it even moreexciting was that when they
(22:20):
really gave them antidepressants, the people who started to feel
better, it was the same part ofthe brain that lit up with the
placebo.
So the placebo effect isn'tjust hocus pocus, it's really
doing something potentially inour brains.
Now the third study is a classicstudy that goes back about 20
(22:42):
years and it was a shamprocedure.
Now, what do I mean by that?
So at the time, people who hadsome arthritic complaints in
their knee might undergo kneearthroscopy and when they would
go in there they would lavagethe joint.
They would take out the brokenpieces of cartilage and they
(23:04):
would wash the joint and thenthe patient might feel better.
So they did a study, which isremarkable.
So half the people got the realdebridement and lavage, the
cleaning of the joint, and theother group had anesthesia.
But all they did was they had alittle cut on the knee to make
(23:27):
it look like they had the actualprocedure, but they didn't.
And they followed these peoplefor two years and, lo and behold
, there was no differencebetween either group.
They both had improvements,both the ones that had the
actual lavage and the placebogroup.
And nowadays you don't see alot of this procedure because
(23:50):
this study pretty much showed itwas a placebo effect.
Well, in sports this happens too.
They've done studies of cyclingperformance.
Get people on a bike, see howhard they can go, see how long
they can go before they getcompletely exhausted.
So in one interesting study.
And all of these studies allhave links in the show notes.
(24:12):
So by all means, go and readthem for yourself.
So one group is told we'regiving you enriched oxygen or a
placebo.
You're not getting enrichedoxygen, and in each case,
nothing was different.
But the people thought, oh, I'mgetting more oxygen, I'm going
to feel better, I'm going to dobetter on the bike.
Lo and behold, they didSimilarly when you were giving
(24:36):
people certain capsules redversus white with certain touted
benefits cycling performanceimproved.
Well, those are four examples.
But this isn't just scientificexperiments.
In fact, this happens regularlyin medical practice.
Now, this was a study in the UKand they asked doctors how
(25:00):
often do you use placebos?
And what they found was theyinterviewed about 800 physicians
.
There is that 12% of them useda pure placebo, a sugar pill.
They gave it to the patient andhoped that the patient might
feel better.
Now, there's some ethicalquestions about this, but that's
(25:22):
what we learned from the survey.
But then when they asked himwell, do you every year use not
a sugar pill, what's called apure placebo, but an impure
placebo?
Now, that's a supplement that'sknown not to work.
So I might give you apeppermint pill for your sore
throat, or I might give you atiny, tiny dose of something
(25:44):
that isn't really going toaffect you medically.
Or I might say well, I know youhave a virus causing your cold,
but I'm going to give youantibiotics anyways.
Or you might have triedibuprofen at home, but I'm going
to give you a prescriptionversion and see if you get
(26:05):
better.
And this happened a lot.
77% of the doctors whoresponded said they use it on a
weekly basis.
So probably not when you go toyour doctor do you get a sugar
pill, because generally you goto the drugstore and they're not
giving you sugar pills.
But you may well be givensomething that the doctor is
like eh, it's not going to hurt.
(26:26):
I don't think it's going tohelp, but it might make you feel
better.
So placebo effect does happen.
Now I have been mentioning thenocebo effect, so let me show
you, share with you information,that this is equally powerful.
So there was an important studycalled the Samson study, where
(26:47):
they took people who were havingproblems with muscle soreness
and weakness from their statins,their Lipitor or Torvastatin or
something like that, just likethe story I've been telling you.
So they did an interestingstudy where they gave these
people 12 pill bottles.
Four of them had a statin, fourof them had a placebo, but they
(27:11):
thought it was a statin, andfour were empty.
So the patient knew that theyweren't on that statin and they
used a symptom score and theybasically the more symptoms,
meaning the more muscle weaknessand soreness, the higher the
score on this visual analogscale.
What did they find?
So when people were actually onthe statin?
(27:35):
So the four bottles thatactually had statins in it, they
had a score of 16, meaning theyhad some symptoms, or some
people had some symptoms.
But when they looked at theplacebo month, the ones where
they took pills, where thepatients thought it was a statin
, lo and behold, there was nodifference in between the real
statin.
Lo and behold, there was nodifference between the real
(27:56):
statin and the fake statin.
The fake statin people hadsymptoms too.
So also, sometimes people stoptaking their medicines because
they say, oh, these side effectsare really bad.
Well, there was no differencein the rate of discontinuation
between the people who got theplacebo and people who got the
statins.
(28:16):
Continuation, between thepeople who got the placebo and
people who got the statins.
Well, the final nocebo one is areally fun one.
There is a phenomenon when youocclude a blood vessel, so let's
say you're getting your bloodpressure measured, so it cuts
off the blood in your armtemporarily, then they release
it and then they measure yourblood pressure.
(28:37):
But if you did that for alittle bit longer and released
it, the blood rushes into yourarm or rushes in into your leg.
This is called flow-mediateddilation.
It's actually a measure of howgood your arteries are and how
flexible they are, and you wantto see a lot of blood flow going
into your arm or leg afteryou've occluded it for a little
(29:01):
while.
So this is a measure ofgoodness of your blood vessels
or how happy they are inresponse to this.
So they gave a series of peoplea milkshake and they had
everybody got the milkshake butone half of the people.
They were told this is amilkshake.
It they had.
Everybody got the milkshake butone half of the people.
They were told this is amilkshake.
It has high calories, has a lotof fat in it.
(29:23):
The second group was the samemilkshake, but they said no, no,
no, this is healthy, it doesn'thave a lot of calories and we
want to give this to you as partof this study.
And lo and behold that whenthey told people that it was an
unhealthy milkshake, that flowwas reduced, the flexibility was
(29:47):
reduced, but when they toldpeople, no, no, it's all very
healthy, it wasn't.
So it was fascinating thatpeople who thought it was bad
for them had a response thatsuggested it was bad for them.
The people who thought it wastotally fine and healthy did not
have that.
Similarly, a lot of peoplethink they have gluten
(30:10):
sensitivity and that they reallyshouldn't have foods with
gluten.
Here's a fascinating study.
You might want to look at it ifit's something that concerns
you.
They took 165 people and it wasa randomized trial with double
blind, so they basically hadfour different groups and they
(30:31):
gave them a meal or a series ofmeals.
In one case they said, okay,this has gluten in it.
And here you go, here's yourmeal, tell us how you feel.
The next group they said no, no, it doesn't have any gluten in
it, when in fact it actually did.
And what low and polledhappened was that when people
(30:55):
thought it was gluten, they feltworse Right from the gluten.
Then they did the reverse,where they didn't give them
gluten, it was a meal withoutgluten, but half the people they
said there's gluten in here,and half the people they said no
, no, no, there's no gluten.
Lo and behold again, the onesthat were told there was gluten
(31:18):
in the meal felt worse Again.
This is something that might bevery important and something to
test for you.
Clearly, celiac disease is areal deal and people have
changes in their intestines, butfor many other people perhaps
it could be a nocebo effect.
There's also something called anopen placebo.
(31:42):
People might think, oh, howunethical to give somebody a
placebo.
Well, there are examples, lotsof examples, where people got
better and they told them it wasa placebo and what they found
was substantial improvements.
Now how they explained it is.
They said yeah, it's a sugarpill, it doesn't have any active
(32:03):
ingredient.
But in other patients we foundit to be very powerful and it
helped them.
And if you have a positiveattitude about taking the
placebo, it can be helpful andyou really need to take this
pill every day faithfully.
Lo and behold, people knew itwas placebo and they felt better
(32:23):
.
Lo and behold, people knew itwas placebo and they felt better
.
Now let's shift gears to thenext part and ask the question
why does the placebo or noceboeffect occur?
Well, part of it is the powerof positive thinking.
In the 1950s, there was a bookby Norman Vincent Peale of that
(32:46):
name.
We all want to feel we haveagency, that we're not feeling
well, we do something and we'regoing to feel better.
It's very powerful, the role ofthe mind.
So that's one aspect.
But there's some importantstatistics that are also part of
this equation.
One is called regression to themean.
That means if something isreally bad or really good, if
(33:10):
you just wait, you don't doanything, you just wait, it's
likely to go back to normal.
Somebody who hits five, six,seven basketball shots from a
long distance, inevitably weknow it's going to go back to
normal.
If they normally get one forthree and now they've hit six in
a row, we know that that islikely to go away.
(33:33):
And again, if they triedsomething like now I'm wearing
different socks and all of asudden my jump shots aren't
going very well, I blame it onthe socks.
Well, that's called aregression to the mean.
Stock market very high likelyto come back down.
Stock market very low likely tocome up.
(33:54):
Secondly, you may have a chronicissue that undulates, that
comes and goes, it gets betteror worse, your pain from
arthritis, asthma, low back pain, and if you do something and
miraculously, you feel better.
It could also have been thatthe illness was going to kind of
(34:19):
run its course, or at leastthat timing or good timing.
So you get a flu shot andinevitably you get a cold the
day or two later and you blameit on the flu shot.
Well, it could have just been acold that you got by seeing
your grandkids as an example, or, as we talked about with my
(34:41):
friend Tim, the airplane rideand blaming the cold on the
airplane.
Again might have been due tothe airplane, but it could have
just been bad timing.
And then the last kind ofscientific element is called the
Hawthorne effect.
Now, hawthorne was an electriccompany in, of all places,
hawthorne, illinois and this wasdone quite a long time ago.
(35:04):
And what they found was theydid an experiment where they
wanted to see if productivitywould get better if they raised
the lights.
The lighting increased theintensity of the lights in the
workroom.
Lo and behold, productivityimproved.
Then they tested the oppositethey reduced the intensity of
(35:25):
the light.
Lo and behold, productivityimproved.
And what this means is that oneof the phenomenon that can
happen is when you knowsomeone's watching or measuring,
it changes your behavior.
So that's another piece of thepuzzle that may cause this very
(35:45):
real effect of nocebo or placebo.
Well, it's time to wrap up.
Another episode is coming to aclose.
So what do we do with thisinformation?
It is around us all day.
Every day, we will run acrossconcepts like the placebo and
the nocebo.
(36:06):
It isn't just ancient history,like Samson and Delilah, or the
things they said about thedoctor's role in the 1500s.
Yes, hundreds of years agopeople were selling snake oil
and people were using leeches,and people thought that was
wonderful and they got better.
But today it's just the same.
(36:27):
It's just a different product,whether it's special greens from
the garden in packets andcapsules, whether it's red light
therapy will get rid of yourfatigue and have you live longer
or vitality vitamins or a lotof interest in fasting.
(36:49):
Well, if you fast or if you doa detox, we're going to get this
bad stuff out of you.
People feel better and theywere like, oh, it worked, but
again, maybe it was the placeboeffect.
Also, in your life, day to day,you may read about maybe a new
surgery or a new treatmentthat's really helping people.
(37:10):
Well, take a close look.
A lot of these studies, or atleast some of them have what's
called a pre-post design.
They measure somebody'ssymptoms, they do something and
they measure their symptomsagain, without a placebo
comparison and, lo and behold,maybe the surgery seems to help
people.
Ask yourself the question didthey do a placebo, and could
(37:32):
that have been what's going onIn your own life?
If you're not sure if it's aplacebo, just like I'm doing do
your own N of 1 assessment, tryit, stop it, try it, stop it.
And, as we talked about in theN of 1 episode, maybe you can
even have your own real placeboby having your partner buy
(37:57):
magnesium.
If you're testing magnesium,and then a pill that wouldn't
help muscle cramps or sleep,like vitamin E, and that person
will give you the pills and youreally won't know what's what.
And then a pill that wouldn'thelp muscle cramps or sleep,
like vitamin E, and that personwill give you the pills and you
really won't know what's what.
So, to finalize, keep your eyesopen for the phenomenon.
Ask yourself might this greatimprovement I'm hearing about or
(38:19):
experiencing be a placebo?
And, most importantly, let meknow what you think.
Does this make sense?
Is it too nerdy?
Please send me a note throughmy website,
(38:48):
drbobbylivelongandwellcom, orreply within the podcast episode
itself.
I love to hear from you and, tothe extent I can, I will
absolutely respond.
So until next time, placebo ornot, nocebo or not, I hope you
can live long and well.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
(39:10):
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
That's doctor, as in D-R Bobby,live long and wellcom.
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