Episode 11: Placebo, Nosebo, Verifiable & Balderdash

spk_0:   0:00
Welcome to the podcast. We've got one for you today. We've got a podcast that we're We've entitled Placebo. No Cibo verifiable and balderdash.

spk_1:   0:13
Just because it's all in your head doesn't mean it's not really. I've been reading a lot lately, and I wanted to share some stuff with you on what effect expectations have on what you perceive and how that relates to how we treat ourselves medically and how we should prepare to treat ourselves medically in the future before the development of antibiotics and opium products like morphine. Who it was a really drug and it actually were. A lot of people have misconceptions about posi placebo effects, which is when you get useful effects from a medication that don't actually arise from the nature of the medication itself and the it's evil twin. No see Bo effects, which is when you take a treatment and side effects develop and you feel the side effects which are also not caused by the actual chemical components of the drugs. A lot of people, the misconception a lot of people have is that these are just occasional and errant effects that they are felt mostly by a weak willed and suggestible individuals, and it's some sort of a moral or character weakness if you are prone to feeling these kinds of effects, The truth is that's just not how your brain is wired. Pain is a particularly important kind of treatment. You think about placebo in no cibo effects because if you think about what pain is, it's your body's warning system. You are much better it feeling the pain of a wound and interpreting what's going on. Then you are about feeling the pain in your heart and interpreting what's going on. A cut on your arm feels like a cut on your arm. Ah, heart attack can feel like jaw pain. It can feel like a pain in your arm or hand. It can feel like a tightness. It could just make you want to vomit and have diarrhea. So it's really hard to interpret the pain from a heart attack. Well, why's your brain wired that way? Because there's a whole lot of value and understanding when you've got a wound in your arm so you could do something useful about it if something goes wrong in your chest. Before the advent of modern medical intervention. There's not a heck of a lot you can do about it, and you have not dedicated much of your internal brain wiring to interpreting that information. Pain is about motivating you to do something different and warning you there's a problem. And because that's the use of pain, it is not simply a receptor system. It doesn't just take information from a part of the body where something's wrong, reported to your brain and your brain says Okay, this is where the pain is, and that's what's going on. Instead, pain is a highly interpretive thing. You really do feel less pain from, say something that you find valuable and interesting. And when you're absorbed in it, like running a marathon or I'm told, having a baby, you feel less pain because it was expected. And it's part of an experience that's valued, so it's not as dangerous to you and because it's not as dangerous to your brain, interprets it in a different way. If you feel helpless and in a bad situation and something catches you by surprise, you'll interpret it as being more painful because that's a hired in your situation.

spk_0:   3:55
And even in everyday life. You'll notice this. You'll notice if you're listening. If you let's say you have to go to a lecture, and for whatever reason you have to go training or whatever. If it's training that really is interesting and engaging and thought provoking, you won't notice that you're sitting in a very horribly uncomfortable chair and you won't notice that you're sitting in a cold room. But, man, if it's something that just is boring and is uninterested ing and your brain is wandering, you'll notice that cold chair and you'll notice that cold room because that's just the way we're wired and you know, even the little. And when you have an itch, you start concentrating on the itch, and then everything comes all about the it's because that's what your brain is telling you to do. Present your you got an inch, but you're in the middle of a ah, playing football. You're not gonna notice that. I mean, it's just your brain is engaged else, wise

spk_1:   5:00
in neurophysiology. It's a founding principle that what you perceive is a combination of the sensory information that's actually coming in, and your expectations about what that incoming information will mean you combine those things together before you actually perceive him. That's where we get placebos and no see Boz.

spk_0:   5:22
So first of all, let's do definition. What is a placebo on what is a no Stevo

spk_1:   5:29
when you're given a medical treatment? And it has a beneficial effect that is not directly traceable to the chemical components of the medical treatment or electrical components? Whatever. It's not really a direct effect of the treatments themselves. That's a placebo effect. If you take a medical treatment and side effects developed, you get bad effects from it, and those are not directly traceable to the medical treatment. It's a no cibo effect. The only way to reliably sort these things out guys is controlled studies that you have to be sneaky about it. Because people's brains are clever, they will detect whether the treatment Israel or whether they're in the control group if they have any information, and that will affect how strongly they feel it. A nice example of this is a book I was listening to yesterday that was presenting some evidence on the placebo effect, and this was a serious kind of treatment. It was a treatment for Parkinson's disease, and it was a surgical treatment for Parkinson's disease. So they actually had to cut away parts of the people scalps. They had to use bone drills to partially open the skull. And then they go in there and very carefully stir around with some electrodes to do the treatment. So this is not a, uh, casual thing. And it was carefully controlled and carefully done because they really needed to know if it worked. They had to do a controlled study on it. So they got volunteers. They told him, Hey, we're gonna put you either in the control group where we're going to do the rest of the surgical procedure. But we're not going to do anything to your brain or you're going to be in the experimental group where we're actually going. Thio, perform the treatment. We're gonna watch all for a while and see how the disease progresses in both of the groups. But if you were in the control group and it worked really well, we'll give you the real treatment afterwards for free. But the volunteers didn't know which her there in, and the doctors who were directly taking care of these people knew there in one group of the other, but didn't know if they were in the control of the experimental group. So they had done everything they could to seriously control this trial, and they went forth on the study and one of the individuals in this study was having really great outcomes from it. You know, he was curious. So he went on the Web and he started talking to in a Web support group. He searched for other people who had been in this trial, and he found a bunch of other people that were in the trial. And all these people started comparing notes, and they started comparing what the side of their head felt like, where the surgery had been and how big the indentation waas and what the scar looked like. And from this, they thought, they figured out who had been in the control group who had been in the experimental group. And, hey, all the people who thought they were in the control group, they were basically saying, Yeah, it doesn't seem to make much difference. People who thought they were in the experimental group were recording much better results. So for the doctors who were treating these patients and for the patients themselves.

spk_0:   8:56
We're stuck wings of the year Little way we're driving that you saw two geese parents in about seven gobbling goslings.

spk_1:   9:06
They're making their own clock at the moment. Anyway, You gotta smell the roses,

spk_0:   9:12
jump those turtles.

spk_1:   9:14
So the preliminary idea from people in the study and from their doctors, was that this treatment was making a big difference because the people who thought they were in the experimental group were showing actual regression of their disease, which almost never happens in Parkinson's and the people who thought they were in control group. We're proceeding normally, and that's how it stood until the final analysis of the data came out, when the people actually figure reported the experimenters had known all along. But they hadn't told the primary care positions every it was revealed to everyone which proof they were actually in. And lo and behold, the experimental treatment had done essentially no good, no statistically significant difference in outcomes. The people who thought they were in the experimental group had significantly better outcomes than the people who thought they were in the control group, but a lot of them were wrong, guessed wrong about which group they were in. And based on that, they saw riel measurable improvements in their disease process. It was all a placebo effect, but it wasn't balderdash because of the placebo effect. This guy who had almost become wheelchair bound is now hiking Yosemite with his son because the placebo effect was so riel and so effective. Once he found out he was in the control group. At first he was floored because he had seen such obvious improvements. And at first it felt like his world was crashing down because, well, this treatment didn't actually work. I know how bad it Waas. He's like, Hey, wait, I walk better, much, much better now than when I began the trial. So what if it's all in my head? I clearly have control of this at some level by what's going on in my head, I by golly, I'm gonna keep walking. I'm gonna keep hiking. I'm gonna go on that trip with Yosemite to my son. The report I heard was taken more than a year after he found out he was in the placebo group and the significant improvements he had experienced had been retained, and he was doing very well as of 2016 which was the time the book was written inedible after that.

spk_0:   11:49
So it's hell, Can you talk a little bit more about the actual? I don't know if you know or if quote unquote week. She used the word, but she's aware we it's the general. We She's a scientist. She uses the scientific we a lot

spk_1:   12:03
other people who actually depend on evidence. Do studies, apply statistical analysis to the outcomes and are very careful to sort out riel effects from any kind of extraneous effects, including placebos and no see Boz. I count myself with those guys, those those people and I Are we

spk_0:   12:22
okay? By the way, Welcome to Iowa, everybody. We're now in Iowa. We just crossed the state line here a couple minutes ago at the fireworks stand, which there's always fire understand when you go to Iowa,

spk_1:   12:32
probably because we sell him in Iowa doesn't

spk_0:   12:35
Okay, so but Iowa has better rooms. Hillary of that only slightly better, but better. Okay, but they do have rumble strips, which we don't like. Anyway, um, if you can and I'm not, we haven't talked about this for the show. Can you tell a little bit about the of site? Not This is the psychological but the physiological effects of placebo. And they were gonna get to why we're talking about this. What What difference this makes. But first, I want Thio. What's known about the physiological reactions and effects to of a placebo? The fact

spk_1:   13:13
although the placebo effect has been known to exist for an extraordinarily long time like earliest Greek physician, writings level long time is what I'm talking here. It garnered surprisingly little close scientific scrutiny until lately because people did have that misconception that it was something that the weak willed we're just making up and therefore it wasn't real. But recently there have been some people who have dedicated close scientific attention to it. It's not well understood yet, but I'm gonna share with you some of the stuff they have figured out. One aspect of it is that the tendency to develop both placebo and no cibo effects is linked to specific genetic traits. You could do a genetic test on somebody, look to see if they've got one version of a gene or a different version of the gene, and that gives you a very strong idea of how much they will develop either placebo or no civil effects. And part of it is due for pain, at least to the way the opioid receptors in the brain were. There's this drug called naloxone, and they use it to block opioid receptors. Opioid receptors are the ones that give you pain relief from all the opium based drugs like morphine and oxycodone, and deals like that. They work on opioid receptors, so when they're doing research on pain, they often use this blocker naloxone that stops up. Those receptors essentially subtract out the action of those receptors and see what goes on without him. Well, if a guy is experiencing a placebo effect from a drug and you give him this blocker of opioid receptors, the placebo effect goes away. You haven't told him anything different. His expectations were no different, but he just loses the effect of the placebo. So how we interpret that is the reason we've got opioid receptors in the brain is not so opium poppies can affect us. The opium poppy has just made use of that as a deterrent we've got opioid receptors in the brain because our brain uses opium like compounds as chemical signals. So one group of neurons can talkto a different group of neurons, their communication signal. That means very specific things in the brain. You block that communications system in the brain and the placebo effects go away. So, at least for pain relief, the placebo effects works on the neuro transmitter that uses the opioid receptors. Wait,

spk_0:   15:57
we're coming in tow. We're coming into Milton, and we've got Amish people all over the place in their little buggies. And you have to kind of really be careful with

spk_1:   16:05
famous cheese

spk_0:   16:07
T right over there. Good cheese. But it's also about half Amish, so you really have to be careful here. You have to watch. It's not so bad during the day. But when you're coming through here a night on a Sunday night and they're all going to church mortar words when the time of year when the weather is Uh huh the sun is down. Those black carriage is getting really hard to see. Even with the blinking lights, man, we get really off track on Milton lowing. It's like you just go right now in the Milky Way, but anyway,

spk_1:   16:42
part of it. So it is one part of your brain talking to other parts of your brain to create the effect. It works on particular receptors, Um, and the ability to activate those parts of the brain is partly determined by these specific genetic A wheels, by the way that is not linked to particular personality traits. The fact that somebody is more intelligent doesn't not make them any less susceptible to placebo effects. The fact that somebody is more gullible or less educated does not make them any more susceptible to placebo effects. It's not a character flaw. It's physiological thing. In

spk_0:   17:24
fact, you're better off if you are.

spk_1:   17:26
Oh sure, because if you are susceptible to placebo effects, you can get relief from a much wider range of treatments for the kinds of disorders in which placebo and no cibo effects are Most prominent. Pain is at the top of that list. Sleep disorders are high on that list, and so are things that rely on immune system activity like auto immune sores and psychological effects, most importantly, depression. I'm not saying depression is all in your head guys. It is a biological, real thing. But if you are prone to placebo effects, you're more likely to get relief from a wide array of treatments, including homey apathy, including acupuncture, including aromatherapy, including medical treatments produced by drug companies and some men. Percentage of the effects you feel from all of these treatments are possible that

spk_0:   18:28
now here's something that that I know that she doesn't know that I know. I know I am very susceptible to the placebo event. I know that she didn't think I knew that, but I do. I know that. And I don't worry about it. Whatever works at work, I don't care. I'll give an example, and then then we're gonna come back to why this is important. Maybe should do the why this is important for Preppers now. Okay. Rather than, of course, the 4th 1 of the fourth part of our beings full of beans, bullets, bandages and you will This is two of our four. This is bandages and you. So why is this important for Preppers? And we'll come back to my example.

spk_1:   19:11
They're too significant reasons. It's important for preppers. Actually, one is the straightforward. You wanna have preps that are actually going to be effective for everyone. And that means the effects you're looking for are physiological based. Well, Steve O and no Cibo effects are much more dependent on a person's expectations, and they're much more dependent on their inherent tendency to have placebo and no civil effects. So the stuff you prep, you wanna work on people, no matter what their psychology about it is and what their tendency to placebos is, you want stuff. The flat out works for pain. The anti inflammatory agents that block pain as well, like the ask for an end, all of its derivative drugs, the kinds of stuff you normally take for inflammation or pain relief. Those have strong, demonstrably physiological effect. Those suckers were

spk_0:   20:18
Tylenol type ad ville. Any of that stuff and you know it worked already knows it works because it does work. This isn't

spk_1:   20:26
Not only does everybody know it, which I have a lot of

spk_0:   20:29
things, End said. Just use that She

spk_1:   20:33
made a lot of the stuff that for very many years, everybody knew, worked, actually doesn't physiological. Uh, but not only does everybody know it works when you look very carefully and do everything you can to eliminate the placebo effects with control trials. It still works, and we could describe the physiological pathways that make it work, and we can interrupt it with other treatments. So,

spk_0:   21:00
and more importantly, it's reproducible every time. Yeah, that zip, it works. Yeah, it's reproduced well, that will come back to reproducible after bed.

spk_1:   21:11
So all the opium based pain relief things really work. As far as I have been able to distinguish in my reading so far, the active ingredients in ST John's wort, or depression, really works. So you want to have stuff in your perhaps that actually works and is not dependent entirely on expectations. And Siebel affects because its effectiveness will very too much from individual to individual.

spk_0:   21:45
Let me go get my example now. This is something we both I've got somewhat of. Ah, the thing in the nose where it's, you know, my my everyone's called. I personally deviated septum. That's what I got. And so sometimes I have trouble breathing, and when the weeds come out, I get hay fever. It just happens. And also additionally, both of us are divers, which means that that going into all the details that a suit if ed type truck pseudoephedrine is something that can help us keep our nasal and ear passages easy to open, which is important because you're changing pressure depths when you're diving. And so you have to be able to equalize the pressure between the air on the inside of your head, in the air on the outside of your head when

spk_1:   22:44
you dive to the bottom of the school. Year started running. Diving magnifies that a lot

spk_0:   22:51
for the pool's 13 feet deep or 12 feet deep or whatever, and we go 100 feet deep. So you can imagine if you couldn't equalize the pressure of the amount of pain, it would be undoable. You would injure yourself. So anyway, so we use suit if it well, unfortunately, unfortunately, the meth heads have made getting sued. If at a pain in the tail

spk_1:   23:14
is their primary ingredients, start to make.

spk_0:   23:16
I hate meth heads. If you're a meddling or not, because you're listening to this and methods don't care about anyone. Meth, you know, I kick to the groin for you Meth heads. I don't like you why

spk_1:   23:30
it messes with people's physiology, and it's just a little thing. They end up doing horrible things

spk_0:   23:36
anyway, so it's made our suit. If it really hard to get, I mean, we get so get something. So they came out with a non, uh, non pseudoephedrine based replacement. The column P e. Is different. There's the actual suit. If Ed Brand and then there's the off brand of pseudoephedrine type P E, I should have

spk_1:   24:02
mixed boat. They make the real stuff,

spk_0:   24:04
but the p E stuff people did studies and initially, and I don't know if it's still true. But the initial studies that I read and this is one of the ways I know that I am someone successful to the placebo effect because the P E doesn't work better or didn't in the early studies didn't work any better than the placebo. It waas ineffective,

spk_1:   24:33
however, when the original trials with the drug to people and asked if it helped. Sure it helps, they didn't carefully control it with a placebo. When they were first doing the exploratory studies, they were checking to see if it was safe and stuff like that, right, and it looked like it works.

spk_0:   24:50
This isn't over the counter drugs, so you don't have to prove that it works. You just have to prove that it's safe.

spk_1:   24:55
You do have to prove that it works. But the stringency of the trials is not sufficient. And drugs that were already approved before the current set of FDA regulations went into effect. They didn't have to use the very stringently controlled trials. They had to give the drug to people and give have a control group that they didn't give the drug to. When you do that, it works. When you give the control group a similar looking pill and tell everybody the same thing, controlling experimental effect goes away.

spk_0:   25:35
So I don't know now. Maybe it's not policy, what with this truck. Maybe they did some more studies and they found it. Or maybe they may have found a way to make it better. But I found the P E worked to an extent with me. It wasn't nearly as good as the other, but it at least opened up my nose enough so I could breathe. Now the question is whether that's actually some sort of placebo effect. I don't

spk_1:   25:57
know. I have a pretty good idea because that is a characteristic when you would first take it. I was around when he was first taken. These drugs, he's like, Yeah, it worked pretty good. But by the two hours into it, you're supposed to take a dose every four hours. I was like, No, I'm all clogged up again. It was a very short term effect. It's not universal, but many placebo effects are relatively short term.

spk_0:   26:22
Well, another one now, And this is I don't think, uh um I don't think this is as placebo as the other, probably. Or maybe but the fake African tape out have to use the brand name. Doesn't really know what else you call it. No spray. There's two kinds of original. Yeah, that one. I mean, it will work for just a few minutes on both of us, and then it doesn't work. So it's not long, so I think that one has more chemical based something or other than the other one that's gonna be it worked right away. I mean, it's pretty obvious, but it just doesn't last for very long.

spk_1:   27:05
Yeah, that one is just metabolized away faster. So, uh, you don't adapt to it. So you come depended on it as you do if you take the oxygen dazzling stuff for too long, too many days of time.

spk_0:   27:18
Now, here's a question for you. Can you become addicted to placebo effect? Drugs?

spk_1:   27:26
Um, strictly speaking, No, because to become addicted is a physiological description of changes. As somebody who works in the field, I don't use the term addicted unless it does particular things to your brain that make your brain actually act different if you don't have it.

spk_0:   27:46
Well, I think the Africa is something that you just can't take long term without rebound congestion.

spk_1:   27:53
When you have it in your system for a while, your own sells biochemistry change. And until that, biochemistry changes back, you're gonna be clogged up without drugs.

spk_0:   28:03
When I was a kid, I got myself hooked on that stuff because I was having trouble breathing and I can always So I used it for weeks on end. And, Boy, you don't you don't even want to know what you re about. Congestion feels like it is not good. Anyway.

spk_1:   28:20
People become dependent on a placebo. Absolutely, because that means something else in addiction, because dependency can definitely be a brain generated problem, right? Rather than a biochemistry of the drug generated problem. And yet people do become dependent on placebos in the if you take their placebo away. They was thinking it was working. You take it away, they will have negative effects. Absolutely. It's a patient

spk_0:   28:54
for us. Not really changing this every but for us, it's a work in progress. She is working on research because we don't just do stuff. Okay, We're not going to just plan a bunch of stuff and see what You know what I don't

spk_1:   29:08
like. We're just randomly driving through Iowa, talking off the top of our heads. Right? But we're actually reading and studying in the background.

spk_0:   29:16
Right? So right now she's not. She wants to d'oh a preppers medical garden to have herbs and whatever else the chicken grown.

spk_1:   29:31
Yeah, poppies don't grow it in our climate

spk_0:   29:34
way. Could have on hand in case. Well, uh, we have a S t Shh. Key F

spk_1:   29:45
hex. In case, uh, the insurance system blows up to the point where we can't afford to visit doctors or what? I was not very implausible,

spk_0:   29:59
right? So Anyway, having around and even just for general health and wellness. If you could heal yourself without with his minor of you know, it's better to do it yourself if you can.

spk_1:   30:11
Besides, if your health cake and biology geek, it's cool.

spk_0:   30:15
So anyway, where she's working on this and it's a it's a very early stage. But one of the things that that I'm rolling her talk about this and I'm gonna point out is because there's a lot of really bad information out there on this. There's a lot of information that is, uh, not studied, is not reproducible and why that matters. It's no, it's not like, Oh, because the drug companies are out to get us and all this kind of stuff what they are. But it's not about that. It's about you need to be ableto have reproducible results. And if you look at a lot of the information that's out there, it is based on, um, let this hearsay. But what's the word? I'm looking for anecdotal evidence and added total evidence could get back into this placebo effect. Kind of You don't really sure, because of no control on it, you don't have these people took it these people, Didn't these people have? This had the effect. These people that mean a lot of the reasons you don't have to control effect in the what you want to call it homeopathic. You want to call it alternative medicine. A lot of the reasons you don't have that is because there's no profit motivation behind it or not enough profit motivation to fund the studies.

spk_1:   31:34
I'll actually extend that little bit further of. When I first started reading about acupuncture and started reading, they actually had done some scientific studies where they had control groups that had experimental groups. They checked out what was going on with the acupuncture. When I first started reading that research some years ago, it looked to me as if the acupuncture was actually being effective when they tested it in controlled trials. Uh, in some places that put the needle in the functional place in other places that put the needle in a that the special collapsing needles where the subjects thought the needles were going through the skin. But when it looked like you were pushing the needle down, it was like a magician's trick needle. That sucker would just collapse on itself, so the subjects wouldn't really know whether they were getting the treatment or whether they were getting the placebo. Even though it was an acupuncture thing, they actually managed to fool them into thinking they were had been sticking into their skin through their skin when they didn't. When I first started reading the research, it looked a lot like acupuncture worked, and I had going in expecting to find it not working because the theory behind it smells like hogwash. Frankly, it had all the explanatory story behind it. The story was selling it, and not the actual treatments will look like. So the original studies. I started to change my opinion for a while there, I'm like, Okay, maybe there's just something going on here. We don't know how it's physiological working, and they just made up this fun but hogwash smelling backstory because they observed it worked, and they needed some explanations that make up the explanation. And there's some physiology we hadn't discovered. I was surprised, but I was like, Okay, looks like it works. But now, 10 years down the road, that changed the way the trials are done because they've discovered that some of the subjects. Actually, there was a difference that was detectable, that they didn't know what time. They have refined the technique for how they do the acupuncture studies, and once they were fined the technique, the evidence evaporated. It was just a people's brains. Being very sneaky about figuring out whether they were in the control group of the experimental group was the relevant. That's better. So it's not only that people haven't done studies, it's that guys designing a good study is horror developing really good controls for some of this is hard. And if you miss at all, you leave the door open for placebo and no Cibo effects out there. Which is why there's a whole lot of things that look like they've got some evidence that turn out not to be terribly effective when you get even more careful about how you do the studies.

spk_0:   34:43
Okay, so we've got this

spk_1:   34:46
heart one waas. You want stuff that

spk_0:   34:48
you had

spk_1:   34:49
more. Yeah, there was a party to

spk_0:   34:51
go the park to Sorry I was going. I was going on to Andrew Whitworth, but we'll get back to that joker in a bed.

spk_1:   34:58
Part two is I don't know about you guys, but I will flat up raise my hand and admit it. I have every intention of using the placebo effect when I helped free people

spk_0:   35:11
and I have every intention

spk_1:   35:13
I've done it on. Can

spk_0:   35:16
I have every intention of believing what she says? Because she's a physiology and she knows Bath. Huh? I don't care if it's a placebo. I just wanted to work.

spk_1:   35:30
Here's the deal. You want somebody to have a placebo Effect Absolutely used the placebo effects for all their work because they will enhance physiological basis pain. Really, they will enhance physiological based improvements in sleep. They will enhance a lot of treatments for a lot of people. If you present the treatment with a story that makes it believable because our brains are, we want to understand things. Our brains are wired to understand things. You got to give people a story that makes it believable, and it's best if you make it evident what treatment they're getting. You notice how popular aromatherapy is. Yes, and how many people report riel and significant improvements with aromatherapy. Yes, I believe them. I believe they're experiencing riel observable improvements when they take aromatherapy, and I also believe in the best majority of cases that is due to the placebo effect. Aromatherapy is so effective because it works on aroma, which is deeply wired to our brains. It's deeply wired to the subconscious parts that deal with expectations it's not wired nearly is directly to the prefrontal cortex, where we do our most reasonable thinking. Sense does a better job of bypassing reason than any other sense we've got.

spk_0:   36:58
And this isn't this is a modern theory, either. This has been known for years. One of our very favorite things in the world is to listen to audio books and our favorites. Serious Together is an audiobook. Siri's by Patrick O'Brien. It's the John Aubrey Stephen Maturation Ah, serious that was popularized in the movie Master and Commander. It's a brilliantly done Siri's, and the audiobook versions by Simon Vans are just like the most amazing books I have ever read in most people. Is it okay, Napoleonic era British Navy? Really? No. Trust me on this. Trust her on this. They're brilliant, literally, and it's hilarious. It's fun, it's It's just it's a rollicking, but what do things that's Dr Matt Trin is one of our heroes. Uses he uses to placebo effect to great effect because in the book Siri's you know he gives them to the blue pill. And part of the blue pill will be, um, the hell always mix in stuff that will make them run to the head all the time to clean out their system. And he does that because it works better when sailors know they've been dosed. He makes them bigger by filling with chalk so that they think they're getting more medicine. Sailors want to know they've been dosed. That's that's one of his big things.

spk_1:   38:32
So he does it on purpose and aromatherapy. Did you ever wonder why it happens to the only the most aromatic and pungent of compounds that seemed to have effects when you put them in those little dispensers that they use for aromatherapy and take the treatments? Because a large number of effective medicinal compounds are actually odorless, colorless, tasteless? That's not strange at all, but you don't know your windows and therefore the placebo. It and no Cibo effects are not nearly as abundant. All those guys

spk_0:   39:09
okay, what are the things we were talking about? Well, just before the show, we're talking about what we put in a home. You are Home Herb garden for medicines. My my first thing with mint. It grows okay. Growth like weed. You can use it for many, many, many things, Miss cool. It's wonderful. It's got great flavor mint oil. It's got all kinds of stuff. A T. You know, it's just a tea. It's really good. Um, it boy does it grow. But if you were to use a strong flavored something like meant menthol, you know, I'm saying, if you were to use meant, it helps. So the fact that this is a potent

spk_1:   40:02
political effects on the taste receptors and the blood flow in the tongue and nasal areas. If it's got those physiological effects, you can sell other physiological effects because people feel one and have the other. I was reading the same book about one set of controlled trials. They started with an actual effective drug. They added a component that made it very pungent, and then they subtracted the real drug halfway through the trial. So the person had the real drug. They're having the real physiological effects. They were associating it with pungent compounds they put in there. They removed what they knew to be the active physiological compound. Continued giving the same person, the aromatic and the person continue to experience the effects until they took it away.

spk_0:   40:55
Her Mike slipped. Hopefully, I'm gonna have to adjust that imposed. You gotta be careful. Her Mike doesn't slip. So if there's a volume different. Sorry about that. I didn't notice when it slipped. It's going up over your head. We wear headsets, likes meddling. Okay, well, I'll use the voice level, or it may cause a little bit of degradation in the sound. Sorry about that. We'll do our best run away, little bird. We got a road kill. Uh, buzzard. It's the season. We're just a little little sight. It is the season of the red wing blackbirds who are the toughest little birds on the planet. I love red winged Blackbird. They're the most territorial mean we'll drive through the country and with every mile of passage, will see a red winged blackbird or two or three beating the holy front at ah Hawks. Who's the hawk will fly near their nasty. The red winged blackbirds will be autumn like fighter jets on a bomber.

spk_1:   41:53
They just gang up all right, When you're cycling, they'll even dive on your head from the back if they we

spk_0:   42:00
want to touch briefly on the no See Bo effect. Even though this is not as important for propping as the placebo effect, it's important that people understand what it is. So give us a brief, easy definition of the no see Bo effect

spk_1:   42:13
evil twin of the placebo effect generated in the brain in response to treatment. Not a direct response to the physiological effect of the treatment. But they're harmful when you do a clinical trial. One of these very carefully controlled clinical trials, the number of reports of things like headache, sleeplessness, itch, difficulty of focus of attention, stomachaches, digestive problems of various sorts, the incidents of report of those kinds of effects absolutely reliably every single time are higher in both the control and the experimental group than they are in the general general population, because the effect that they are taking any treatment at all, even though it may be a control, suggests to people that they may have negative side effects and therefore anything first it can actually generate things like pain, which are very psychologically controlled. And it also focuses the attention on everything that was going on to start with. So no Cibo effects are also a real deal. And the more evident the treatment becomes and the more worrisome the story of the treatment sounds to people, the more side effects they'll generate. Once upon a time, I was taking chemotherapy and one of the things my position insisted that at the beginning of every day before I even went into the center, I would take anti nausea drugs first thing in the morning because he had so many patients who would start puke ing as soon as they saw the building. That, ladies and gentlemen, is a no cibo effect. So is a large percentage, but absolutely not all of the nausea that was generated by the treatments themselves.

spk_0:   44:10
I will. I'm to give you a perfect example of the no see Bo Effect had nothing to do with drugs. I am a diver, a CZ, you know, and I but I get horribly seasick on boats. I mean, I get horribly seasick, and once you jump off the boat and get in the ocean and you're stable. You're good because you're you're stable. You're the ocean maybe moving around you, but you don't notice it, okay? And yes, the ocean is moving around you. Um, but as I was coming back up to the boat when we're diving on the A risk any which, by the way, is not a good dive to do unless you're experienced. We're coming back up in this boat. There was the season started to pick up, so we were in about 56 foot seat, which is really too much to do diving in. Um, we're out there and and I I go up and I'm swimming up and I'm waiting. Get back on the boat and I just see the boat bobbing around there like a cork and I throw up underwater. Just me Seeing the boat bobbing around like a court was enough to set my no cibo effect off because I knew what was coming. And by the way, throwing up underwater is not nearly as bad as it sounds. If you know what to do, if you're trained to deal with it, it's actually better than the worst part. Is official fish for a reason. Yeah, they call it feeding the fish for a reason because it really didn't show up. But anyway, I was a little worried because we had big, huge bear kudos around us at the time. I mean, six footers and they they were cool. Dimas kudos. We'll talk about that. Getting off the point. One more thing that I wanted to touch on and we're talking about things where you were dealing with the don't have necessarily good scientific research. Peer based, um, control study. Sometimes even when you do quote unquote have good quote unquote good scientific Pierce Pierce study. It can be balderdash, and it can be harmful on there's a case case in point. We're not gonna go into two vaccines, really in this episode, that's a whole different thing. And we may do that in the future. The vaccine missed that are out. There was a lot of vaccine, miss a lot of blood of that stuff. Nonsense. There's a man by the name of Andrew Whitworth who needs Lakefield. Whitfield, I'm sorry. Needs to be kicked very sincerely in the groin for what he did. Basically, the reason that everybody is all up in arms about autism and vaccines is because this guy did a quote unquote study and he published it in a real actual, honest to God. Periods are reviewed. Journal.

spk_1:   47:22
Not only a real one, A well respected.

spk_0:   47:25
This is a top quality one.

spk_1:   47:28
When read his original work, the manuscript he turned in for publishing the problems that later were uncovered in the work. We're not evident. When you read the manuscript, you read the manuscript. It looks like he had done a good study.

spk_0:   47:46
Unfortunately, it was hogwash. It was balderdash. And what happened was it got published, and people start going Who? Autism MMR vaccine. Tomorrow would just go ahead and tell a quick story told story.

spk_1:   48:05
So Andrew Wakefield presents this manuscript to The Lancet about looking at rates of autism before and with and without the kids having taken the MMR vaccine, and he's got a lot of data in there, and the way he describes the procedure, it looks like a reasonably controlled study. It looks like a decent science to start with the looks like actually pretty good science. So the Lancet publishes it, and since it is so central to well, being of the population as a whole. Whether or not vaccines cause autism, that is a big, important thing. Ah, whole bunch of people jump in with their own carefully controlled studies and they try and replicate his results and nobody can replicate his results. They're all finding no particular correlation with autism and vaccines of any sort. And when I was first reading up on this, I actually read through four of the significant attempts to replicate his effects.

spk_0:   49:12
No math indicated here. These are not people who work for the drug company. No, these air independent researchers who will not be in any way financially affected by the outcome of this study, mostly where the companies weren't paying for these studies that you were universities. Exactly. There's a research problem. That's where a lot of these things get duplicated like Oh, yeah, let's see if we can reproduce that result. We've got the pattern here. You have to reinvent the wheel. We just follow what he says, and it should show up what we see. But it doesn't

spk_1:   49:43
Yeah, being able to for other people to replicate the results is an important check that both the work has been well described and that the work has been honest. And when a bunch of other researchers attempt to do this because it was highly significant, it was worth a lot of people jumping in into the pile. Nobody was replicating it. They called for Andrew Wakefield than while He's still a doctor. He's no longer licensed to practice, but they didn't take his being and be away. They asked Dr Wakefield to supply his original data, which you can do if you're published in a good review journal. You could be required to supply that. And he supplied it and two major problems. One. It was junk. He hadn't done things the way Hit said had done things. He'd done it that way for a small percentage of his data. And then he had collected a lot of other data in a much more haphazard fashion and pulled it all together and described it always the good stuff and to some of it was flatly made up. He had fabricated some of the information that he put in the data sets. They contacted some of the places and persons he claimed to have done. The research there like this guy wasn't here and he wasn't doing that work. So it was flatly from fabricated in part, leaving a tiny sample of well done research with a whole bunch of padding of badly done stuff. Turns out Andrew Wakefield was working for some lawyers who were attempting to get a settlement on behalf of some kid who had both had an MMR vaccine and had an autism problem. He was associated with financial concerns that he hadn't disclosed at the time. Heck, Andrew Wakefield's made millions out of this, but when the work couldn't be replicated and they went back and found it to be a fraud, the lands that said, Hey world, we are so sorry we fell for this paper. The manuscript looked good. The description looked good. We trusted it. We published it. We're sorry because this guy just didn't do what he said he had done. He fabricated data. This paper is completely wrong. We retract it. We're pulling it out of the back archives. Sorry we were wrong. And the British medical authorities pulled the guy's medical license because of some of the really, really shady things had done with his research subjects. They're just like, No, you can't do that with people. You can't have a license to practice medicine in the UK anymore. They pulled his license, but he had a great story and because he had a great story and it played to fears inherent in people had that created the suggestion and a lot of people's minds that this was gonna be true. And that's what started the whole anti vaccine movement. Was that one paper in 1997?

spk_0:   52:58
So why we bring this up? What was the point of bringing this up? Well, first of all, it's to talk about the difference between the scientific method of under up of going through in frightening what works and what doesn't through peer reviewed research. And what happens when something in science is shown to be balderdash. Okay, it took a little bit of time, but people who had no financial interest in it at all went in and found it to be doing. And eventually the scientific community entirely agrees that it's doing okay. Unfortunately, a lot of people out in the public don't I don't I have no idea what they're thinking. I I just don't I don't get this.

spk_1:   53:52
He's got a good story.

spk_0:   53:53
He's got a good story. It's crap. It's complete baloney.

spk_1:   53:56
It plays both to people's fears and to people's inherent distrust of the man, right and for that reason, itself.

spk_0:   54:05
But the other part of this is Ah, lot of the stuff that people sell in through alternative medicine is equally ah, bunch, oh, designed to help them make money. But there is no scientific community out there debunking that you have nobody back stopping you. There's nobody behind it saying, Ah, wait, this isn't reproducible. This isn't something that we can say. Hey, yes, that works or hey, no, that doesn't work. It's a bunch of hooey, but nobody is researching and saying that is a bunch of hooey.

spk_1:   54:42
A lot of people who sell these alternative medicine products actually do believe in them. Yeah, because they are human beings, too, and they're trying to do well. And a lot of one of the people who writes and does research in the subject of placebo effects is someone who was herself for many years. She was actually what was that? Acupuncture. No one told me apathy. It was homey apathy, she once took a homey up homeopathic treatment. When she had felt she had no other options, she saw Riel improvement for it, even though she'd been scientifically trained. She was like, Hey, this really looks like it's working And for many years she practiced as a homeopathic person. She was actually a medical physician first. She practiced homey apathy for a few years, actually said she ended up making more at it than she did in traditional medicine. But when she started doing the tightly controlled research of it because she was going to show people that, hey, there is something here who have been missing this really works. She had the research skills she went to go research it awake. It's not doing a darn thing. This actually was a placebo effect, and I've been selling it as if it was real for years. So she switched careers again and is no longer a homeopath. But now she does. She teaches at a university and does research on the placebo effect to find out the real physiological basis, and her work is part of what I was drawing from earlier when I was describing it.

spk_0:   56:24
Now we are takeaway we have couple takeaways from here. Um, tick away. One is we'll find out as much information as you can about what you're doing and try and in find things that are actually scientifically reproducible. Okay, but also take away two is understand the placebo effect and keep it as a tool in your toolbox because as it's riel, it's a really thing. It's not just some made up people who get pain relief from the placebo. It doesn't matter. Getting pain relief. That is the bottom line. Whatever is causing it. They're getting pain, really so hurt

spk_1:   57:14
less than that's the goal.

spk_0:   57:15
There was what we were gonna leave you with one little thing. There was a TV show years ago, mash that an episode that was about the placebo effect, and they ran out of. Basically, they ran out of pain medicine and the doctors decided, Well, let's just go make up some stuff and say that it is Ah, powerful new pain reliever because they had nothing else to fall back on, and in the appropriate amount of people it worked. Even though it was just powder, it worked. So the placebo effect is a real thing We just want you to know that you're what you're dealing with. That's all we're saying is Just know what you're dealing with.

spk_1:   57:59
Don't fall for it, but do use it because it can enhance the value of lots of other treatments. And there is absolutely nothing wrong with people using the way people's brains are wired to give them relief.

spk_0:   58:15
We hope you enjoyed our thoughts today. And, uh, as always, the best thing that you can do to help us out. We don't want your money, but we would like you to share with links to the podcast with all your friends. You will try notto get run over by a car. Here is I'm driving and you go ahead, wrap up the program. I got drive here.

spk_1:   58:36
Uh, but I want you to thrive on and not being fooled by fake treatments. But also be not being afraid or ashamed to use the value of your own mind and other people's minds. And how it works is a part of thriving. That's true. Now that's true. If there's some emergency, he will

spk_0:   58:58
you well spices out. Bye.