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So your belief or expectation in a pill doesn t seem to have much effect on, say, the immune system or your cholesterol levels or your blood sugar.
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So things that we re not consciously aware of.
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And, you know, taking a placebo is not going to be able to suddenly magically produce a chemical that your body isn t normally capable of making.
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This is the art of charm.
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Learn everything you need to know to crush it in business, love and life.
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Welcome to the Art of Charm.
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I m your host, Jordan Harbinger.
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Today we re talking with Dr. Joe Marchant, author of Cure, a journey into the science of mind over body.
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We re gonna talk about the placebo effect.
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Is kiss it and make it all better real?
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How emotional states influence your health?
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What the mind can really do?
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How it works and why it works?
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And last but not least, how we can use these latest findings in our own lives and harness our own placebo effect.
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Enjoy this one with Dr. Joe Marchant.
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And with that, welcome to the show.
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We bring together the best thought leaders, teachers, and exceptional individuals to teach you how to be a top performer in life, love, and at work.
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If you re new to the show, we d love to send you some top episodes and the toolbox where we discuss body language, nonverbal communication, networking, negotiation, persuasion, everything else we teach here at AOC.
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In the USA, text charmed to 33444, that s C-H-A-R-M-E-D, to 33444.
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Everywhere else, go to theartofcharm.com.
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We may not have all the answers, but we definitely have all the right questions.
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All right, let s talk to Dr. Jo Marchant.
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So Jo, tell us what you do in one sentence.
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I m a science journalist and author.
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Great, and what I really like about this is you re not just a writer, you ve got a PhD in genetics and medical microbiology, and so you write about things that you actually know about.
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This isn t kind of like, oh, I m gonna write about stuff and then exaggerate a lot of it so it s more interesting.
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Yeah, I m a scientist by training so seeing the evidence is really important to me and being rigorous is really important to me.
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I do sometimes delve into subjects that I wasn t an expert on before and I think that that helps me to kind of bring together different points of view rather than following any one agenda but the actual sort of methodology of the science and the reliance on evidence I feel quite strongly about.
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Well, this makes sense.
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I mean, part of being a writer is getting to explore different topics that are interesting, so I understand that pull.
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I mean, we certainly didn t start this as a show that was supposed to be about the things it s about, so I understand that.
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In the book Cure, you talk a lot about several different topics, one of which is the placebo effect, and I found this super interesting because I always thought the placebo effect was what happens when you get kind of
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unsophisticated people, you give them sugar pills, and they imagine results, and everyone quietly snickers behind their back and says that the real drug that we were testing is a bunch of malarkey because the placebo effect did the same thing.
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But what your book is saying, or what it seems to be saying, is that not only is placebo effect just as real as most effects from any other real, quote unquote, real drug, it s actually not only more useful in many cases, but more natural, safer, and sometimes the only thing that actually works
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Yeah, that s a very good description you just gave actually of the kind of conventional view of placebos, that if somebody gets better after getting a fake treatment, then either they would have got better anyway or they ve somehow been fooled into thinking that they ll feel better even if nothing s actually changed.
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But yeah, the really interesting thing that s coming out of the research now, including brain scanning and those kinds of studies, is that when somebody responds to placebo,
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You see these measurable biological effects happening in their brains that are identical in many cases to the changes that you get with drugs.
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So when someone responds to a placebo painkiller, neuroscientists can see the release of endorphins in the brain, which is exactly the same pathway that opioid drugs, things like morphine, work through.
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Parkinson s patients, when they respond to placebo, they get a release of dopamine in the brain, which is the neurotransmitter that they re
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lacking, so again it s the same pathway as the drug and so again and again researchers are finding that we don t imagine the improvement that we see after taking a placebo, it s actually a real biological change.
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This is big news because, at least in my opinion, because people often think things that happen in the mind are often sort of magical or woo woo or maybe not even real and somehow science can t explain it or if science can explain it, it s usually explained by yes, what s happening is you re a moron and you believe stupid things and this is ridiculous.
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get real and take this new drug or this other drug or just get ready to die a slow, painful death.
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And this notion is both behind quacky claims of miracle cures as well as on the far other side of this argument, the skeptics  arguments that thoughts can t influence health and anybody who believes so is full of crap or easily deluded.
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Yeah, the claims I think underlying that is this idea that we ve got this mysterious magical force of the mind that doesn t need to obey scientific rules and therefore it can pretty much cure anything.
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And I think the skeptics are like, well, the mind couldn t possibly cure anything.
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Again, they ve got this idea of it as some sort of ephemeral thing.
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But yeah, that s for me, the scientific view is that the mind and the body are entwined.
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And if you have a change in the body, you have a change in the mind.
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If you have a change in the mind, you have change in the body.
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So the mind is working through
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defined biological pathways that we can study scientifically.
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And often these sort of natural biological pathways that are happening in the brain and the body, these are the same pathways that we take advantage of when we re using drugs as well.
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So there s nothing kind of magical about it.
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It s just the way that we ve evolved essentially.
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So let s talk more about the power of placebos.
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I mean, it seems like conventional thinking, going back to what we d said earlier, is that if a treatment works no better than placebo, it just doesn t work.
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And that s not really the case anymore, or at least that s what you re arguing is no longer the case or has never been the case.
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Well, if a treatment works no better than placebo in a trial, it tells you that that treatment isn t working necessarily the way you think it s working.
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So if you take acupuncture, for example, or homeopathy, and you can test those against placebo or fake versions of themselves,
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and there s no difference, then it tells you that those needles aren t really doing anything, or that homeopathic remedy isn t doing anything.
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But that doesn t mean that it isn t working, because placebo responses themselves aren t all the same.
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Some can be larger than others, and they can be actually larger than the responses you d get with conventional treatment.
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So there s a very interesting trial in more than 1,000 patients with chronic low back pain, so a really big trial.
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There was no difference in that trial between acupuncture
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and placebo acupuncture.
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So this is a kind of fake acupuncture where the needles go in the wrong places and they don t properly penetrate the skin.
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So scientists usually say, oh, well then it s worthless, it doesn t work, throw it out.
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But in this trial, there was a third group.
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The third group got the conventional treatment, including the drugs, the painkillers.
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That group did barely half as well as either of the groups that got the acupuncture.
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So a placebo controlled trial tells you something about the way in which a treatment is working.
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But just because something is no better than placebo doesn t mean it can t actually be helping patients quite significantly.
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So I think we have to change our attitudes a little bit to the way that we interpret these trials and to how we think about what it means for a medicine to work or to not work.
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Right, so this almost shows more about what scientists maybe don t know about how the body works and how the brain works to respond to, say, pain versus this just not being a real thing, right?
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This just not being a real cure or being quackery.
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Yeah, we need placebo-controlled trials to tell us whether drugs are working through direct biochemical effects, and that s fine.
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But what we re doing at the moment is throwing out everything else, because everything else is in the placebo group.
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But actually, particularly when it comes to symptoms that we experience, things like chronic pain, particularly, but also nausea, fatigue, depression, all of these things that have to do with quality of life, the brain plays an incredibly important role.
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Our minds, our attitude is really important.
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And so we re throwing out all of the very things that could be helping us.
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There s a lot of research now that s going into, well, how can we use these placebo effects to help people with those symptoms?
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When it comes to health and conventional science and medicine, why do you think that we tend to ignore or downplay the effect of the mind on the body?
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Why do that when we re looking for results?
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I think there s quite a lot of things going on there.
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One is just, I think there s a lot of prejudice in science
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that anything to do with the mind, subjective things are kind of flaky and not very scientific.
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And possibly that goes back to Descartes, even the philosopher in the 17th century, who kind of divided stuff into objective, physical, measurable things that could be studied scientifically.
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And then the subjective thoughts, beliefs, you know, the stuff of the minds that he thought could not be studied scientifically.
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And no neuroscientist that was respected today would really
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argue that we have such a split.
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You know, every different sort of mental state or thought that we might have is reflected by a physical change in the brain.
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But I think there s still a hangover from that, that scientists don t think that anything that s subjective, like pain, for example, is really very scientific.
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I think it s also to do with where the money comes from in trials, because the vast majority of clinical trials are funded by drug companies.
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And so you wouldn t really expect them to be carrying out trials in mind-body therapies or anything that s going to reduce our reliance on drugs.
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But if you re going to base your medicine on evidence, then the evidence you end up basing it on is going to depend on what trials you do, and that depends on who s paying for them.
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So it s kind of a self-fulfilling prophecy, if you like, that we end up with most of our medical care.
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based on physical treatments and drugs that you can sell.
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So basically, if I m a drug company and I m paying for the trial, I don t want to prove that your mind can heal.
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I don t want to prove that sugar pills that convince you to do things can heal you.
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I want to prove that this chemical that I ve worked on that cost me hundreds of millions of dollars to research is the only option that you have, so prove that.
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I don t want to prove the other.
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In fact, I probably want to argue against those other things, but the best way to do that is simply to drown it out or make sure that it doesn t get any oxygen.
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Yeah, and I don t think we can necessarily blame them for that.
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You know, that s just the job that they do.
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They re drug companies.
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You know, I don t think we should be relying on drug companies to tell us everything we need to know about what s effective medical care.
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I think we need to find maybe other funding streams or other ways of doing this.
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So it s not a case of I think drug companies are evil and we should blame them for the whole thing.
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I just think that it s a really bad idea to rely on them for all of the evidence that underlies our medical system.
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Right, it s kind of like relying on a coal company to say, by the way, have you guys seen solar energy?
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We could totally improve on this and we would have no need for all this oil that we keep drilling.
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There s no incentive for them to do that.
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Yeah, or letting all of your research for sort of good nutrition come from companies that make sugar.
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You know, it just doesn t make sense.
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Yeah, whether it s nefarious or not, the hashtag capitalism here says, look, look where the incentives lie.
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And the other thing that tends to push mainstream opinion away from any kind of alternative healing, and I mean alternative healing, and I m taking a wide swathe of this, because I don t want placebo effect to get mixed up with snake oil, literally or figuratively.
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And I think just recently in topics we ve explored on the show and elsewhere,
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The new generation, people my age now, especially those that read a lot and listen to shows like this, often would not be surprised that our emotional state might be important in warding off disease.
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Depressed people get sick more, people who are happier live longer.
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I mean, this is not news for an ever-growing segment of the population, and the idea that our minds have quote-unquote healing powers, it s seen as so flaky because of the snake oil that we ve seen in the past.
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Yeah, I think we absolutely have to have a scientific approach.
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So I don t think we can just say, oh, the mind s great.
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The mind can cure everything because it doesn t cure everything.
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There are strict limitations on what the mind can do.
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Sometimes it can have a very surprisingly dramatic effect.
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Other times it doesn t have any effect at all.
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So we need to know when it works, in which situations can we try to harness that.
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Yeah, no, I completely agree.
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We don t want to get it mixed up with snake oil.
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I think we absolutely have to base it on scientific trial.
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And I think the science that you write about in the book acknowledges the role of the mind in health, and thereby, hopefully, as you write, rescues it from the clutches of pseudoscience, which is, I think, kind of what we re trying to do here a little bit today.
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Tell us what the placebo effect can do, and then let s talk about what it cannot do.
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because that dividing line where the limitations exist is kind of where the rational and sane of us get off, and the snake oil salesmen we re talking about here continue to go down the path of, this can cure everything, don t go to the doctor, cure your cancer with this drink I made out of pomegranate, or whatever the hell these guys are selling.
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Yeah, so one thing to know about the placebo effect is there s not just one placebo effect, there are many placebo effects.
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So depending on the circumstances, you can get different
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biological changes happening in the body, so depending on how you believe your condition is going to change.
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And there s two main ways in which placebos work.
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One is through conscious expectation, so this knowledge or belief in a treatment that you re taking.
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And that works best for symptoms that we re consciously aware of.
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So things like pain, nausea, fatigue, itching, wheezing.
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It can include
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objective visible changes, things like rashes and swellings, which was a real surprise to me, I hadn t realized that before I started looking at all of this, but generally things that you re consciously aware of, so your just belief or expectation in a pill doesn t seem to have much effect on say the immune system or your cholesterol levels or your blood sugar, so things that we re not consciously aware of and you know taking a placebo is not going to be able to produce, suddenly magically produce a chemical that your body isn t normally capable of making, so you know
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insulin in a patient with diabetes, for example.
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It s not going to help sort of save your body when it s overwhelmed.
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It s not going to shrink a tumor.
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It s not going to banish a serious infection.
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So it s mostly to do with quality of life, pain, depression, nausea, fatigue, those kinds of things.
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There is another type of placebo effect which relies not on your conscious expectation, but more of an unconscious learning process where if you take a drug several times, your body learns the physiological response to that drug.
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And then if you take a placebo, your body automatically triggers that same physiological response.
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It s a little bit like if I asked you to imagine biting into a lemon and sinking your teeth into that lemon and sucking down that juice.
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And if you ve eaten a lemon before, you might start to feel a tingling at the back of your mouth where your salivary glands switching on.
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They re producing extra saliva in preparation for that lemon juice.
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And that s not something that you ve kind of consciously done.
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It s just an automatic response that your body has learned to lemon juice.
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And the same thing happens with other drugs.
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And this kind of learned response, that can reach further into the body, if you like.
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That does affect immune responses, hormone levels, a much wider range of basic physiology, the basic processes of disease, if you like.
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And so what we need to try and do if we want to harness placebo responses is try and use those together in a clever way.
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placebos for depression or pain, for example, and there are trials now suggesting that actually honest placebos work too, that just taking a placebo might give you a significant response, whereas if you want to take an immunosuppressant, if you re a kidney transplant patient, there are studies going on in this right now, you might have a regime where you give somebody a drug several times so that they learn the response and then you can use a placebo to get the same clinical effect without the drug dose, so you re reducing the side effects of those drugs.
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Right, so we re looking at certain types of drugs, or placebo, I should say, that release endorphins that block pain, and this is just a biological machination inside your brain that happens.
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You push the A button and B comes out, right?
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Endorphins are released when this happens versus, or in addition to,
1
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what sounds like a Pavlovian response, where you ve trained your body to release certain types of the immune system that you just mentioned, to ramp things up when XYZ substance is inside our body.
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So, can we do something like, I take this red pill that tastes a certain way, and it actually has something that boosts my immune system.
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Then I take it again a few days later, except it doesn t have that substance in it, but it looks and tastes the same, do I start to then feel similar effects?
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Exactly, that is very, very similar to the trials that are actually being carried out.
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They re actually using a green drink rather than a red pill.
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But yeah, it s exactly what you re suggesting.
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So you could either take this pill that boosted the immune system, or actually what they re using are pills that suppress the immune system.
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Because for patients with autoimmune disease, for example, or organ transplants, you know, there are a lot of people who need to take immunosuppressants and they have horrible side effects.
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So the idea is you train the body to respond to the drug, and then you can get the same response
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your placebo, so they re getting the immunosuppression they need without the toxicity of those drugs.
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And it s something that you could probably do, I mean it works with pain as well, Parkinson s disease is another one where it s being looked at, that you could have a blister pack of pills and you don t know which ones are the placebos, which ones are the drugs, they re just mixed up together.
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The idea is you end up with the exact same clinical effect but with a much lower drug dose.
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So the placebo effect isn t just one effect, it s a melting pot of responses from what it sounds like.
2
SPEAKER_00
Yes, I mean essentially the brain is controlling all the time lots of different aspects of physiology.
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SPEAKER_00
So the symptoms that we experience, things like pain and fatigue, those are created and controlled by the brain.
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The brain produces different neurotransmitters, things like endorphins, things like dopamine, prostaglandins, cannabinoids.
2
SPEAKER_00
All of these chemicals are being produced by the brain
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pushing our symptoms up and down, regulating how we feel in response to the environment.
2
SPEAKER_00
And that can be in response to physical signals like, you know, results of infection and injury.
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But also our psychological state, you know, the information that we re perceiving about our surroundings, our mental state at any particular time, that s also pushing those symptoms up and down.
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So these thoughts and beliefs and emotions
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whether you re stressed, whether you re worried about something, whether you feel safe and cared for, all of this is causing different neurotransmitters in the brain to be released, which is changing the levels of those symptoms that we experience.
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And then when it comes to other aspects of physiology, like the immune system, again, the brain is in constant two-way communication with the immune system, determining how the system should be regulated depending on our environment.
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With the immune system, it seems that our conscious thoughts don t seem to play
2
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such a big role, but these learning processes do.
2
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So again, it s understanding how is the brain interacting with these different things, whether it s pain, whether it s immune responses, what are the mechanisms, and then we can develop ways of sort of cleverly pushing things in the way that we want them to go, without sometimes the use of drugs.
2
SPEAKER_02
So is the placebo effect then limited to the maybe natural tools that the body and brain have available?
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SPEAKER_02
Because it sounds like our body s doing all the work, really.
2
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Yeah, absolutely.
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That is the main limitation that you can only work within the natural limits of the body s physiology.
2
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Obviously, if you ve got a drug, you can give much higher doses of something that the body could ever make.
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So you can have more powerful effects.
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But then you also get into the realm of problems with side effects, tolerance, addiction.
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So you can have bigger effects, but there s also much greater dangers.
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And so generally, if we have an effective medical treatment,
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then I don t think it makes sense to suddenly switch to placebos because obviously we get placebo effects when we take real drugs as well.
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You ve got all of those same expectations, all of that s happening.
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So what you d want to do is take the effect of drug and then you ve got the active biochemical effect of that drug and you ve got placebo effect, so that s great.
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SPEAKER_00
But there are lots of conditions where actually conventional drugs don t work very well and where placebo responses are large and where actually there are quite significant downsides to taking drugs, so things like side effects and addiction.
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And so examples of those kinds of cases are chronic pain is a very good one.
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Most of the painkillers we have are not actually very effective for chronic pain, but you ve got huge problems with addiction and we know that placebos are very effective in pain.
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Depression is another one.
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In all but the most severe cases of depression, there s practically no difference between antidepressants and placebos, but the drugs have significant downsides.
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So in these kinds of cases,
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Researchers are saying, actually, it might be worth offering people placebos before progressing, if necessary, to the active drug.
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SPEAKER_02
Yes, this is interesting because it sounds like not only are the limitations totally appropriate because our brain and body can do so much for us, but it sounds like some of the most severe things that humans find themselves afflicted, such as chronic pain or depression and things like that, are actually better served by solutions that don t involve harsh drugs with harsh side effects.
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SPEAKER_00
Yeah, I think so, particularly chronic conditions.
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So even in acute pain, you can use the mind to give people extra pain relief on top of the drugs that they re being given.
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So in acute burns patients, for example, researchers are developing virtual reality worlds that can kind of compel patients  attention to reduce their pain.
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And that s used with drugs.
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So you can use the two together to kind of get more pain relief overall than you would have been able to.
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But in chronic conditions, actually, it seems that it s often
2
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people are in pain and there s no obvious physical injury or perhaps they had an injury and it s healed but they re still in pain.
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And here it really does seem to be the brain that s kind of perpetuating that pain that they re in.
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And this is one reason why giving people those drugs long-term actually isn t very effective.
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SPEAKER_00
So in these cases it really does make sense to start looking for other approaches.
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SPEAKER_00
Taking a placebo is one approach.
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SPEAKER_00
You know it was always thought that that s not ethical because you have to think that a placebo is real for it to work.
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The doctor has to lie to you.
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But now in trials
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They re finding out that actually honest placebos, where you know it s a placebo, work too.
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So that s one option.
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But then there are also lots of other ways that we can use that knowledge about the importance of the brain to develop other techniques, whether that s improving care in medicine.
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SPEAKER_00
That s something we haven t talked about yet, that studies of placebo effects are showing that just the sort of quality of the interaction with the practitioner, that human care that you get, is very important for triggering large placebo effects.
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SPEAKER_00
just giving people better care regardless of the actual treatment would be important.
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SPEAKER_00
We can use alternative medicines as a way of harnessing placebo effects, some people suggest that, or we can develop these completely new techniques like the virtual reality I mentioned.
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SPEAKER_00
So taking some placebo pills is one option but there are lots of other ways of triggering placebo effects, even things like cognitive behavioral therapy or
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Mindfulness meditation, which is shown to be very effective for chronic pain, for example, is just a way really of changing your own attitude and triggering your own placebo effects, if you like.
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SPEAKER_02
You ve mentioned that showing people additional care and things like that, it helps to utilize the placebo effect.
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SPEAKER_02
So basically, kind of reducing this down to absurdity, it sounds like kiss it and make it all better in terms of a kid falling down and scraping his knee is actually kind of legit.
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SPEAKER_00
Yeah, I mean, I have two young children, and I really like knowing now that if they fall over and hurt themselves, they kiss it better.
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SPEAKER_00
That s actually doing something biological.
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I know that that is having a concrete effect to reduce their pain.
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I m a mum, I would have kissed them better anyway, but I quite like knowing that that is the case.
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SPEAKER_00
But even among adults, there s some very interesting research coming out of Harvard University, for example, where they re trying to really tease apart what are the active ingredients of these placebo effects?
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Can we isolate them and maybe incorporate them into conventional medicine?
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And so I can give you just a couple of quick examples.
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There was one study in patients with irritable bowel syndrome where one group got no treatment, one group got sham acupuncture,
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from a practitioner who was sort of polite but cold, didn t really talk to the patients.
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And one group got sham acupuncture from a practitioner who was warm and empathic and asked lots of personal questions and listened to the answers and touched them on the arm.
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And that group got hugely more relief from their symptoms than the group that got the same sham acupuncture but with a cold but polite practitioner.
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That group also did better than the no treatment group.
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So there was something about the needles that triggered a placebo effect.
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that interaction with the practitioner was very important.
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SPEAKER_00
There was one other study in acid reflux disease where the researchers looked at the difference between a homeopathic remedy and a placebo.
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There was no difference between the two.
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SPEAKER_00
But they also looked at the difference between a standard 18-minute consultation with the doctor and then a longer 42-minute consultation with the doctor, the sort of long personalized consultation that you might have with a homeopathic therapist.
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In that first group with the shorter
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consultation, 17% of them said their symptoms were at least hard.
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In the group with the long consultation, that proportion jumped up to 75%.
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So I think we all know that being cared for kind of helps and makes you feel better, but it s just how dramatic that difference can be.
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For me, that was really surprising that, you know, acid reflux disease is not usually thought of as, it s not a psychosomatic condition, you know, it has a real physical cause and can be very distressing for people.
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But just having that change in the consultation, regardless of the actual treatment they were getting, made a huge difference to their outcomes.
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SPEAKER_02
benefits from placebo, but on the other side of that same coin, since it is limited to what the brain and body can do, what are some examples, actually, of things that we can t change?
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SPEAKER_02
I mean, I m thinking cholesterol or blood sugar.
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SPEAKER_02
Are those things that we can help with placebo, or is that just, hey, look, this is the machinery, we can t ignore it?
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SPEAKER_00
Yeah, so there s no evidence, as far as I know, that placebo statins is gonna change your cholesterol level, for example.
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SPEAKER_00
That doesn t seem to be controlled by the brain.
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blood sugar levels as well.
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SPEAKER_01
So the brain can only change things where it s got a pathway or a mechanism for doing it, if you like, and generally the brain is controlling physiology through the autonomic nervous system, which leads to lots of different sort of organs and pathways in the body, including the cardiovascular system, the digestive system, the immune system.
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So all of these things, in theory, the brain can change and regulate, and then we can use the mind to sort of
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feed into that.
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We can t necessarily will these changes consciously.
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You can t just suddenly say, oh heart, beat faster now please.
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But if we re scared, you know, that thought can trigger that change.
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So that s one limitation is that you can t just will these things to happen.
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You can t will your immune system to change in a certain way.
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You can t wish your pain away.
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But we can find clever ways to use the mind, like visualizing the lemon that I mentioned earlier, like the placebos with the immunosuppressants.
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We can find ways of influencing these things.
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But yeah, things like
3
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cholesterol and blood sugar.
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And just cancer, for example, you can use the mind certainly to improve quality of life and help with pain and nausea and fatigue and that kind of thing.
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SPEAKER_01
But there s very little evidence for a strong placebo effect when it comes to actually shrinking that tumor.
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SPEAKER_01
So this is not a case of throwing out physical treatments.
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We still need physical treatments.
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There are lots of things that drugs can do that the mind cannot do.
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But I think we ve gone too far the other way.
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We re in a situation where we re using drugs
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for everything regardless, and we re using much higher doses than we need to.
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So by incorporating the power of the mind back into medicine, I think that would help us to just reduce that reliance on drugs and physical treatment that s going to be better for everybody around.
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SPEAKER_00
Right, it reminds me of, is it Chris Rock who has that bit, it s like, they got drugs for everything, are you hot, are you cold, are you too skinny, are you too fat, it s something like that.
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SPEAKER_00
Yeah, we re using drugs for everything, and when I was a kid, which was a long time ago, but not that long ago, I mean, in the 90s, that was when I remembered drug commercials coming on TV.
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SPEAKER_00
They ve gotten more and more ridiculous as the years have gone by, and now watching them, having not entirely my whole life grown up with them, but having
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watched way too much TV and being able to pay close attention, it s just kind of ridiculous, some of the things that you end up getting drugs for.
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Ask your doctor about this.
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Everybody has that.
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But then if you listen to the side effects, which the VO guy, the voiceover guy, does really, really quickly in the same monotone, it s like, who wants to risk leaky, you know, insert the blank here,
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because they wake up at night sometimes when they re not supposed to.
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I mean, it s just complete lunacy to me.
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And I m not anti-drug.
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I m a little bit more anti-drug probably than the average person, but I m not crazy with it, and I m certainly not someone who goes to do natural cures all the time, especially if there s no science behind it.
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SPEAKER_00
But I love the balance that you took with the placebos.
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SPEAKER_00
Of course, just because the benefits mediated by placebos are mostly subjective,
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you argue that they still have potential value for medicine, and that leads to the question, though, why aren t practitioners using more of this?
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SPEAKER_01
I think it might be partly just because the evidence base, so far, a lot of the studies are fairly small, or we have the basic science to understand the mechanisms in an experimental setting, but those trials that you need to really translate that into medicine aren t always there, and I think that is partly a political
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SPEAKER_01
issue where people who are giving out the grants find it hard to get their heads around this kind of work.
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SPEAKER_01
A lot of the researchers I spoke to said they find it really hard to get funding for the work that they re doing.
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SPEAKER_01
Yeah, the funding that we mentioned for the clinical trials where most of these are carried out by drug companies.
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SPEAKER_01
So there s just a lot of obstacles against doing the work that needs to be done to really translate this into medical care.
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I think the upside is that a lot of this we can look at as individuals.
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You know, I certainly feel that I can incorporate a lot of this into my own life in terms of, you know, the way that I
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view my own symptoms now, I would say, has changed.
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So I still listen to the symptoms, if I m in pain or I m tired or feeling ill or whatever, but I don t have to be controlled by it.
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I don t have that anxiety of, oh no, I m in pain and it s going to get worse.
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And I ve been able to realize that when we experience symptoms like pain, it s not always an accurate reflection of the injury or the damage, if you like.
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It can be vastly amplified by our anxieties.
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So I think that s kind of empowering, really, to know that
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my mental state can control that or through distraction or mindfulness or other techniques, we can reduce the pain.
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We don t have to be ruled by it.
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SPEAKER_00
If the placebo effect is regulated by the mind, does this mean that in different types of minds, for example, different cultures, we see different placebo effects, different degrees of it maybe?
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SPEAKER_01
Yes, absolutely.
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SPEAKER_01
There are big cultural effects
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placebo effects aren t anything to do with the placebo itself.
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SPEAKER_01
You know, take a sugar pill, there s nothing in it.
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It s inert, it can t do anything.
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SPEAKER_01
What triggers the placebo effect is your response to that treatment, so what it means to you.
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And obviously that can be different between different people, different situations and different cultures.
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So one really nice example is that red or pink pills tend to trigger particularly large placebo effects for pain, whereas blue pills tend to have more of a calming effect.
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They re good for treating anxiety or helping you to sleep.
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except among Italian men.
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I don t know if you can guess why.
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I m afraid to.
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They think that it s because blue is the color of their national football team.
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So for Italian men, the color blue is exciting and arousing rather than relaxing.
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So it s just to make the point that it s the meaning that it has for you as an individual rather than anything inherent about the placebo itself.
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And because of that, people are going to respond differently to different placebos depending on how you feel about them.
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So somebody who
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has a lot of faith in conventional medicine, for example, may well have a very strong placebo effect for drugs that prescribe, whether it s for chronic pain or depression, you might do very well on that.
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Whereas if you re the kind of person who s actually quite skeptical of drugs and worried about side effects and you much prefer the idea of alternative therapies or psychotherapy or whatever, you re probably not going to do very well on an antidepressant or a painkiller.
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SPEAKER_01
You re probably going to do better on the therapies
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that you feel more comfortable with.
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So, particularly for these conditions where most of the response to the treatment is actually a placebo effect, it s worth shopping around and thinking about what appeals to you, what do you have high expectations for.
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You know, the trials show that the people who feel engaged with their treatment and have high expectations for it, who do better, who have these strong placebo effects.
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SPEAKER_01
Another thing I would say is that the social interaction with the practitioner is so important.
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Again, it s worth finding a doctor or a medical practitioner that you at least respect and trust, rather than somebody that you feel that you don t get on well with.
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SPEAKER_01
And different kinds of medical practitioner are probably going to appeal to different people.
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Some people want a very authoritative physician who s just going to tell them what the matter is and tell them what they re going to do about it.
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SPEAKER_01
Other people want to have more of a sort of equal dialogue.
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So again, it s finding what suits you and is going to make you feel the most confident about how your condition is going to improve.
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SPEAKER_00
One thing that I thought was super interesting was that we re experiencing the placebo effect with any drug.
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Even quote-unquote real drugs, you still have the placebo effect happening.
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We discussed that with things like antidepressants and pain meds.
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But one phenomenon, I still don t quite understand why, even if people know it s a placebo, it can still work.
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SPEAKER_00
How is that possible?
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Why does that happen?
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SPEAKER_01
This is really interesting, isn t it?
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Because the absolute dogma about placebos until about five years ago
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was that you have to think it s a real treatment.
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You have to be fooled for it to work.
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And therefore, for doctors to prescribe it, they d have to lie to patients.
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That would be unethical.
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SPEAKER_01
So everyone s been like, well, placebo effect is all very nice, but we can t use it in medicine.
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SPEAKER_01
And then just in the last few years, all these trials have come out showing that you can give people a placebo and tell them it s a placebo, and they still feel better, which seems really crazy to start off with.
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SPEAKER_01
So there was a trial in 2010 was the first one, I think, in Irritable Bowel Syndrome.
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SPEAKER_01
They gave patients sugar pills, told them they were sugar pills, and they did significantly better than the people in the trial who didn t get the sugar pills.
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SPEAKER_01
And that s now been shown in ADHD, in migraine headaches, in depression, and in chronic low back pain.
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SPEAKER_01
And there are a lot more trials now in the pipeline as well.
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There are several possible reasons for this.
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One is that in some of these trials, they weren t just given the pill.
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The patients were given kind of like a little seminar on educating them on
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SPEAKER_01
placebo responses and how they work and why a placebo might help them.
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SPEAKER_01
So similar to some of the stuff that I ve been talking to you about.
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So it may be that it wasn t just the pill, that it s just believing in the placebo effect, if you like, is a bit like believing in a drug.
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SPEAKER_01
If you ve got that expectation that the placebo is going to help you, that could be enough.
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SPEAKER_01
It could just be that there s something about being in a trial and receiving that medical care and attention and having that attention paid to you by these top scientists and being looked after.
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that regardless of the treatment, even if it s a placebo and you know it s a placebo, that human care is enough to reduce symptoms.
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SPEAKER_01
Or it might be more to do with these automatic learned responses I was telling you about.
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SPEAKER_01
So if people have taken, say, painkillers in the past, their bodies learned
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SPEAKER_01
appropriate response and then when they go into a trial and get a placebo that response is triggered because the thing about these automatic learned responses is that they happen regardless of what you know about the placebo it just happens anyway it s probably actually a mixture of all those things but the upshot is that it s just really transforming people s view about placebo from a kind of yeah all very nice but we can t use it into oh wow this is something that we could really start to use and harness in medicine
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SPEAKER_00
I feel like different cultures have their different placebos.
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SPEAKER_00
In fact, my girlfriend, her family s Chinese.
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SPEAKER_00
She s Chinese as well.
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One day I had a headache.
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I was at their house and her mom s like, oh, I ll make you some tea that ll make the headache go away.
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SPEAKER_00
And my first thought was tea doesn t make headaches go away.
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SPEAKER_00
What s wrong?
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SPEAKER_00
Why do you prescribe tea for everything?
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SPEAKER_00
Are you thirsty?
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SPEAKER_00
Have some tea.
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SPEAKER_00
You re not thirsty.
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SPEAKER_00
Have some tea.
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SPEAKER_00
Headache?
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SPEAKER_00
Tea.
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SPEAKER_00
Tired?
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SPEAKER_00
Here s some tea.
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SPEAKER_00
That s what they do, because it s a Chinese thing, right?
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SPEAKER_00
And I drank the tea, and she said, so your headache went away, huh?
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SPEAKER_00
And I was like, well, not yet.
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SPEAKER_00
And then after a while, it did.
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SPEAKER_00
And of course, I m like, well, of course my headache could have just gone away on its own.
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SPEAKER_00
But I thought, what s the harm?
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SPEAKER_00
I had just read your book, by the way.
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SPEAKER_00
And I thought, what s the harm in just believing that tea cures headaches?
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SPEAKER_00
I don t take Tylenol or painkillers anyway, I might as well have something else that, in air quotes, cures my headaches.
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SPEAKER_00
So sure, tea cures my headaches, why not?
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SPEAKER_00
So I never get headaches because I just drink tea, which I do all day anyway.
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SPEAKER_00
And it s just something like, I ve kind of thought, why not just program myself with this useful belief system?
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SPEAKER_00
It s a little bit flaky because there s probably not a whole lot of actual mechanism going on here.
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SPEAKER_00
On the same token, I m okay with it, because otherwise I would just suffer through the headache and not care, because I don t like taking things like Tylenol.
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SPEAKER_00
And I was laughing at myself, because I m the last person who does this kind of woo-woo thing, but I thought, why not?
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SPEAKER_00
Why not go for it?
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SPEAKER_00
And I can t say whether or not it works, but I can say with a certain degree of certainty that there s hundreds of millions, if not more, Chinese people who believe that tea cures pretty much everything.
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SPEAKER_01
Well, I agree with you.
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I think, why not?
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SPEAKER_01
I don t really agree with believing in
4
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these crazy alternative therapies that crystals are healing you or these kind of paranormal, I don t know, angels or past life regression, you know, these slightly mad things, because I think that s dangerous.
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SPEAKER_01
That can lead you into rejecting perhaps conventional medicine when you needed it.
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SPEAKER_01
But in terms of the mind, I don t think there s any harm in just working out what sort of beliefs and attitudes are helpful for you.
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SPEAKER_01
And we know from study after study after study
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But if the expectation is hugely important in pain, if you believe that your pain is going to reduce, it will reduce.
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SPEAKER_01
That s programmed into us.
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SPEAKER_01
It s part of an evolutionary response, really, that if you re stressed or worried or anxious about an injury, your pain will go up because it s a warning signal.
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SPEAKER_01
If you feel cared for and you believe that you ve received effective medical treatment, your pain will come down because that s a signal for your brain that the crisis is over.
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SPEAKER_01
It can ease off on that warning signal.
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SPEAKER_01
So it s just programmed into us.
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SPEAKER_01
So yeah, why not?
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SPEAKER_01
Tea, whatever, just find
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SPEAKER_01
an attitude, an activity, a belief that works, I think we can all take responsibility for harnessing that.
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SPEAKER_01
We don t have to be passive recipients of pills.
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SPEAKER_01
We can engage in our own mental state and our own physical condition.
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SPEAKER_00
Yeah, it makes a lot of sense.
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SPEAKER_00
Magnets was one of the things Jason brought up, and he said tea is the Chinese chicken soup, absolutely.
4
SPEAKER_00
Yeah, why not?
4
SPEAKER_00
Yeah, why not?
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SPEAKER_00
And this is something I found very humorous.
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SPEAKER_00
Studies show also that the more a placebo costs, the better it works.
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SPEAKER_00
It s showing probably because we believe that expensive treatments are more effective.
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SPEAKER_00
And I thought to myself, we also see this with food, consumer products, technology, clothing.
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SPEAKER_00
Maybe those aren t as measurable because they re not medical results, but I think almost anybody can agree with this.
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SPEAKER_00
Anything that s marked up as more expensive
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SPEAKER_00
and becomes, quote unquote, a luxury, is somehow a cut above.
4
SPEAKER_00
Whether it s your iPhone or the latest computer that you ve got, a type of car that you have, clothing that you have, but especially, and maybe this is just a California thing, but food.
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SPEAKER_00
Isn t that why Instagram started?
4
SPEAKER_00
People were posting pictures of their food on social media and they thought, why not?
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SPEAKER_00
It s a billion dollar idea.
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SPEAKER_00
They were right.
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SPEAKER_00
We ve got this sort of programming in our brain, hardwired.
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SPEAKER_00
The more resources something requires, the better it is, or the better it theoretically must be.
4
SPEAKER_01
Yeah, absolutely.
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SPEAKER_01
I mean, we think of placebo effects to do with medicines, but it s actually every aspect of our conscious experience is being affected by our attitudes and our beliefs and our emotions and our expectations.
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SPEAKER_01
We do construct our own reality to a certain extent.
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SPEAKER_01
I mean, obviously, within limits, it s based on certain information that s coming into us.
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SPEAKER_01
But how things taste, how things look even, depends on our sort of previous expectations.
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SPEAKER_01
There was this picture of a dress.
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SPEAKER_01
and then people couldn t decide if it was white and gold or if it was blue and black.
4
SPEAKER_00
I think we did have that.
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SPEAKER_00
I didn t ever get what that was.
4
SPEAKER_00
That was one of the biggest internet fights of all time, yes.
4
SPEAKER_01
So it s just showing you that for some people, it was the exact same dress, but for some people it looks white and gold, for some people it looks blue and black.
4
SPEAKER_01
So that s where Envision researchers are realizing that we play a huge part in constructing what we see in the world around us.
4
SPEAKER_01
It s the same with taste, it s the same with what we hear.
4
SPEAKER_01
Absolutely, in terms of price or other aspects of what we expect something to be, that can be a self-fulfilling prophecy.
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SPEAKER_01
Or if you re on holiday and you have a certain wine and it tastes amazing and you buy a case and you bring it home and you taste it at home and it s really not that great.
4
SPEAKER_01
So it s all to do with our sort of attitude at the time.
4
SPEAKER_01
So yeah, it s not just medical symptoms like pain, it s everything that we experience.
4
SPEAKER_00
We saw this in the book with the different types of pills.
4
SPEAKER_00
You take two pills, they work better.
4
SPEAKER_00
You take a big pill, it works better.
4
SPEAKER_00
You take a pill that s a certain color, it works better.
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SPEAKER_00
So the more dramatic the treatment, the bigger the placebo effect.
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And of course, the problem that you mention in the book was, well, oops, now we ve got to have fake surgery in order to get the placebo effect from surgery.
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Yeah, so you kind of would think, wouldn t you, that well surgery is a kind of proper treatment, so you probably wouldn t have placebo effects in surgery, but actually in trials it has the biggest placebo effects of all.
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So there was a big analysis recently of a whole load of different surgical techniques that were, you know, all thought to be really promising and then half of them
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the real surgery was no better than the fake surgery.
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This is for conditions from osteoarthritis to angina.
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I mean, it was just incredible, really, that surgeons have been doing a lot of these techniques, because traditionally, they don t test their surgical procedures in placebo-controlled trials, because it was always thought that fake surgery wasn t very ethical.
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So they just kind of go ahead and do it and see people getting better.
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And it s only in the last few years that we re realizing how much of that was actually placebo effects.
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And then it s a dilemma, then, because what do you do?
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If a surgery is really helping people,
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but it s only working through a placebo.
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Do you stop doing that and take that benefit away from those people?
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I mean, it s a difficult one.
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You talk a lot in the book about stress, bad stress and turning it into good stress.
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Let s learn how to do this and take advantage of some of our brain power to limit stress.
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Because as we know, cortisol ages us, stress ages us.
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Literally, at a genetic level, this takes effect.
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If you could, explain that and then maybe give us some ways we can help manage it.
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Okay, so most people are familiar with stress or the fight-or-flight response.
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So we know that if we re anxious or afraid or nervous, this fight-or-flight response kicks in and it s meant to help us respond in emergencies.
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So your pupils will dilate, your heart beats faster, your blood pressure goes up, blood is diverted from your gut to your limbs and brain, glucose is released into the bloodstream to fuel your next move.
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So a whole load of changes are happening across your body, which is great in an emergency,
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not great if it s switched on all the time, if you re stressed all the time, that just creates wear and tear on the body, that increased blood pressure, increases the risk of heart disease, for example.
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Another thing that fight or flight does is it triggers a branch of the immune system called inflammation, which is the body s first line of defense against infection and injury.
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Again, if this is switched on long term, that s very damaging, it exacerbates autoimmune disease, makes us more susceptible to infection, everything from the common cold to HIV.
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It s been implicated in cancer.
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Yes, like you say, stress ages us.
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It increases the rate of cellular aging of cells.
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So not good.
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And so one thing I do in the book is I look at the evidence-based ways to reduce stress.
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So what does the trial evidence say?
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What works and what doesn t work?
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Mindfulness meditation is one of the best studied, for example.
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There are now hundreds of trials suggesting that that does reduce stress.
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It also reduces chronic pain, anxiety, and fatigue.
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social connection is another one your sort of best possible protection against stress is to have strong social relationships and that feeds through into life expectancy so people who have strong social relationships who feel sort of integrated and part of a social group they don t get as sick and they live longer that s one of one of the strongest findings that we have in behavioral science but what I found really intriguing so there were some studies done on ways of
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not reducing stress, but just changing how we respond to stress.
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Because fight or flight isn t all the same.
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There s a difference, for example, if you imagine yourself at the top of a ski slope, and you see this sort of steep run going down beneath you, depending on whether you re an experienced skier or not, you might feel joy and exhilaration, or you might feel absolute terror.
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And those do different things to your body, whether you feel confident in a situation, and it s a challenge that you think you can meet,
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or whether you think that you re going to be crushed and you don t have the resources to deal with the situation.
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Those have very different effects.
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If you re feeling confident, psychologists like to call it sort of challenge state.
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rather than a threat state.
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In a challenge state you perform better and it s also much better for your long-term health as well.
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And so just one very quick way to change yourself from a challenge state into a threat state is how you think about your body s response to stress.
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So if you ve got something stressful coming up, whether it s an exam or you ve got to do some public speaking and you notice that your heart s pumping, what researchers did in this study was they said to people who are about to sit an exam or do a stressful test,
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They said if you notice signs of anxiety or stress or arousal in your body, like your palms are sweating or your heart s beating, remember that that is your body working to help you.
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That is going to help you perform better because if your heart s beating, that s going to push oxygenated blood around your body, more oxygen to your brain and to your muscles.
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That s great.
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You re going to perform better.
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Just telling people that so that they saw those signs of stress more positively switched people from a threat state into a challenge state.
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so there was a sort of healthier response for them, but also they scored better.
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So this was in graduates, they did a fake exam in the lab, they scored better in that fake exam.
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And not only that, when they did the real exam, three months later, they scored higher in that exam as well.
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So just that one piece of information, see those signs of sort of arousal in your body, beating heart or whatever as positive, completely changed how they responded to that stress and improve their performance.
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So that s my tip for you.
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Right on, so we re basically harnessing our own kind of reframing the situation.
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Yeah, it s called reframing.
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Yeah, seeing the situation differently changes your physiological response to it.
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That s excellent.
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We can do that at the regular.
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I think regardless of whether or not it s an exam or any kind of situation, if we reframe that as our body getting ready versus us getting ready to have a negative reaction because we re not ready for this or we re underprepared or we re gonna get our butts kicked, it definitely can be a game changer, especially if we believe it.
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It s just taking back some control and if I could give you one other quick example of reframing that has to do with pain.
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So this was a study where volunteers were told they were either going to be subjected to a low level of pain or a medium level of pain or another group was going to be subjected either to a medium level of pain or a high level of pain.
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In that first group, if they got a medium level of pain, so that was kind of the worst out of the two levels of pain they were expecting, they rated that as quite painful, moderately painful and areas of the brain lit up that are
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associated with processing pain.
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In the second group, if they got that medium pain, so exactly the same level of pain, but in the second group, they thought it was either going to be medium or high.
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So now it s the best case scenario.
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It s the lower of the two levels of pain they re expecting.
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They rated that pain as pleasant and parts of their brain lit up that are associated with reward.
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So just by reframing it, seeing what you re getting is either a best case scenario or worst case scenario, completely changed what people were experiencing from being painful
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to being pleasant.
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So it s just an example of showing how important your attitude is, how you see what s happening to you, can either give you a painful experience or a pleasant one.
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Joe, thanks so much for coming on and discussing this with us.
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I know that this book is incredible, took a lot of work, and I really appreciate you sharing some time with the AOC family.
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Thank you so much for having me, I really enjoyed it.
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Interesting stuff, you know, I love the idea that the placebo effect is not only real, but something we can harness and use for ourselves.
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And the science in the book, Cure, is really, really interesting.
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There s a lot about how our minds work, what we can and cannot do, just through the control of our own emotional state, the control of our own brain.
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Fascinating stuff, looking forward to seeing the developments on this front in the future.
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But of course, it s important to remember that just because the mind plays a role in health,
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It doesn t mean it can cure everything, nor does it mean that any therapy that might harness the mind is suddenly justified.
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So be careful.
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When people reject conventional treatments in favor of untested ones, they may die as a result.
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So be careful what you believe, and be very careful about what you do or don t do as a result of those beliefs.
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If you enjoyed the show, don t forget to thank Joe on Twitter.
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We ll have that linked in the show notes, as well as the book, Cure, A Journey into the Science of Mind Over Body, and other resources we ve mentioned on the show.
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You can tap our album art and most mobile podcast players to see the cheat sheet for this episode.
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We ll link to the show notes right on your phone.
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I m also on Twitter, at The Art of Charm.
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I post a lot of insights, articles, I go back and forth with you all there, so it s a great way to engage with us, right there on Twitter, at The Art of Charm.
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and I also want to encourage you to join our social capital challenge at theartofcharm.com slash challenge or in the USA only text charmed to 33444, that s C-H-A-R-M-E-D to 33444.
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The challenge is about improving your networking skills, your connection skills, inspiring people to develop connections and relationships with you.
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We ll also email you our fundamentals toolbox that I mentioned earlier on the show and I ve got videos with drills and exercises every week to help you move forward.
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It ll make you a better networker, it ll make you a better connector, and a better thinker.
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That s theartofcharm.com slash challenge or text charmed in the US to 33444.
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This episode of The Art of Charm was produced by Jason DeFilippo.
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Jason Sanderson is our audio engineer and editor.
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Show notes on the website are by Robert Fogerty.
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I m your host, Jordan Harbinger.
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Go ahead, tell your friends, because the greatest compliment you can give us is a referral to someone else, either in person or shared on the web.
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Now stay charming and leave everything and everyone better than you found them.
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Thanks for listening to the Art of Charm.
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Get more confidence, relationship skills, life hacks, and more at theartofcharmpodcast.com.