0:05

The placebo

0:05

effect is when someone sick

0:07

gets better by taking a fake pill

0:10

that contains no actual medicine. Or

0:12

they get fake injections. Or even

0:15

fake surgery. The effect is not

0:17

in your head. The results are scientific

0:20

and measurable. That already sounds

0:22

crazy. But it gets a lot

0:24

crazier. We have these expectation

0:27

effects that go kind of beyond the medical

0:29

setting into things like how

0:31

easily you can perform a workout, you know, how

0:34

well you can get fit,

0:35

the effects of sleep loss, even

0:38

the effects of your mindset on aging

0:40

and how quickly you age. These are

0:42

all expectation effects that go way beyond

0:45

what we once knew about the placebo effect. I'm

0:47

David Pove, and you're about to hear some

0:50

very strange unsung science.

0:57

Hey, Prime Members, you can listen to Unsung

0:59

Science ad-free on Amazon Music.

1:02

Download the app today. Get

1:27

started at Dexcom.com. Dexcom

1:30

data on file 2023. If your glucose alerts

1:32

and readings from the G7 do not match symptoms or expectations,

1:34

use a blood glucose meter to make diabetes treatment decisions.

1:37

For a list of compatible devices, visit www.dexcom.com

1:40

slash compatibility.

1:41

I'm Candace DeLong, and on my new podcast,

1:43

Killer Psyche Daily, I share a quick

1:46

10-minute rundown every weekday

1:48

on the motivations and behaviors of the

1:50

cold-blooded killers you read about in

1:52

the news. Listen to the Amazon Music

1:55

exclusive podcast, Killer Psyche

1:57

Daily, in the Amazon Music app.

1:59

and unload the app today.

2:02

Season 2, Episode 15, what

2:05

if placebos are the medicine?

2:11

Every modern army employs medics

2:14

to treat the wounded soldiers. And

2:16

in World War II, anesthesiologist

2:18

Henry Beecher was one of them. And

2:21

what he found was that when he was treating

2:23

soldiers, he found that often, you know,

2:26

they seemed to kind of

2:28

not need pain relief when they came off

2:30

the battlefield. And this

2:32

got him kind of wondering whether it was just the pure relief

2:35

of having been saved from the battlefield that

2:37

was kind of producing its own euphoria

2:39

that was then reducing their

2:41

kind of pain that they were feeling. So they actually refused

2:44

to have morphine when they were offered

2:46

it, which is incredible. And this was quite a high

2:48

percentage of people. So that suggested

2:50

there was some way that kind of the psychology

2:52

of the soldier could influence the pain they

2:55

were feeling.

2:56

This is David Robson, author of

2:58

The Expectation Effect, How

3:00

Your Mindset Can Transform Your Life.

3:03

Now, there's this other story that says that

3:05

he actually ran out of his

3:07

drugs at one point. And so his

3:09

nurse started injecting salt

3:13

solution instead of morphine. And

3:15

what they found was that a lot of these soldiers

3:17

really did experience that kind of pain

3:19

relief. And it seemed to be quite profound. And then, you

3:22

know, he studied this in later, more controlled experiments

3:24

and found that that was indeed the

3:26

case. Every

3:29

year, the pharmaceutical industry tests

3:31

thousands of new drugs.

3:33

And in clinical trials, to see if they

3:35

actually work, they usually test

3:37

each drug candidate against pills

3:39

that look identical but don't

3:42

actually contain any medicine. They're

3:44

just sugar pills. They're called

3:46

placebos. The idea

3:49

is not to compare the candidate drug with

3:51

doing nothing. That would be a bad

3:54

study because even if the medicine

3:56

doesn't do anything, some people

3:58

will get better.

3:59

because of the placebo effect. The

4:02

researchers might think that the medicine works

4:04

when it actually doesn't. No,

4:06

the point of comparing the test medicine against

4:08

the placebo is to subtract

4:11

out what's called the placebo response.

4:14

For example,

4:15

if 75% of patients get better with

4:18

the actual medicine, and 50%

4:21

of them get better taking the placebo, you

4:24

know that the actual medicine's effect

4:26

is 25%. Keep

4:28

in mind that the people who got the fake pills

4:31

might be showing improvement because they just

4:33

got better over time,

4:35

or saw a fluctuation in their systems.

4:38

Either way, you now have a better idea

4:40

of what effect the actual medicine

4:42

candidate produces. The

4:45

best studies are double blind,

4:47

meaning that neither the researcher nor

4:50

the patient knows which pills are

4:52

which. That's to make sure that the researchers'

4:54

own words and attitudes don't

4:57

somehow give away whether a

4:59

patient is getting the good stuff or the sugar pill,

5:01

which they worry could skew the results. But

5:05

in the last couple of decades, science

5:07

has started to realize, well, wait

5:09

a minute, why are we subtracting out

5:12

the placebo effect? If it's

5:14

producing positive outcomes in patients,

5:16

maybe we should consider treating them with

5:19

placebos. Like if it's providing

5:21

relief, could we actually harness that

5:24

effect as well, potentially reducing

5:26

the doses of drugs that we give to

5:28

people?

5:29

What's crazy is that the placebo effect

5:31

is not just some woo woo, if

5:33

you dream it, it will come true kind

5:36

of thing. There are measurable biological

5:38

effects.

5:39

There's been one study after another. Most

5:42

of them have to do with pain.

5:44

One of my favorites was that if you give

5:46

people morphine and you

5:48

give it through the IV drip, so it's kind of surreptitiously

5:51

delivered, that produces much less

5:54

pain relief than if you give morphine

5:57

in front of the patient with the doctor telling

5:59

them what they're doing.

5:59

doing. In one study, researchers

6:02

at Columbia and Stanford gave students

6:05

free bottles of a new energy drink that

6:07

contained 200 milligrams of caffeine,

6:10

two and a half times as much as what's in

6:12

a red bowl.

6:14

Or at least that's what they told the students.

6:17

I mean, it was just a bottle of pure water. But

6:20

it was turned into a placebo for

6:22

this kind of energy drink that was meant to leave you

6:24

feeling more alert and, you know, kind

6:26

of energized. And that's indeed

6:28

what they found. It actually produced a change in

6:31

blood pressure and, you know, feelings of

6:33

alertness that just didn't come, obviously,

6:35

when you just drink a glass of tap

6:38

water. Wait, blood pressure?

6:40

See that's another one of those examples where

6:42

it crosses over from the woo woo into the

6:44

physiological. Yeah, exactly.

6:46

In all these ways, there are

6:48

objective measurable changes.

6:51

It's not just the patient self-reporting.

6:54

And it's not just fake medicines, by the

6:56

way.

6:57

There's even been tests of fake

6:59

surgery. You mentioned one study

7:01

in the book where doctors

7:05

would go in to put a stent in

7:07

during heart surgery,

7:09

but not actually put one. Yeah,

7:11

that's right. The surgeon did actually kind of

7:13

make a cut in their skin and, you know, like perform the

7:15

actions as if they were delivering the stent.

7:17

It's just there was no stent attached to

7:19

the catheter that they were inserting. The

7:21

patient fully believed they were they could

7:24

have been receiving the stent. It was quite

7:26

a big group sample of patients.

7:28

They found no statistically significant difference

7:31

in their symptoms. And I should I should

7:33

emphasize actually that this was a very particular

7:36

use of the stent. So it was for treating

7:39

angina. So, you know, pain

7:41

in the chest. I'm not saying that doctors don't

7:43

need to use stents at all. But for the treatment of

7:45

angina, it certainly seemed that there was no

7:47

benefit of having the stent over just

7:50

having the placebo surgery. Wow. Well,

7:52

the whole thing starts to make you wonder how

7:55

much of real medicine

7:58

and surgery is benefiting

8:01

from the placebo effect. Like

8:03

when we buy Advil or

8:06

something, I wonder if the

8:08

fact that we expect will get better

8:10

from it

8:11

is boosting its actual medical

8:13

effect. Yeah, I think it is. And actually,

8:16

you know, drugs marketing is really important

8:18

in the size of the placebo

8:20

effect. You can find all kinds of painkillers,

8:23

some of them, you know, like with bright packaging

8:25

and, you know, telling you, will produce

8:27

like 10 times greater pain relief than

8:29

the average painkiller. And, you

8:31

know, what we know is that when you have all of that positive

8:34

reinforcement of the positive expectation,

8:36

then it really is more powerful. And

8:39

you're saying,

8:40

comparing a drug that has 200 milligrams

8:44

of ibuprofen versus a generic

8:46

one that also has 200 milligrams of ibuprofen.

8:49

That's exactly it. Yeah, you're getting

8:52

the exact same chemical. It's just the way it's

8:54

presented.

8:55

It gets even weirder. It turns

8:57

out that bigger fake pills

9:00

produce a more dramatic effect than smaller

9:03

fake pills.

9:04

And even the color matters.

9:07

Yeah, all kinds of these things seem

9:09

to make a difference. You know, if say

9:11

you're trying to receive like a kind

9:14

of tranquilizing drug to reduce anxiety,

9:17

that actually blue pills seem to be more effective

9:19

in that case than if you have a red pill because

9:22

we associate blue with a kind of calmness.

9:25

That's crazy. Do you

9:27

think

9:28

modern pharmaceutical companies know

9:30

that as they decide how to design

9:32

their pills? I expect they probably do. And

9:35

you know, that alone is enough

9:37

reason for them to change the color of the pill. We

9:39

also know that fake capsules have

9:42

a stronger beneficial effect than fake pills

9:45

and fake injections have the biggest

9:47

effect of all.

9:49

Now,

9:50

to be clear, this stuff isn't

9:52

magic. Placebos work on

9:54

some ailments much better than others. They're

9:57

amazing for pain and do a

9:59

good job on...

9:59

insomnia, depression, anxiety,

10:02

and problems with peeing and pooping.

10:05

But they can't shrink tumors, they

10:07

don't lower cholesterol, they don't bring down

10:10

high blood pressure, they can't cure

10:12

malaria, they can't

10:13

make a wound heal faster. The

10:15

placebo effect is primarily

10:18

reducing symptoms. People

10:20

say, you know, medicine's really into the underlying pathophysiology.

10:23

We get rid of this chemical, fix

10:25

this organ that has a word, just to repair

10:28

trauma. But actually, patients'

10:31

symptoms are really important. Ted

10:33

Kappchuk is a professor of medicine at

10:35

Harvard, where he's the director of the program

10:38

in placebo studies.

10:40

And what do they do there? We do nothing

10:42

but placebo research. We try to

10:44

find out how we can amplify the placebos, make them

10:47

smaller, make the effects higher or smaller.

10:49

Few people have been working as hard, for

10:52

such a long time, to advance the

10:54

idea of placebos as

10:56

treatment.

10:57

So let me tell you a very

10:59

simple example of a placebo effect.

11:02

I could pick headaches,

11:04

I could pick irritable bowel syndrome,

11:07

chronic pains in the belly. But

11:09

let's start with a low back pain. You fall down,

11:12

hurt yourself, get an injury, trauma

11:14

in your back, you're hurt.

11:17

You're hurt, so the doctor prescribes aspirin

11:20

or Advil. Maybe try some physical

11:22

therapy. And in time, the

11:24

injury heals, and the pain stops.

11:27

For most people. But for

11:30

many people, 50 to 100 million

11:32

Americans, the

11:35

brain doesn't shut off the single.

11:37

It keeps firing in the brain. That's

11:40

what most chronic pain is. Your nerves

11:43

change their functioning structure, and

11:46

they keep firing, telling you you're in pain.

11:48

Because we do know, when you respond to placebos,

11:51

endorphins, dopamine,

11:53

cannabinoids are released.

11:59

treat it like opioids or

12:02

use the same pathways as the placebo

12:04

effect. So you're saying that the symptom

12:06

of pain continues long after

12:08

the actual injury. Right. The brain

12:11

is misfiring. It's a false alarm. That's

12:14

very, very common. 15 to 20%

12:17

of every medical kind, especially, has patients

12:19

coming in saying,

12:20

you gave me this drug, I did the surgery and

12:23

I'm still in the same pain. And doctors, what

12:25

they do, they send them to psychologists. And it's not

12:27

a psychological problem. Most of the time

12:30

it's a question of how the nerves work.

12:33

A lot of people haven't quite up to that explanation.

12:36

What Capchuck has discovered after 30 years

12:39

of research is that there's a lot more

12:41

to the placebo effect than the pill

12:43

itself. Well, first of all, it's

12:45

not a pill, the effect of a pill, because

12:48

it has no effect. It's everything that surrounds

12:50

the pill. The ritual, the symbols,

12:53

the acts of kindness, the

12:56

smells, bells and whistles of a clinical

12:59

interaction.

12:59

That's really an incredible

13:02

important drama of every person who

13:04

seriously wants to get healing. If

13:06

you need any proof that the doctor's attention

13:09

really makes a difference, consider one

13:11

of Capchuck's most famous studies.

13:13

It was a study of 262 people

13:16

with irritable bowel syndrome, IBS.

13:20

It's like a perpetual stomach ache accompanied

13:22

by various pooping problems. It's

13:25

a really nice study. It's one of my more well-known

13:27

studies, but it was published in British Medical

13:30

Journal 2008. He divided these

13:32

people into three groups, or

13:35

as they call these groupings in the clinical trial,

13:37

biz arms, three arms.

13:40

We randomized 260 patients

13:43

to three arms. One was

13:45

no treatment control. The

13:47

second arm was it's a needle

13:49

that looks like an acupuncture. It is

13:51

an acupuncture needle. It goes in and

13:54

patient feels it. It stands there straight

13:57

up, but in fact, it's a magic sword.

13:59

The needle goes up the shaft. You can't tell

14:02

the difference between it and real acupuncture. Oh,

14:04

man. Fake acupuncture. This

14:07

second group had no doctor-patient

14:09

relationship at all.

14:10

An acupuncturist breezed in, asked

14:13

if the patient was comfortable, and breezed out. But

14:16

then there was the third group.

14:18

Now you also got the fake needle, but then the

14:20

doctor, the acupuncturist would say,

14:22

so I've read your chart. I have a good

14:24

idea what's going on, but I want to hear in your

14:27

own words what is

14:29

going on. How does this affect

14:31

you? What symptoms are the worst? What makes it better?

14:34

How does it make you feel? What things can you do

14:36

that you

14:37

still can do? What things do you can't do? And why

14:39

do you think it's the core? A real schmaltzy relationship.

14:42

It was a little probably over the top. The article

14:44

about the study that I read, it said that in

14:46

the third group, practitioners were required

14:49

to touch the hands or shoulders of members

14:51

of the third group and spend at least 20 seconds

14:54

lost in thoughtful silence.

14:57

You know, it was great. We went over the top. By

14:59

this incredible result, as

15:02

good as it could get, where the

15:05

intense doctor-patient relationship, 60%

15:09

of the people got better. If

15:12

they had only the

15:14

paraphernalia fake acupuncture,

15:16

about 40% got better. And those

15:19

people who are in no treatment control, they

15:21

had 27% improvement. Time

15:23

heals. And I would say that it's

15:26

clear that patient-doctor relation can

15:28

modulate placebo effects

15:30

from that study. It's so mind-blowing. By

15:32

a third, by a third better. It's really amazing.

15:35

So this seems like a valid

15:38

study. The numbers were big enough. It was well-designed.

15:41

Why didn't that instantly translate into

15:44

a universe of doctors who do not

15:46

rush you through the office?

15:48

Two reasons. The evidence wasn't good enough, but

15:50

the real evidence is doctors don't mostly

15:52

care about placebo effects. I

15:54

teach in a medical school. The students get

15:57

taught

15:58

that if it's not more than a... placebo,

16:00

it's worthless,

16:01

right? The placebo is junk.

16:03

I mean, that's what you get taught when you're studying the development

16:05

of pharmaceuticals and devices

16:08

and surgery even. So it's

16:10

always been tending to be marginalized placebo.

16:14

The other reason doctors don't care about

16:16

it is that placebo

16:18

is tainted with deception and trickery

16:21

that you have to conceal or deceive

16:24

the patient and make them think it was

16:26

a real drug or a real intervention. So

16:29

I study with the greats

16:32

and people that my predecessors,

16:34

my teachers, and everyone

16:36

believes that. And here's where

16:38

things get really nuts. Ted

16:41

Kaptchuk is the first man who ever ran

16:43

a study to answer the question, would

16:46

a placebo still work if

16:48

you knew you were getting a placebo?

16:51

After the ad break, I'll

16:53

tell you how he tracked the answer down. Casey

17:00

Shane was murdered in the middle of an August night, shot

17:02

point blank while idling in his Dodge pickup truck in

17:05

North Indianapolis. There was

17:07

no physical evidence, no known motive, and

17:10

no one coming forward with information.

17:12

Except one woman who swears to this day she

17:15

saw Leon Detroit Benson pull the

17:17

trigger. Leon Benson was

17:19

sentenced to 60 years in prison, all

17:21

because one person swore they saw something.

17:24

But what if she was wrong? And

17:26

what if we could prove that she was wrong? From

17:29

Wondery and Campside Media

17:30

comes season three of the

17:32

hit podcast Suspect, co-hosted

17:35

by me, Matt Cher, alongside

17:37

attorney, Laura Bazalon. This

17:39

is a story of a botched police investigation,

17:42

the dangers of shaky eyewitness testimony,

17:44

and a community who feared law enforcement,

17:47

with good reason. Listen to Suspect,

17:50

five shots in the dark, wherever

17:52

you get your podcasts, or binge all

17:54

eight episodes ad free on Wondery

17:56

Plus. Find Wondery Plus in the Wondery app,

17:59

or on Apple.

18:02

We've been talking to Ted Kapschuck, who

18:05

runs a Harvard group dedicated to turning

18:07

the placebo effect into an actual

18:09

medical treatment. But remember,

18:11

most doctors have encountered placebos

18:14

only in the context of studies, where

18:17

you're giving half the patient's real medicine and

18:19

the other half a fake pill that has no active

18:22

ingredients. And in those double-blind

18:24

studies, they tell you that you

18:26

may be getting a placebo.

18:28

You could never give a placebo pill

18:30

to a sick person and pretend

18:32

that it's medicine. You can't lie

18:34

to them, first do no harm, right?

18:37

Informed consent and all that stuff. That

18:39

would be really unethical. And

18:42

so, as a result, few doctors give

18:44

a placebo to patients and claim that it's

18:47

real medicine. Well, few

18:49

doctors admit to it. So

18:51

Kapschuck had what may sound like the craziest

18:54

idea in all of crazy

18:56

plesibology. What

18:58

would happen if we gave patients a placebo

19:01

and told them it was a placebo?

19:04

They said, let's try this. Let's

19:07

do an experiment

19:09

where we tell people it's placebo.

19:11

We have to try it. He approached the

19:13

gastroenterologist he'd worked with on a recent

19:15

experiment. And I said, Tony, I

19:18

got to do this. I got to do this.

19:20

I want to give patients a placebo and tell them it's

19:23

placebo. And he was great. He

19:25

said, Ted, the

19:26

craziest thing I've heard. I'm on board. And

19:28

I said, we have to get a grant. And he said, you're never going

19:30

to get a grant. And he said, Ted, can

19:32

you recruit the patients and pay for parking? I

19:35

said, yeah, I'll do the work for free

19:37

and we'll sneak them into the research part

19:39

of the hospital and not have to

19:41

pay the fine. And we came out there.

19:44

It actually worked pretty good. 60% of

19:47

people got better on the open label, plus

19:49

usual care. 30% got better

19:51

without an extra treatment. That

19:54

blew us all the way. I don't know. It's really

19:56

hard to believe. In other words, compared

19:58

with the people who got. no treatment at all,

20:01

twice as many people got better when they'd taken

20:03

a placebo that they knew had no

20:06

active ingredients. What Cap Chuck calls

20:08

an open label placebo

20:10

or honest placebo.

20:12

But what about people who got an honest placebo

20:15

versus people who got

20:17

dishonest placebos, pills

20:19

they thought might contain actual medicine

20:21

in those double blind trials?

20:24

Yeah, we've compared them directly many times,

20:26

several times. There's no difference.

20:28

I've been published for great studies

20:31

with 300 people, an earlobal,

20:33

and there's no difference to double blind, no label. It's

20:36

so hard to believe. There have been now over

20:38

a thousand patients randomized to this kind of

20:40

thing in different conditions like low back

20:42

pain, migraine headache, knee

20:44

osteoarthritis, all kinds of

20:46

pain conditions, and also lots of non pain conditions.

20:49

Cancer related fatigue, it's been done three times

20:51

now. Perimenopausal hot flashes. So

20:55

there's a lot of evidence for it. It's

20:58

hard to believe, but I guess it's

21:00

because the nerves

21:03

are in a context of healing. It happens

21:05

automatically. It's like

21:07

the rituals, the bells and whistles,

21:09

the doctor. It's not a mind cure.

21:12

It's actually the nervous system regulates

21:14

itself. It's much smarter than the mind.

21:17

The non-conscious world

21:19

of our being is what's doing it. And

21:22

that's really a breakthrough. But it occurs

21:24

to me that there would be no side effects either. No,

21:27

in person, honestly, placebo has no side

21:29

effects. When I was a kid and I found out placebo

21:31

effect,

21:33

about the same time I found out about

21:36

this effect that the placebo

21:38

effect still works if you

21:40

know it's a placebo. Yeah. You're

21:42

the guy who figured that out?

21:44

Yeah, that's my first experiment and I've done 15

21:46

of them since then.

21:48

That was you? That

21:50

has been a cornerstone of my cocktail

21:53

party conversations. I really want to take

21:55

the taint out of placebo, the

21:57

idea that you need deception in some ways.

21:59

And this healing rituals

22:02

tricks our minds to turn down

22:05

the amplified pain sensation.

22:08

It turns down the false alarm.

22:10

Absolutely incredible. So do we have any

22:12

idea what the physiological

22:15

explanation is for that? Oh, thank

22:17

you. Thank you. Thank you, that's a really important

22:19

question to ask. We don't 100%

22:21

know everything what's going on there, but

22:25

the simplest explanation is that

22:27

the nervous system amplifies symptoms,

22:30

not only pain,

22:32

and sometimes it gets stuck there and up

22:34

in the brain. The

22:37

pathways that make the pain light

22:40

up, the false alarms, are the same pathway

22:42

that the placebo sometimes

22:45

in some people turned down.

22:47

We know for a long

22:49

time that for double blinds and deceptive

22:52

placebo, neurotransmitters were

22:54

involved like endorphin.

22:56

If you respond to placebo, there's a release

22:59

of maybe endorphins, cannabinoids,

23:01

dopamine. We now know, recent

23:03

experiments tell us that even with open label, you

23:05

get the endorphins involved, right?

23:07

So we know that in many cases,

23:10

after you take a fake pill, your

23:12

brain releases real chemicals, which

23:15

produce genuine improvements in your

23:17

symptoms. We know that the placebo

23:20

effect gets magnified if you get a lot

23:22

of attention from the doctor. Schmaltz,

23:25

as Gaptchuk calls it. Okay,

23:27

so in three groups in general,

23:29

a group that gets no care might

23:32

get less pain over time just because

23:34

it fades.

23:36

Placebo effect with no Schmaltz

23:39

does better than that, but

23:41

a placebo pill plus Schmaltz

23:44

will get a bigger placebo effect.

23:47

Now, remember

23:48

our author friend, David Robson? I'm

23:51

David Robson. I'm 35 years old. I'm

23:54

the author of The Expectation Effect.

23:57

There are actually only two chapters in his book

23:59

about the

23:59

placebo effect. To him, the

24:02

placebo effect is only one form

24:05

of the expectation effect. Placebos

24:08

are a subset of the effect that

24:10

expectations can have on your life. One

24:13

of the best examples concerns exercise.

24:16

They gave these students a genetic

24:18

test for a variant that's known to affect

24:21

your kind of capacity for endurance

24:23

exercise. If you have one variant

24:26

of the CREV1 gene, it seems

24:28

that you are a bit better

24:29

able to do endurance exercise and that's reflected

24:32

in physiological measures like the gas

24:34

exchange within the lungs. So they gave

24:37

these students this genetic test, but

24:39

then they gave them sham feedback. So

24:41

the students didn't initially find

24:44

out what variant they had. And

24:46

what the researchers found was that those expectations

24:49

alone, independent of the

24:51

genes they were carrying, influenced

24:54

their performance in this endurance exercise.

24:57

And in some cases, the influence

25:00

of the expectations was actually greater

25:02

than the influence of that gene.

25:04

So the gas exchange within

25:07

the lungs, the expectations were a bit

25:09

more powerful. So if I told

25:11

you, oh, lucky you, you've got the gene,

25:14

you'll run better, longer. You believe

25:17

it and you do?

25:19

Yeah, exactly. That's what they found. And,

25:21

you know, it also affected feelings of how hard they

25:23

were working out. If you thought you had the good

25:25

gene, you could be really like going for it on the

25:27

treadmill, but it didn't feel like so

25:30

exhausting. So I think it speaks more

25:32

broadly to, you know, the narratives we carry

25:34

around us. Like if you've always just assumed

25:37

that you just aren't cut out for exercise,

25:39

maybe because of, you know, what you see in your family members,

25:41

maybe because of, you know, memories from

25:44

high school of not really enjoying gym class.

25:46

Well, that is actually going to have a similar

25:48

kind of expectation

25:49

effect on you. And

25:51

then there's the aging study performed

25:53

in 2002 by Becca Levy at

25:55

Yale.

25:56

So that's the one that really blew my mind. She

25:59

found that people... People's kind of self-reported

26:01

expectations of aging, you

26:03

know, midlife seemed to predict their

26:05

longevity by seven and a half

26:08

years. So if they thought that things

26:10

would get better of age, they lived longer. If

26:12

they expected that things would automatically get

26:14

worse with age, they lived seven

26:16

and a half years less than

26:19

the other people. So a huge effect.

26:21

That includes getting the various diseases

26:23

you can get when you're older too. Here's

26:26

Becca Levy herself in an

26:28

American Medical Association video. We

26:30

were able to look at people who had the risky

26:33

gene for developing dementia.

26:36

And we were able to look at people who were free of dementia

26:38

at baseline. And then we followed them over

26:41

six years to see whether they

26:42

developed dementia. And we found that even

26:44

in this high risk genetic group, if

26:46

they take in more positive age beliefs,

26:49

they actually have, we found had a 40% reduced

26:52

risk of developing dementia.

26:55

And their risk of developing dementia was as low

26:57

as people who were

26:59

not born with that risky gene.

27:01

There's a really big body of evidence

27:03

that's built up over the last 20 years

27:05

that shows this to be the case. So the

27:08

big question is, well, how could that happen?

27:10

Well, one explanation is that if you

27:12

think things get better with age, you

27:15

take better care of yourself.

27:17

But Robson says there's more to it than that.

27:20

The expectation effect messes with your

27:22

release of damaging stress

27:24

hormones.

27:25

So what you see is that people

27:27

who have the negative expectations of aging,

27:30

they start to feel a

27:32

lot more vulnerable.

27:33

And they're going to see the challenges around

27:36

them, even something like going to post a letter,

27:39

you know, going to the store

27:41

to get you groceries, you're going to start

27:43

worrying about, you know, losing your way

27:45

or, you know, having a fall. And that sense

27:48

of vulnerability increases the

27:50

kind of stress that they're feeling. So you see

27:52

for these people, a steady rise

27:54

in the stress hormone cortisol. And

27:57

again, that then causes a steady rise

27:59

in inflammation. which we know causes

28:01

bodily wear and tear.

28:03

And over time, the

28:05

consequences add up and

28:08

it just puts you at a higher risk of all of these

28:10

different illnesses associated with aging and

28:12

eventually your mortality. Well, what

28:14

should we do with that information? Should

28:17

medical science

28:19

at every checkup tell

28:21

you getting older is nothing to worry about?

28:24

Right. I think we do need to take action. And you

28:27

know, Bekelevi in her first paper was that if

28:29

we found that there was some kind of virus that

28:31

was reducing people's longevity

28:33

by seven and a half years, we would be taking action.

28:36

But actually what she argued is that,

28:38

you know, the ageism that permeates

28:40

our culture is, you know, is

28:43

a pathogen, it is having that effect.

28:45

As a society, we should be fighting ageism

28:48

a lot more fervently than we do at the

28:50

moment. So we need to stop reinforcing

28:53

this message that as you get older,

28:55

is automatically a time of vulnerability

28:58

and decline. So I think that's a no

29:00

brainer really is that we have to kind of, you

29:02

know, be a bit more careful about kind of what messages we're

29:04

sending to other people and ultimately what

29:07

messages we're internalizing ourselves.

29:10

You know, I watched a couple of Bekelevi's videos.

29:13

At one point, she suggests keeping

29:15

an ageism journal.

29:17

What that involves is for one week, writing down

29:20

all the messages about aging that you encounter,

29:22

whether it be in social media, whether

29:25

it be in a magazine,

29:27

seeing advertisements, whether it be, you know,

29:29

talking to a relative or

29:31

overhearing a conversation in a coffee shop, write

29:34

it down and then write it down whether it's positive

29:37

or negative.

29:37

And if it's negative, take a moment

29:39

and think, could there have been a different portrayal

29:41

of that older person? You know, it's true.

29:44

Think about it. It's no longer cool to make

29:46

fun of people's looks or race or

29:49

disabilities. But for some

29:51

reason, making fun of old

29:53

people is still fair game.

29:55

The conversations I had with my dad at the end of his life

29:57

were the same ones we had when I was about six. The

30:00

rolls just flip around. We

30:03

would go out to eat, walk into a restaurant.

30:05

I would look at my dad and go, shhh, listen to

30:07

our hair.

30:10

Don't touch anything. Don't

30:13

talk to anybody. I'll be back in a minute, alright? Wear

30:17

your shoes.

30:20

That's comedian David Dyer on YouTube.

30:23

Sure makes me look forward to getting old.

30:27

Anyway, so what have we learned? The

30:30

placebo effect is real, it's

30:32

measurable, it produces physical

30:34

changes in your body, and it's freaking

30:37

weird. Placebos even

30:39

work when you know you're getting them.

30:41

Even though you know they can't

30:43

work on you, they work on you. If

30:46

you ask Harvard's

30:47

Ted Kaptchuk, modern medicine

30:49

is just ignoring a vast

30:51

realm of potential treatments that

30:54

could be helping people right now.

30:56

He believes that placebos shouldn't just

30:58

be a nuisance variable in medical trials.

31:01

Placebos should be considered treatments

31:03

in their own right. They

31:05

work. But making them mainstream

31:08

will be an uphill battle. But

31:10

it hasn't caught on, and I've asked many

31:12

of my colleagues who've been doctors in my

31:15

studies, I said, what are you using when you thought these great

31:17

results? It's not standard care.

31:20

You know, you can train in medical school to

31:22

do placebos. You would train not to give placebos.

31:25

I'd give them a break, and it's

31:27

going to take a shift. But you know what? I never stopped

31:29

fighting.

31:30

So, we'll see where it goes.

31:41

In

31:55

Schuster and CBS Sunday Morning. And

31:57

it's produced by PRX Productions. For

32:00

Simon & Schuster, the executive producers are

32:02

Richard Rohrer and Chris Lynch. The PRX

32:05

production team is Jocelyn Gonzalez, Morgan

32:07

Flannery, Pedro Rafael Rosado,

32:10

and Morgan Church. Jesse Nelson

32:12

composed the Unsung Science theme music, our

32:15

fact checker is Christina Ribello, and

32:17

Olivia Noble fixed the transcripts.

32:20

For more of my stuff, visit DavidPogue.com

32:23

or follow me on Twitter at Pogue. That's

32:26

P-O-G-U-E. We'd

32:28

love it if you'd like and follow

32:29

Unsung Science wherever you get your

32:32

podcasts. And spread the

32:34

word, will you?

32:39

Hey, Prime members, you can

32:42

listen to Unsung Science ad-free

32:44

on Amazon Music.

32:45

Download the Amazon Music app today.

32:48

Or you can listen ad-free with Wondery

32:50

Plus in Apple Podcasts. But

32:52

before you go, tell us about yourself by completing

32:54

a short survey at wondery.com slash

32:57

survey.