716: Jo Marchant | Placebos and the Science of Mind over Body

716: Jo Marchant | Placebos and the Science of Mind over Body

[00:00:00] Jordan Harbinger: Coming up next on The Jordan Harbinger Show.

[00:00:03] Jo Marchant: There's another type of placebo effect, which relies not on your conscious expectation, but more of an unconscious learning process, where if you take a drug several times, your body learns the physiological response to that drug. And then if you take a placebo, your body will somatically trigger that same physiological.

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[00:01:20] Today, one from the vault from a couple of years back that I particularly enjoyed. We're talking with Jo Marchant, author of Cure: A Journey into the Science of Mind Over Body. Now, we're talking about the placebo effect. There's nothing magical here. A lot of people like to equate magic with the mind over matter and all that stuff. No, it's kind of like a kiss and make it all better kind of thing. Is that real? How do regular emotional states influence our health? What can the mind really do? How and why it works? And more importantly, perhaps what are the limitations of the placebo effect? We see a lot of pseudoscience lately about it. "Ah, the placebo effect, it cured me of this. It helped me with this other thing," whatever, "cancer." Some of it's real. Some of it just is not, and it's very dangerous to confuse the two. Last but not least, how can we use these latest findings in our own lives and harness our very own placebo effect? I hope you all enjoy this one from the vault with Dr. Jo Marchant.

[00:02:16] So Jo, tell us what you do in one sentence.

[00:02:19] Jo Marchant: I'm a science journalist and author.

[00:02:21] Jordan Harbinger: What I really like about this is that you're not just a writer. You've got a PhD in genetics, in medical microbiology. And so you write about things that you actually know about. This isn't kind of like, "Oh, I'm going to write about stuff and then exaggerate a lot of it. So it's more interesting."

[00:02:35] Jo Marchant: Yeah. I'm a scientist by training. So seeing the evidence is really important to me and being rigorous is really important to me. I do sometimes delve into subjects that I wasn't an expert on before. And I think that that helps me to kind of bring together different points of view rather than following any one agenda, but the actual sort of methodology of the science and the reliance on evidence, I feel quite strongly about.

[00:02:57] Jordan Harbinger: In the book Cure, you talk a lot about several different topics. One of which is the placebo effect. And I found this super interesting because I always thought the placebo effect was what happens when you get kind of unsophisticated people, you give them sugar pills and they imagine results. And everyone quietly snickers behind their back and says, that the real drug that we were testing is a bunch of malarkey because the placebo did the same thing. But what your book is saying or what it seems to be saying is that not only is placebo effect just as real as most effects from any other real, quote-unquote, real drug. It's actually not only more useful in many cases, but more natural, safer, and sometimes the only thing that actually works.

[00:03:39] Jo Marchant: Yeah, that's a very good description. You just gave actually a kind of conventional view of placebos. That if somebody gets better after getting a fake treatment, then either they would've got better anyway, or they've somehow been fooled into thinking that they feel better, even if nothing's actually changed. But yeah, the really interesting thing that's coming out of the research now, including brain scanning and those kinds of studies is that when somebody responds to placebo, you see these measurable biological effects happening in their brains that are identical in many cases to the changes that you get with drugs.

[00:04:10] So when someone responds to a placebo pain killer, the neuroscientists can see the release of endorphins in the brain, which is exactly the same pathway that opioid drugs, things like morphine work through Parkinson's patients when they respond to placebo, they get a release of dopamine in the brain, which is the neurotransmitter that they're lacking. So again, it's the same pathway as the drug. And so again and again, researchers are finding, we don't imagine the improvement that we see after taking a placebo. It's actually a real biological change.

[00:04:40] Jordan Harbinger: This is big news, or at least in my opinion because people often think things that happen in the mind are often sort of magical or woo-woo or maybe not even real. And somehow science can't explain. 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 and get real and take this new drug or this other drug, or just get ready to die, a slow painful death." And this notion is both behind quacky claims of miracle cures as well as on the far other side of this argument, the skeptics arguments that thoughts can't influence health and anybody who believes so is full of crap or easily diluted.

[00:05:18] Jo Marchant: Yeah. The quack claims, I think, underlying that is this idea that we've got this mysterious, magical force of the mind that doesn't need to obey scientific rules and therefore, it can pretty much cure anything. And I think the skeptics are like, well, the mind couldn't possibly cure anything. Again, they've got this idea of it as some sort of ephemeral thing. But yeah, for me, the scientific view is that the mind and the body are entwined. And if you have a change in the body, you have a change in the mind; if you have a change in the mind, you have a change in the body. So the mind is working through defined biological pathways that we can study scientifically. And often these sorts of natural biological pathways that are happening in the brain and the body, these are the same pathways that we take advantage of when we're using drugs as well. So there's nothing kind of magical about it. It's just the way that we've evolved essentially.

[00:06:02] Jordan Harbinger: So let's talk more about the power of placebos. I mean, it seems like conventional thinking, going back to what we'd said earlier, is that if a treatment works no better than placebo, it just doesn't work. And that's not really the case anymore, or at least that's what you're arguing, it's no longer the case or has never been the case.

[00:06:18] Jo Marchant: Well, if the 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. So if you take acupuncture, for example, or homeopathy, and you can test those against placebo or fake versions of themselves, and there's no difference, then it tells you that those needles aren't really doing anything or that homeopathic remedy isn't doing anything. But that doesn't mean that it isn't working because placebo responses themselves aren't all the same. Some can be larger than others and they can be actually larger than the responses you'd get with conventional treatment.

[00:06:49] So there's a very interesting trial in more than a thousand patients with chronic low back pain. So it's a really big trial. There was no difference in that trial between acupuncture and placebo acupuncture. So this is a kind of fake acupuncture where the needles go in the wrong places and they don't properly penetrate the skin.

[00:07:05] Jordan Harbinger: Right.

[00:07:05] Jo Marchant: So scientists would usually say, "Oh, well, then it's worthless. It doesn't work. Throw it out." But in this trial, there was a third group. The third group got the conventional treatment, including the drugs, the painkillers, that group did barely half as well as either of the groups, that got the acupuncture. So a placebo-controlled trial tells you something about the way in which a treatment is working, but just because something is no better than placebo doesn't mean that can't actually be helping patients quite significantly. So I think we have to change our attitude a little. So the way that we interpret these trials and to how we think about what it means for a medicine to work or do not work.

[00:07:37] Jordan Harbinger: Right. So this almost shows more about what scientists maybe don't know about how the body works and how the brain works to respond, to say pain versus this just not being a real thing, right? This is just not being a real cure or being quackery.

[00:07:51] Jo Marchant: Yeah. Like we need placebo control trials to tell us whether drugs are working through direct biochemical effects, and that's fine. But what we're doing at the moment is throwing out everything else because everything else is in the placebo group. But actually, particularly when it comes to symptoms that we experience — things like chronic pain, particularly, but also nausea, fatigue, depression — all of these things that have to do with quality of life, the brain plays an incredibly important role. Our mind, our attitude, is really important. And so we're throwing out all of the very things that could be helping us. There's a lot of research now that's going into, well, how can we use these placebo effects to help people with those symptoms?

[00:08:27] Jordan Harbinger: When it comes to health and conventional science and medicine, why do you think that we tend to ignore or downplay the effect of the mind on the body? Why do that when we're looking for results?

[00:08:39] Jo Marchant: I think there's quite a lot of things going on there. I mean, one is just, I think there's a lot of prejudice in science. That anything to do with the mind, subjective things are kind of flaky and not very scientific. And possibly that goes back to Descartes, even the philosopher in the 17th century, who kind of divided stuff into objective, physical measurable things that could be studied scientifically, and then the subjective thoughts, beliefs, you know the stuff of the minds that he thought could not be studied scientifically. And no neuroscientist that was respected today would really argue that we have such a split. Every different sort of mental state or thought that we might have is reflected by a physical change in the brain.

[00:09:24] But I think, there's still a hangover from that, that scientists don't think that anything that's subjective, like pain, for example, is really very scientific. I think it's also to do with where the money comes from in trials because the vast majority of clinical trials are funded by drug companies. And so you wouldn't really expect them to be carrying out trials in mind-body therapies or anything that's going to reduce their reliance on drugs. But if you're going to base your medicine on evidence, then the evidence you end up basing it on is going to depend on what trials you do and that depends on who's paying for them. So it's kind of a self-fulfilling prophecy if we end up with most of our medical care based on physical treatments and drugs that you can sell.

[00:10:00] Jordan Harbinger: So basically, if I'm a drug company and I'm paying for the trial, I don't want to prove that sugar pills that convince you to do things can heal you. I want to prove that this chemical that I've worked on that cost me hundreds of millions of dollars to research is the only option that you have. So prove that I don't want to prove the other. In fact, I probably want to argue against those other things, but the best way to do that is simply to drown it out or make sure that it doesn't get any oxygen.

[00:10:23] Jo Marchant: Yeah, and I don't think we can necessarily blame them for that. You know, that's just the job that they do. They're drug companies. You know, I don't think we should be relying on drug companies to tell us everything we need to know about what's effective medical care. I think we need to find maybe other funding streams or other ways of doing this. So it's not a case of I think drug companies are evil and we should blame them for the whole thing. I just think that it's a really bad idea to rely on them for all of the evidence that underlies our medical system.

[00:10:50] Jordan Harbinger: Right. It's kind of like relying on a coal company to say, "By the way, have you guys seen solar energy? We could totally improve on this and we would have no need for all this oil that we keep drilling." There's no incentive for them to do that.

[00:11:00] Jo Marchant: Yeah. Or letting all of your research for sort of good nutrition come from companies that make sugar, you know, it just doesn't make sense.

[00:11:06] Jordan Harbinger: Whether it's nefarious or not. The hashtag capitalism here says, look, look where the incentives lie. And the other thing that tends to push mainstream opinion away from any kind of alternative healing — and I mean, alternative healing, and I'm taking a wide swath of this because I don't want placebo effect to get mixed up with snake oil, literally or figuratively. And I think the new generation, people my age now, often would not be surprised that our emotional state might be important in wording off disease, depressed people get sick more, people who are happier live longer. I mean, this is not news for an ever-growing segment of the population. And the idea that our minds have, quote-unquote, "healing powers," it's seen as so flaky because of the snake oil that we've seen in the past.

[00:11:53] Jo Marchant: Yeah. I think we absolutely have to have a scientific approach. So I don't think we can just say, "Oh, the mind is great. The mind can cure everything," because it doesn't cure everything. There's strips of limitations on what the mind can do. Sometimes it can have a very surprisingly dramatic effect. Other times it doesn't have any effect at all. So we need to know when it works, in which situations can we try to harness that. So we don't want to get it mixed up with snake oil. I think we absolutely have to base it on the scientific trial.

[00:12:21] Jordan Harbinger: And I think the science that you write about in the book acknowledges the role of the mine and health and thereby, hopefully, as you write, rescues it from the clutches of pseudoscience, which is, I think kind of what we're trying to do here a little bit today.

[00:12:34] Tell us what the placebo effect can do and then let's talk about what it cannot do. Because that dividing line where the limitations exist is kind of where the rational insane of us get off in the snake oil salesman, we're talking about here, continue to go down the path of, "This can cure everything. Don't go to the doctor. Cure your cancer with this drink I made out of a pomegranate," or whatever the hell these guys are selling.

[00:12:55] Jo Marchant: Yeah. So one thing to know about the placebo effect is there's not just one placebo effect. There are many placebo effects. So, depending on the circumstances, you can get different biological changes happening in the body. So depending on how you believe your condition is going to change. And there's two main ways in which placebos work, one is through conscious expectations. So yeah, this knowledge or belief in a treatment that you're taking. And that works best for symptoms that we're consciously aware of — things like pain, nausea, fatigue, itching, wheezing. It can include objective, visible changes, things like rashes and swellings, which was a real surprise to me. I hadn't realized that before I started looking at all of this.

[00:13:37] But generally, things that you're consciously aware of. 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. So things that we are not consciously aware of and, you know, taking a placebo is not going to be able to suddenly magically produce a chemical that your body isn't normally capable of making. So, you know, insulin in a patient with diabetes, for example. It's not going to help sort of save your body when it's overwhelmed. You know, it's not going to shrink a tumor. It's not going to banish a serious infection. So it's mostly to do with quality of life pain, depression, nausea, fatigue, those kinds of things.

[00:14:12] There is another type of placebo effect, which relies not on your conscious expectation, but more of an unconscious learning process, where if you take a drug several times, your body learns the physiological response to that drug. And then if you take a placebo, your body automatically triggers that same physiological response. It's a little bit like if I asked you to imagine biting into a lemon and sinking your teeth into that lemon and sucking down that juice. And if you've eaten a lemon before you might start to feel a tingling at the back of your mouth, where your salivary gland's switching on. They're producing extra saliva in preparation for that lemon juice. And that's not something that you've kind of consciously done. It's just an automatic response that your body has learned to lemon juice. And the same thing happens with other drugs.

[00:14:59] And this kind of learned response that can reach further into the body if you like. That does affect immune responses, hormone levels, a much wider sort of range of basic physiology, the basic processes of disease if you like. And so what we need to try and do, if we want to harness placebo responses, is try and use those together in a clever way. So you could have placebos for depression or pain, for example. And there are trials now suggesting that actually honest placebos work too, which is 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 effect of those drugs.

[00:15:46] Jordan Harbinger: You're listening to The Jordan Harbinger Show with our guest Jo Marchant. We'll be right back.

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[00:19:02] Now back to Dr. Jo Marchant.

[00:19:06] Right. So we're looking at certain types of drugs or placebo, I should say, that release endorphins that block pain. And this is just a biological machination inside your brain that happens. It's like you push the A button and B comes out, right? Endorphins are released when this happens versus, or in addition to what sounds like a Pavlovian response where you've trained your body to release certain types of the immune system that you just mentioned to ramp things up when X, Y, Z substance is inside our body. So can we do something like I take this red pill that tastes a certain way, and it actually has something that boosts my immune system? Then I take it again a few days later, except it doesn't have that substance in it, but it looks and tastes the same, do I start to then feel similar effects?

[00:19:51] Jo Marchant: Exactly. That is very, very similar to the trails that are actually being carried out. They're actually using a green drink rather than a red pill, but yeah, it's exactly what you're suggesting. So you could either take this pill that boosted the immune system, or actually what they're using are pills that suppressed the immune system, 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.

[00:20:14] So the idea is you train the body to respond to the drug and then you can get the same response with your placebo. So they're getting the immunosuppression they need without the toxicity of those drugs. And it's something that you could probably do. I mean, it works with pain as well. Parkinson's disease is another one where it's being looked at that you could have a blister pack of those pills and you don't know which ones are the placebos, which ones are the drugs. It just mixed up together. The idea is you end up with the exact same clinical effect, but with a much lower drug dose.

[00:20:41] Jordan Harbinger: So the placebo effect isn't just one effect. It's a melting pot of responses from what it sounds like.

[00:20:48] Jo Marchant: Yes. I mean, essentially the brain is controlling all the time. Lots of different aspects of physiology. So, the symptoms that we experience, things like pain and fatigue, those are created and controlled by the brain. The brain produces different neurotransmitters — things like endorphins, things like dopamine, prostaglandins, cannabinoids — all of these chemicals that are being produced by the brain that kind of pushing our symptoms up and down, regulating how we feel in response to the environment. And that can be in response to physical signals, like, you know, results of infection and injury.

[00:21:20] But also our psychological state, you know, the information that we're perceiving about our surroundings. Our mental state at any particular time, that's also pushing those symptoms up and down. So these thoughts and beliefs and emotions, whether you are 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.

[00:21:44] And then when it comes to other aspects of physiology, like the immune system, again, the brain is in constant two-way communication with the immune system, determining how the system should be regulated depending on our environment. With the immune system, it seems that our conscious thoughts don't seem to play such a big role, but these learning processes do. So, again, it's understanding how is the brain interacting with these different things, whether it's pain, whether it's immune responses, what are the mechanisms. And then we can develop ways of sort of cleverly pushing things in the way that we want them to go without sometimes the use of drugs.

[00:22:18] Jordan Harbinger: So is the placebo effect then limited to the maybe natural tools that the body and brain have available? Because it sounds like our body's doing all the work really.

[00:22:28] Jo Marchant: Yeah, absolutely. That is the main limitation that you can only work within the natural limits of the body's physiology. Obviously, if you've got a drug, you can give much higher doses of something that the body could ever make. So you can have more powerful effects. But then you also get into the realm of problems with side effects, tolerance, addiction. So you could have bigger effects, but there's also much greater dangers.

[00:22:50] And so generally, if we have an effective medical treatment, 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. You've got all of those same expectations, all of that's happening. So what you'd want to do is take the effect of drug, and then you've got the active biochemical effect of that drug, and you've got zero effect. So that's great, 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.

[00:23:22] And so examples of those kinds of cases are chronic pain is a very good one. Most of the painkillers we have are not actually very effective for chronic pain, but you've got huge problems with addiction. And we know that placebos are very effective in pain. Depression is another one in all, but in most severe cases of depression, there's practically no difference between antidepressants and placebos, but the drugs have significant downsides. So in these kinds of cases, researchers are saying actually it might be worth offering people placebos before progressing if necessary to the active drug.

[00:23:53] Jordan Harbinger: 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.

[00:24:14] Jo Marchant: Yeah, I think so, particularly in chronic conditions. So even in acute pain, you can use the mind to give people extra pain relief on top of the drugs that they're being given. So in acute burns patients, for example, researchers are developing virtual reality world that can kind of compel patients' attention to reduce their pain. And that's used with drugs. So you can use the two together to kind of get more pain relief overall than you would've been able to but in chronic conditions — actually, it seems that it's often people are in pain and there's no obvious physical injury or perhaps they had an injury and it's healed, but they're still in pain. And here, it really does seem to be the brain that's kind of perpetuating that pain that they're in.

[00:24:54] And this is one reason why giving people those drugs long term actually isn't very effective. So in these cases, it really does make sense to start looking for other approaches, taking a placebo is one approach. You know, it was always thought that that's not ethical because you have to think that a placebo is real for it to work. The doctor has to lie to you, but now in trials, they're finding out that actually, honest placebo is where you know a placebo works too, so that's one option.

[00:25:18] But then there are also lots of other ways that we can use that knowledge about the importance of the brain to develop other techniques, whether that's improving care in medicine — that's something we haven't talked about yet that studies of placebo effects are showing that sort of quality of the interaction with the practitioner, that human care that you get is very important for triggering large placebo effects. So just giving people better care, regardless of the actual treatment would be important.

[00:25:41] We can use alternative medicines as a way of harnessing placebo effects and people suggest that, or we can develop these completely new techniques, like the virtual reality I mentioned. Taking placebo pills is one option, but there are lots of other ways of triggering placebo effects, even things like cognitive behavioral therapy or mindfulness meditation, which is trying to be very effective for chronic pain, for example. It's just a way really of changing your own attitude and triggering your own placebo effect if you like.

[00:26:09] Jordan Harbinger: You've mentioned that showing people additional care and things like that is it helps to utilize the placebo effect. So basically, kind of reducing this down to absurdity, it sounds like kiss it and make it all better in terms of a kid falling down and scraping is neat is actually kind of legit.

[00:26:25] Jo Marchant: Yeah. I mean, I have two young children and I really like knowing now that if they fall over and hurt themselves, a kiss makes it better. That's actually doing something biological. I know that that is having a concrete effect to reduce their pain. You know, I'm a mom, I would've kissed them better anyway, but I quite like knowing that that is the case.

[00:26:43] But even among adults, so there's some very interesting research coming out of Harvard University, for example, where they're trying to really tease apart, what are the active ingredients of these placebo effects. You know, can we isolate them and maybe incorporate them into conventional medicine? And so I can give you just a couple of quick examples.

[00:26:59] There was one study in patients with irritable bowel syndrome, where one group got no treatment. One group got sham acupuncture from a practitioner who was sort of polite but cold, didn't really talk to the patients. And one group got sham acupuncture from a practitioner who was warm and empathic, and like asked lots of personal questions and listened to the answers and touched them on the arm. And that group got hugely more relief from their symptoms than the group that got the same sham acupuncture, but with a cold but polite practitioner, that group also did better than the no treatment group. So there was something about the needles that triggered a placebo effect. But then that interaction with the practitioner was very important.

[00:27:37] There was one other study in acid reflux disease, where the researchers looked at the difference between a homeopathic remedy and a placebo. There was no difference between the two, but they also looked at the difference between a standard 18-minute consultation with the doctor, and then no longer 42-minute consultation with the doctor, the sort of long personalized consultation that you might have with a homeopathic therapist. In that first group with the shorter consultation, 17 percent of them said their symptoms were at least halved. In the group with the long consultation that proportion jumped up to 75 percent.

[00:28:10] So I think we all know that being cared for kind of helps to make you feel better, but it's just how dramatic that difference can be. For me, that was really surprising. That, you know, acid reflux disease is not usually thought of as it's not a psychosomatic condition. You know, it has a real physical cause and can be very distressing for people. But just having that change in the consultation, regardless of the actual treatment, they were getting made a huge difference to their outcomes.

[00:28:35] Jordan Harbinger: So you end up with things that formally took really hazardous drugs to control. And we end up with essentially zero side effect benefits from placebo, but on the other side of that same coin, since it is limited to what the brain and body can do, what are some examples actually, of things that we can't change? I mean, I'm thinking cholesterol or blood sugar. Are those things that we can help with placebo? Or is that just, "Hey look, this is the machinery, we can't ignore it"?

[00:28:59] Jo Marchant: Yeah. So there's no evidence as far as I know that placebo statins is going to change your cholesterol level, for example. That doesn't seem to be controlled by the brain. I think blood sugar levels as well. So the brain can only change things where it's got a pathway or a mechanism for doing it if you like. And generally, the brain is controlling physiology through the autonomic nervous system, which leads to lots of different sorts of organs and pathways in the body, including the cardiovascular system, the digestive system, the immune system.

[00:29:29] So all of these things, in theory, the brain can change and regulate. And then we can use the mind to sort of feed into that. We can't necessarily will these changes consciously. You can't just suddenly say, "Oh, heart beat faster now, please." But if we're scared, you know, that thought can trigger that change. So that's one limitation is that you can't just will these things to happen. You can't will your immune system to change in a certain way. You can't wish your pain away, but we can find clever ways to use the mind. Like visualizing the lemon that I mentioned earlier, like the placebos with the immunosuppressants, we can find ways of influencing these things, but yeah, things like cholesterol and blood sugar and just cancer, for example. You can use the mind certainly to improve quality of life and help with pain and nausea and fatigue and that kind of thing.

[00:30:17] But there's very little evidence for a strong placebo effect when it comes to actually shrinking that tumor. So this is not a case of throwing out physical treatments. We still need physical treatments. There are lots of things that drugs can do that the mind cannot do, but I think we've gone too far the other way. We're in a situation where we are using drugs for everything regardless. And we are using much higher doses than we need to. So by incorporating the power of the mind back into medicine, I think that would help us to just reduce that reliance on drugs and physical treatment. That's going to be better for everybody all around.

[00:30:46] Jordan Harbinger: Right. It reminds me of — is it Chris Rock who has that bit? It's like, "They got drugs for everything. Are you hot? Are you cold? Are you too skinny? Are you too fat?" It's something like that. Yeah. We're using drugs for everything. And when I was a kid, which was a long time ago, but not that long ago, I mean, in the '90s, that was when I remembered drug commercials coming on TV. They've gotten more and more ridiculous as the years have gone by and now watching them, having not entirely my whole life grown up with them, but having watched way too much TV and being able to pay close attention, it's just kind of ridiculous. Some of the things that you end up getting drugs for. Ask your doctor about this. Everybody has that, but then if you listen to the side effects, which the VO guy, the voiceover guy does really, really quickly and the same monotone. It's like, who wants to risk leaky, you know, insert the blank here because they wake up at night sometimes when they're not supposed to.

[00:31:36] I mean, it's just complete lunacy to me. And I'm not, anti-drug, I'm a little bit more anti-drug probably than the average person, but I'm not crazy with it. And I'm certainly not someone who goes to do natural cures all the time, especially if there's no science behind it. But I love the balance that you took with the placebos, of course, just because the benefits mediated by placebos are mostly subjective. You argue that they still have potential value for medicine. And that leads to the question though. Why aren't practitioners using more of this?

[00:32:07] Jo Marchant: 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 issue where people who are giving out the grants, find it hard to get their heads around this kind of work. A lot of the researchers I spoke to said they find it really hard to get funding for the work that they're doing.

[00:32:37] Yeah. The funding that we mentioned for the clinical trials, where most of these are carried out by drug companies. So there's just a lot of obstacles against doing the work that needs to be done to really translate this into medical care. I think the upside is that a lot of this we can look at as individuals. You know, I certainly feel that I can incorporate a lot of this into my own life in terms of, you know, the way that I view my own symptoms now I would say has changed.

[00:32:59] So I still listen to the symptoms, if I'm in pain or I'm tired or, you know, feeling ill or whatever, but I don't have to be controlled by it. I don't have that anxiety. "Oh, no, I'm in pain and it's going to get worse." I've been able to realize that when we experience symptoms like pain, it's not always an accurate reflection of the injury or the damage if you like. It can be vastly amplified by our anxieties. So I think that's kind of empowering really to know that my mental state can control that. Or, you know, through destruction or mindfulness or other techniques, we can reduce the pain. We don't have to be ruled by it.

[00:33:35] Jordan Harbinger: This is The Jordan Harbinger Show with our guest Jo Marchant. We'll be right.

[00:33:40] This episode is sponsored in part by Progressive insurance. Let's face it. Sometimes multitasking can be overwhelming. Like when your favorite podcast is playing, the person next to you is talking and your car fan is blasting, all while you're trying to find the perfect parking spot. But then again, sometimes multitasking is easy, like quoting with Progressive insurance. They do the hard work of comparing rates. So you can find a great rate that works for you, even if it's not with them. Give their comparison tool a try, and you might find getting the rate and coverage you deserve is easy. All you need to do is visit Progressive's website to get a quote with all the coverage you want, like comprehensive and collision coverage or personal injury protection. Then you'll see Progressive's direct rate and their tool will provide options from other companies all lined up and ready to compare. So it's simple to choose the rate and coverages you like. Press play on comparing auto rates, quote at progressive.com to join the over 27 million drivers who trust Progressive.

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[00:34:36] Jordan Harbinger: This episode is also sponsored by No Lie podcast. If you've been on YouTube or Facebook, you've probably seen a video from Brian Tyler Cohen. He's racked up more than a billion views in just a few years. Brian also hosts one of the country's top-ranked political podcasts called No Lie with Brian Tyler Cohen, where he breaks down the biggest story of the week and interviews the biggest names in politics. He's even interviewed President Biden if you're. Plus he's spoken with Kamala Harris, Elizabeth Warren, Katie Porter, Jamie Raskin, Pete Buttigieg, Jen Psaki, and plenty more big names. I'm noticing a slight skew in one direction, just for those of you who haven't noticed. So check out No Lie with Brian Tyler Cohen and see why he has more than two million subscribers across all platforms. It's a political podcast that cuts right to the point with no fluff. It focuses on the issues that you care about and is the top destination for our leaders in the House, Senate, and White House. That's no lie with Brian Tyler Cohen available anywhere you listen to podcasts.

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[00:35:50] Now for the rest of my conversation with Jo Marchant.

[00:35:55] 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.

[00:36:06] Jo Marchant: Yes, absolutely. There's there are big cultural effects. Placebo effects aren't anything to do with the placebo itself. You know, it's like a sugar pill. There's nothing in it. It can't do anything. What triggers the placebo effect is your response to that treatment. So what it means to you, and obviously, that can be different between different people, different situations and different cultures.

[00:36:26] So one really nice example is that red or pink pills tend to trigger particularly large placebo effects to pain, whereas blue pills tend to have more of a calming effect they could for treating anxiety or helping you to sleep except among Italian men. I don't know if you can guess why.

[00:36:43] Jordan Harbinger: I'm afraid to.

[00:36:45] Jo Marchant: They think that it's because blue is the color of their national football team. So for Italian men, the color blue is exciting and arousing rather than relaxing. So it's just to make the point that it's at the meaning that it has for you as an individual, rather than anything inherent about the placebo itself. And because of that, people are going to respond differently to different placebos depending on how you feel about them. So somebody who you know has a lot of faith in conventional medicine, for example, may well, have a sort of very strong placebo effect for drugs that prescribe whether it's for chronic pain or depression. You know, you might do very well on that. Whereas if you are 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 the antidepressant or painkiller. You're probably going to do better on the therapies that you feel more comfortable with.

[00:37:37] So particularly for these conditions where most of the response to the treatment is actually placebo effect, it's worth shopping around and thinking about what appeals to you, what do you have, high expectations for it. You know, the trials show that the people who are feel engaged with their treatment and have high expectations for it who do better, who have these strong placebo effects.

[00:37:57] Another thing I would say is. This social interaction with the practitioner is so important. So again, it's worth finding a doctor or a medical practitioner that you at least respect and trust rather than somebody that you feel that you don't get on well with and different kinds of medical practitioners are probably going to appeal to different people. You know, some people want a very authoritative physician, who's just going to tell them what the matter is and tell them what they're going to do about it. Other people want to have more of a sort of equal dialog. So again, it's finding what suits you and it's going to make you feel the most confident about how your condition is going to improve.

[00:38:30] Jordan Harbinger: One thing that I thought was super interesting was that we're experiencing the placebo effect with any drug. Even, quote-unquote, "real drugs," you still have the placebo effect happening. We discussed that with things like antidepressants and pain meds, but I still don't quite understand. Even if people know it's a placebo, it can still work. How is that possible? Why does that happen?

[00:38:50] Jo Marchant: This is really interesting, isn't it? Because the absolute dogma about placebos until about five years ago was that you have to think it's a real treatment. You have to be fooled for it to work and therefore, the doctors who prescribe it, they'd have to lie to patients. That would be unethical. So everyone's been like, "Well, placebo effect is very nice, but we can't use it in medicine." And then just in the last few years, all these trials have come out, showing that you can give people a placebo and tell them it's a placebo and they still feel better, which seems really crazy to start off with.

[00:39:19] So there was a trial in 2010 was the first one I think, in irritable bowel syndrome. They gave patients sugar pills, told them they were sugar pills, and they did significantly better than the people in the trial who didn't get the sugar pills. And that's now been shown in ADHD, in migraine headaches, in depression, and in chronic low back pain. And there are a lot more trials now in the pipeline as well.

[00:39:40] There are several possible reasons for this. One is that in some of these trials, they weren't just given the pill. The patients were given kind of like a little seminar on educating them on placebo responses and how they work and why placebo might help them. So similar to some of the stuff that I've been talking to you about. So it may be that it wasn't just the pill that it's just believing in the placebo effect if you like is a bit like believing in a drug. If you've got that expectation that the placebo is going to help you, that could be enough. It could just be there's something about being in a trial and receiving that medical care and attention and having that attention paid to you by these top scientists and being looked after that, regardless of the treatment, even if it's a placebo and you know, it's a placebo that human care is enough to reduce symptoms.

[00:40:27] Or it might be more to do with these automatic learned responses I was telling you about. So if people have taken, say painkillers in the past, their bodies learned the appropriate response. And then when they go into a trial and get a placebo, that response is triggered because the thing about these automatic-learned responses is that they happen regardless of what you know about the placebo. It just happens anyway. It's probably actually a mixture of all those things, but the upshot is that it's just really transforming people's view about placebo from a kind of, "Yeah, all very nice, but we can't use it," into, "Oh, wow. This is something that we could really start to use and harness in medicine."

[00:41:02] Jordan Harbinger: I feel like different cultures have their different placebos. In fact, my girlfriend, her family's Chinese. She's Chinese as well.

[00:41:08] Jo Marchant: Mmm.

[00:41:08] Jordan Harbinger: One day I had a headache. I was at their house and her mom's like, "Oh, I'll make you some tea. That'll make the headache go away." And my first thought was tea doesn't make headaches, go away. What's wrong — why do you prescribe tea for everything? Are you thirsty? Have some tea. You're not thirsty. Have some tea, headache, tea. Tired, here's some tea. And I drank the tea and she said, "So your headache went away, huh?" I was like, "Well, not yet." And then after a while, it did. And of course, I'm like, well, of course, my headache could have just gone away on its. But I thought what's the harm — I just read your book by the way. And I thought what's the harm in just believing that tea cures headaches? I don't take Tylenol or painkillers anyway. I might as well have something else that in, air quotes, "cures" my headaches. So sure, tea cures my headaches. Why not? So I never get headaches because I just drink tea, which I do all day anyway.

[00:41:49] And it's just something like, I've kind of thought, why not just program myself with this useful belief? It's a little bit flaky because there's probably not a whole lot of actual mechanism going on here, but on the same token, I'm okay with it because otherwise, I would just suffer through the headache and not care because I don't like taking things like Tylenol. And I was laughing at myself because I'm the last person who does this kind of woo-woo thing. But I thought, why not? Why not go for it? I can't say whether or not it works, but I can say with a certain degree of certainty that there's hundreds of millions, if not more Chinese people who believe that tea cures pretty much everything.

[00:42:20] Jo Marchant: Well, I agree with you. I think why not? I don't really agree with believing in these crazy alternative therapies that crystals are healing you or these kinds of paranormal, I don't know, all these angels or past life regression, you know, these slightly mad things, because I think that's dangerous. That can lead you into rejecting perhaps conventional medicine when you needed it. But in terms of the mind, I don't think there's any harm in just working out what sort of beliefs and attitudes are helpful for you.

[00:42:50] You know, we know from study after study after study that if the expectation is hugely important in pain. If you believe that your pain is going to reduce, it will reduce. That's programmed into us. It's part of an evolutionary response really. That if you are stressed or worried or anxious about an injury, your pain will go up because it's a warning signal. If you feel cared for, you know, you believe that you've received effective medical treatment, your pain will come down because that's a signal for your brain, that the crisis is over. It can ease off on that warning signal. So it's just programmed into us.

[00:43:18] So yeah, why not? Tea whatever, just find an attitude, an activity, a belief that works. I think we can all take responsibility for harnessing that. We don't have to be passive recipients of pills. You know, we can engage in our own mental state and our own physical condition.

[00:43:34] Jordan Harbinger: And this is something I found very humorous studies show also that the more placebo costs, the better it works showing probably because we believe that expensive treatments are more effective. And I thought to myself, we also see this with food, consumer products, technology, clothing, maybe those aren't as measurable because they're not medical results, but I think almost anybody can agree with this. Anything that's marked up is more expensive and becomes, quote-unquote, "a luxury" is somehow a cut above, whether it's your iPhone or the latest computer that you've got, a type of car that you have, clothing that you have, but especially, and maybe this is just a California thing, but food. Isn't that why Instagram started people were posting pictures of their food on social media and they thought, why not? It's a billion-dollar idea. They were right. We've got this sort of programming in our brain hardwired, the more resources something requires the better it is, or the better it theoretically must be.

[00:44:25] Jo Marchant: Yeah, absolutely. I mean, we think of placebo effects to do with medicines, but it's actually every aspect of our conscious experience is being affected by our attitudes and our beliefs and our emotions and our expectations. We do construct our own reality to a certain extent. I mean, obviously, within limits, it's based on certain information that's coming into us. But how things taste, how things look even, depends on our sort of previous expectations.

[00:44:50] There was this picture of a dress, and then people couldn't decide if it was white and gold or if it was blue and black but it was exact same dress, but for some people, it looks white and gold, for some people, it looks blue and black. So that's where envision researchers are realizing that, you know, we play a huge part in constructing what we see in the world around us. It's the same with taste. It's same as what we hear. So absolutely in terms of price or other aspects of what we expect something to be, that can be a sort of self-fulfilling prophecy.

[00:45:18] Or if, you know, 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 tasted it home and it's really not that great. So it's all to do with our sort of attitude at the time. So yeah, it's not just medical symptoms like pain, it's everything that we experienced.

[00:45:31] Jordan Harbinger: We saw this in the book with the different types of pills. You take two pills, they work better. You take a big pill, it works better. You take a pill, that has certain color, it works better. So the more dramatic the treatment, the bigger the placebo effect. And of course, the problem there in that you mentioned in the book was, "Well, oops, now we've got to have fake surgery in order to get the placebo effect from surgery."

[00:45:51] Jo Marchant: Yeah. So you kind of would think wouldn't you that most surgeries are kind of proper treatment, so you probably wouldn't have placebo effects in surgery, but actually, in trials, there has the biggest placebo effect of all.

[00:46:01] So there was a big analysis recently of a whole load of different surgical techniques that were all thought to be really promising and then half of them, the real surgery was no better than the fake surgery. This is for conditions from osteoarthritis to angina. I mean, it was. Incredible really that surgeons have been doing a lot of these techniques. Traditionally, they don't test their surgical procedures in placebo control trials, because it was always thought that fake surgery wasn't very ethical. So they just kind of go ahead and do it and see people getting better.

[00:46:28] And it's only in the last years that we're realizing how much of that was actually placebo effects. And then it's a dilemma then because what do you do if a surgery is really helping people, but it's only working through a placebo? Do you stop doing that and take that benefit away from those people? I mean, it's a difficult one.

[00:46:44] Jordan Harbinger: You talk a lot in the book about stress, bad stress, and turning it into good stress. Let's learn how to do this and take advantage of some of our brain power to limit stress. Because as we know, cortisol ages us, stress ages us. Literally, from a genetic level, this takes effect. If you could explain that and then maybe give us some ways we can help manage it.

[00:47:03] Jo Marchant: Okay. So, I mean, most people are familiar with stress or the fight-or-flight response. So we know that if we're anxious or afraid or nervous, this fight or flight response kicks in and it's meant to help us respond in emergencies. So your pupils will dilate, your heart beats faster. Your blood pressure goes up. Blood is diverted from your gut to your limbs and brain. Glucose is released into the bloodstream to fuel your next move. So a whole load of changes are happening across your body, which is great in an emergency. Not great if it's switched on all the time. If you're stressed all the time, that just creates wear and tear on the body. That increases blood pressure. It increases the risk of heart disease, for example. 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. Again, if this is switched on long term, that's very damaging. It exacerbates autoimmune disease. It makes us more susceptible to infection, everything from the common cold to HIV. It's been implicated in cancer. Yes, like you say stress, it ages us. It increases the rate of cellular aging of cells. So not good.

[00:48:02] And so one thing I do in the book is I look at the evidence-based ways to reduce stress. So, you know, what does the trial evidence say? What works and what doesn't work? Mindfulness, meditation is one of the best studied, for example. There are now hundreds of trials suggesting that that does reduce stress. It also reduces chronic pain and anxiety and fatigue. Social connection is another one. Your sort of best possible protection against stress is to have strong social relationships, and that feeds through, into life expectancy. So people who have strong social relationships who feel sort of integrated and part of a social group, they don't get sick and they live longer. That's one of the strongest findings that we have in behavioral science.

[00:48:44] But what I found really intriguing — so there were some studies done on ways of not reducing stress, but just changing how we respond to stress. Because fight-or-flight isn't all the same. There's a difference. For example, if you imagine yourself at top of the ski slope and you see this sort of steep run going down beneath you, depending on whether you are an experienced ski or not, you might feel joy in exhilaration, or you might feel absolute. Those do different things to your body, whether you feel confident in a situation, and it's a challenge that you think you can meet, or whether you think that you're going to be crushed and you don't have the resources to deal with the situation, those have very different effects. If you're feeling confident, psychologists like to call it sort of challenge stage rather than a threat state. In a challenge state, you perform better and it's also much better for your long-term health as well.

[00:49:32] And so just one very quick way to change yourself from a challenge state into a threat state is how you think about your body's response to stress. So if you've got something stressful coming up, whether it's an exam or you've got to do some public speaking, and you notice that your heart's pumping, what researchers did in the study was they said to people who were about to sit in exam or do a stressful test, 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. That is going to help you perform better because if your heart's beating, that's going to push oxygenated blood around your body, more oxygen to your brain and to your muscles. That's great. You're going to perform better." Just telling people that, so that they saw those signs of stress more positively. Switched people from a threat state into a challenge state so that it was a sort of healthier response for them.

[00:50:22] So this was in graduates, they did a fake exam in the lab. They scored better in that fake exam. And not only that, when they did the real exam, three months later, they scored higher in that exam as well. So just that one piece of information, see those signs of sort of arousal in your body, beating heart or whatever, as positive completely changed how they responded to that stress and it improved their performance. Seeing the situation differently changes your physiological response to it.

[00:50:48] Jordan Harbinger: That's excellent. We can do that at the regular, I think regardless of whether or not it's an exam or any kind of situation if we reframe that as our body getting ready versus us getting ready to have a negative reaction because we're not ready for this, or we're underprepared, or we're going to get our butts kicked, it definitely can be a game changer, especially if we believe it.

[00:51:06] Jo Marchant: Yeah. It's just taking back some control. And if I could give you one other quick example of reframing that has to do with pain. So this was a study where volunteers were told they were either going to be subjected to a low level of pain or a medium level of pain.

[00:51:18] Or another group was going to be subjected either to a medium level of pain or a high level of pain. In that first group, if they got a medium level of pain, so that was kind of the worst out of the two levels of pain they were expecting, they rated that as quite painful, moderately painful, and areas of the brain lit up that are associated with processing pain. In the second group, if they got that medium pain, so exactly the same level of pain, but in the second group, they thought it was either going to be medium or high. So now, it's the best-case scenario. It's the lower of the two levels of pain they're expecting. They rated that pain as pleasant and parts of their brain lit up that associated with reward.

[00:51:54] So just by reframing it, seeing what you are getting as either a best-case scenario or a worst-case scenario, completely changed what people were experiencing from being painful to being pleasant. So it's just an example of showing how important your attitude is, how you see what's happening to you can either give you a painful experience or a pleasant one.

[00:52:15] Jordan Harbinger: Jo, thank you so much.

[00:52:16] Jo Marchant: Thank you so much for having me. I really enjoyed it.

[00:52:20] Jordan Harbinger: You're about to hear a preview of The Jordan Harbinger Show with Desmond Shum, a Chinese billionaire who did business in the highest circles of the Chinese Communist Party.

[00:52:28] Desmond Shum: Red aristocracy, red aristocrats, they are by bloodline. So when you are born, you're born in this different section of hospital from the rest of the country. No money can buy you into their section. So they'll go to a different private school, kindergarten, different primary school, different secondary school. They have farms dedicated only grow for them. And then the car they ride in, have a separate license plate. We drive in the bike lane. We drive in the bus lane. It's the royalty and the aristocrats of the medieval times.

[00:53:01] Jordan Harbinger: Your wife, she gets an exit band from China, and then she disappears. And this is the part that is just twilight zone bizarre. You've been calling her for four years. Her mom's been calling her every day for four years. You write this book. Suddenly, she calls you on the phone from the number that had been dead for four years. What the hell is going on?

[00:53:25] Desmond Shum: About a year and a half after her disappearance, I was in London talking to this friend. We were having coffee together. He looked me in the eyes. He said, "You know, they will never let her out." And then he said like a matter of family, "If they let out, they're going to give her a shot down her spine, she will come out as a zombie." "Really? The state can do something like that and they will do something like that."

[00:53:46] Jordan Harbinger: You are friendly with many people in Xi Jinping's inner circle. How do you assess his character?

[00:53:51] Desmond Shum: He sees himself as an emperor to rejuvenate a dynasty. That's what he wants to do. I think for everybody, including in Chinese in China, that's the most dangerous thing because he is re-engineering the entire country in every dimension. Where it's going to end? That's the most dangerous.

[00:54:15] Jordan Harbinger: To hear how it all came crashing down, his wife vanished, and his escape abroad, check out episode 684 of The Jordan Harbinger Show.

[00:54:25] I love conversations like this. This is what I'm talking about when I talk about me, just loving the heck out of science. Placebo effect is always, always interesting for me and the reason I wanted to do this show. I remember a few years back when I really wanted to do this episode of the show because I'm fascinated with the mind can do for the body, but I'm also just very alarmed by people selling placebo-ish cures for things. We know now that it's limited essentially to pain and you can't have a placebo effect that cures an actual ailment other than pain. And not knowing that is very problematic because you see these cures online, or these people talking on TV, "Look at this, it cures this, it cures that," and that is just not true. It's dangerous. And it can dissuade people from getting actual, real medical treatment. And that's probably what's most insidious and most dangerous about all of this. You give your money to a con man instead of getting actual cancer treatment, for example, that can kill.

[00:55:19] So this type of thing is sort of near and dear to my heart. I do really want to educate people on these things. So I appreciate Dr. Jo Marchant's time here. Big, thank you to her for coming on the show. Links to the book and everything else mentioned on the show will be in the show notes at jordanharbinger.com. Books are always at jordanharbinger.com/books. Please use our website links if you buy the book. It does help support the show. The links work overseas. They're Amazon links. They work with audiobooks. Anywhere and anything you get through those links does help. I know people are like, "Oh, I live in Japan. I can't do it." Yes, you can, and please. Transcripts are in the show notes. Videos are on YouTube. Advertisers, deals, and discount codes, every way to support the show, is at jordanharbinger.com/deals. Please consider supporting those who support this show. I'm at @JordanHarbinger on both Twitter and Instagram or connect with me right there on LinkedIn.

[00:56:06] I'm teaching you how to connect with great people and manage relationships using the same software, systems, and tiny habits that I use every single day. It's our Six-Minute Networking course. That course is free over at jordanharbinger.com/course. I'm teaching you how to dig the well before you get thirsty and build those relationships before you need them. Most of the guests on the show actually subscribe to the course. So come join us, you'll be in smart company where you belong.

[00:56:30] This show is created in association with PodcastOne. My team is Jen Harbinger, Jase Sanderson, Robert Fogarty, Millie Ocampo, Ian Baird, Josh Ballard, and Gabriel Mizrahi. Remember, we rise by lifting others. The fee for this show is that you share it with friends when you find something useful or interesting. If you know somebody who's into science or even pseudoscience, or really wants to learn about the placebo effect, what it can and cannot do, please share this episode with them. The greatest compliment you can give us is to share the show with those you care about. In the meantime, do your best to apply what you hear on the show, so you can live what you listen, and we'll see you next time.