Can You Trick Your Body into Healing? The Placebo Effect Explained

Jason: Hey Kathy, do you think the doctors who use placebo to help people get better should have their license taken away and be thrown in jail?

Kathy: Yeah. Well, if you do that, you’d have to turn all the hospitals into prisons.

Jason: Yeah, but what about the PT and chiropractic clinics?

Kathy: Prison.

Jason: Okay. Well, what about dentists?

Kathy: Jail.

Jason: All right. Well, today on the PTCH Podcast, we’re going to bust some myths about the placebo effect and its evil twin, nocebo. So keep listening and you’ll find out how and why just about every health treatment out there is

[0:30] affected by this crazy psychological phenomenon. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast?

Kathy: Chiropractors and physical therapists don’t like each other.

Jason: Oh, think again.

Kathy: I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger.

Jason: I’m Dr. — I’m Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better.

Kathy: Welcome to the PTCH Podcast.

Jason: Remember, there’s no I in PTCH.

[1:02] Kathy: Okay.

Jason: All right.

Kathy: Welcome,

Jason: welcome, welcome back.

Kathy: Welcome back to the PTCH Podcast.

Jason: Yes.

Kathy: We hope you came back for your second view.

Jason: Listen, you know, we have 22 other episodes out there. Yeah, if you find you’re not into this one.

Kathy: Mhm. There’s a lot of other ones out there. Sarcopenia.

Jason: Yes.

Kathy: Cardiology, health matters.

Jason: The yoga one’s quite popular.

Kathy: Yoga is great.

Jason: Great. Yes. We are like one short of our two dozenth.

[1:32] episode. That’s great.

Kathy: The podcast with Stacy about nutrition and menopause.

Jason: Yes. Yes. Heavily requested. Yes.

Kathy: And widely appreciated. So —

Jason: Okay. Well, but today we’re going to talk about something that is near and dear to your heart.

Kathy: I’m so excited.

Jason: I think they teach this at chiropractic school, too. Right.

Kathy: Well, they teach it at every school. Okay.

Jason: Okay. You’re right. I did learn it in PT school. It’s called the placebo effect.

Kathy: Yes. Placebo.

[2:03] It’s fun to say.

Jason: It is.

Kathy: Placebo. Try it. Try it.

Jason: Placebo.

Kathy: Placebo. Right. Mhm.

Jason: Do you want to define that for us?

Kathy: I do. Well, a lot of people have heard of this and I think that there’s a lot of misconceptions about the placebo effect. But a placebo — it comes from a Latin term which means — I think it means like “I will please.”

Jason: Yeah. So, or like something that will please you.

Kathy: So the placebo effect is basically just

[2:34] that. It’s a treatment that has a pleasing effect, but it isn’t necessarily having some intended physiological purpose.

Jason: So a lot of times people will misinterpret this to mean like it’s a fake treatment that doesn’t work. Right.

Kathy: Like, oh, that doesn’t work. It’s just placebo. Right.

Jason: Right. Right.

Kathy: Which is actually the opposite of the truth.

Jason: Right.

Kathy: Because if it is placebo, it means

Jason: it worked.

Kathy: Worked.

Jason: Yeah.

Kathy: Yes. And it’s a really — it’s a really kind of a powerful idea. It’s basically

[3:05] your body’s ability, your brain’s ability to make yourself feel better. And in some cases even get healthier. Okay. And I think one of the things that people don’t realize about it is that it is a feature in just about every single health intervention that you could have,

Jason: right?

Kathy: It is the gold standard against

[3:35] which all other treatments are measured.

Jason: Yeah.

Kathy: Yeah.

Jason: So —

Kathy: it’s a big deal. It’s worth talking about today.

Jason: Is the sugar pill involved? Did you bring sugar pills?

Kathy: Yeah, I brought a lot of sugar pills and I already took them all. Yeah.

Jason: So that’s — and that’s really the classic thing that people think about with placebo. And part of the reason for that is some of the — I guess — I won’t say easy — well, I will say easy because there’s probably no better term,

[4:06] but I don’t want to imply that scientific research is easy. But I think one of the interventions that’s best suited for the scientific method is like pharmaceuticals, right? I’m going to take this pill and this pill, I’m going to take them and it’s relatively easy to figure out did it have the effect that I wanted to or not. Right?

Kathy: It gets a lot more complicated with some other therapies and I’ll get into that. But the sugar pill is the classic placebo where I’m taking this pill. It’s

[4:36] like a little white pill and I take it and all it is is sugar. It’s something that’s fairly inert. It’s not expected to have any sort of therapeutic benefit. Right.

Jason: But what we find is it does —

Kathy: and that’s the placebo.

Jason: Sometimes my pain is gone.

Kathy: Yeah. Exactly. Yeah. So it’s a really, really fascinating thing. So if you have one group of people that’s taking that placebo, that sugar pill, and then you have another group of people that is taking your treatment that you’re trying to test,

[5:07] Jason: you see who gets better results.

Kathy: Yeah.

Jason: Yeah.

Kathy: Science.

Jason: Science.

Kathy: We love it.

Jason: It’s science. Just sciencing it up, right? Science out there doing its thing. So, there’s so much fascinating research that’s been done on placebo, and I’m just so excited to share today.

Kathy: Can’t wait.

Jason: Yep. So, let’s jump into it, shall we? Let’s go. So, one of the first things that people should know about the

[5:37] placebo effect is that it is not just something that is in your mind, right? It’s not like I’m taking the sugar pill and now I’m just like — I’m going to fake that I feel better. There’s measurable physiological effects

Kathy: from a placebo treatment.

Jason: Now the whole range of effects that we could have in the body isn’t necessarily available to us.

Kathy: For example, a placebo is probably not going to shrink a tumor,

[6:07] Jason: right?

Kathy: It’s probably not going to kill bacteria or anything like that. But you can certainly cause the brain to release neurotransmitters or chemicals, or upregulate a system or downregulate a system, so that you get a physiological effect.

Jason: Right?

Kathy: So for example, one of the oldest and most interesting kind of field experiments that was done with this was

[6:37] Jason: Actually, a guy — I think his name was Beecher. Did I get this correct? I think I remember —

Kathy: Beecher. I know that guy.

Jason: Yeah, Beecher. Yeah. Beecher. Beecher.

Kathy: No. His name was Henry Beecher and he was a medic.

Jason: And this was in World War II and they ran out of morphine.

Kathy: Yes. And so what he did, instead of giving soldiers morphine, he gave them saline injections. So it’s just salt water. Yeah. Right. So it’s harmless. It’s not going to cause them any harm.

[7:08] Right. But 40% of the people that he treated with salt water got better. They were pain-free.

Jason: Less pain.

Kathy: Yeah.

Jason: That’s amazing.

Kathy: Yeah. It’s crazy, right?

Jason: Yeah.

Kathy: And so it’s like, wow, why do we use morphine at all?

Jason: Yeah.

Kathy: So, the reason — and morphine is a really great example — because our body has the ability to make morphine. You know what that’s called when we make morphine?

Jason: Morphine.

Kathy: It’s called endorphins.

Jason: Oh, yes. That’s right. So I did learn that one. Endorphin is endogenous

[7:39] morphine, basically. And so morphine is actually the synthetic version of endorphin.

Kathy: And so yeah, it’s kind of a cool thing. You have an expectation of receiving a treatment and your brain’s like, “Oh, you understand on some level this is supposed to be the effect.” So the brain just fills in the blanks and it

Jason: releases some endorphins.

Kathy: This is how we do it.

Jason: Yeah.

Kathy: Follow along, people.

Jason: Which chemically is basically the same thing. So,

Kathy: really, really fascinating.

Jason: Yeah. I think that we use this a lot

[8:11] because we work with people who are in pain.

Kathy: Yes.

Jason: And we do some things that definitely involve a placebo effect,

Kathy: right?

Jason: Have you ever had somebody come in and they just have a real crap attitude about getting better? How does that usually work out, Kathy?

Kathy: I’m not talking about any of your co-workers. Hey, everybody at Encore is very positive and happy. So,

Jason: hey, physical therapy is so good. It

Kathy: is. You got a lot more.

Jason: Yeah. Encore.

Kathy: Mm-hm. Mm-hm.

[8:41] Yes, I have had a lot of patients that come in and say, “I don’t think this is going to help me.”

Jason: Yeah.

Kathy: Mm-hm.

Jason: Yeah. Or, “I’ve already tried physical therapy.” You’re no different.

Kathy: Yeah. But sometimes, because I know that I have people that come in and they say the same thing with chiropractic. They’re like, “Oh, I’ve been to a chiropractor before.” Chiropractic doesn’t work. Why are you here, sir?

Jason: My wife.

Kathy: Yep.

Jason: My wife.

Kathy: Oh, I hear that a lot. And so, one thing that helps that person more than actual

[9:13] treatment is the conversation around it, right? So it’s like, “Hey, we’re going to try this.” And we set some expectations and, you know, a lot of times those people get better because they choose to. So, yeah. Cool.

Jason: Yeah. You’ll appreciate this because you deal with a lot of knees.

Kathy: Yes.

Jason: Love me some knees.

Kathy: Yes. Knees. So a lot of times we think about placebo, we’re just thinking about that sugar pill. No.

Jason: But it’s not just a pill. It can be another type of treatment. Right. So

[9:44] there was a really great study — 2008, maybe I think it was in 2008 — where they did sham knee surgery.

Kathy: Right, so now you have these arthroscopic surgeries where you just make a few holes, you put in, you snippity-snip whatever, and — you could tell I’m trained as a surgeon —

Jason: snippity-snip.

Kathy: Snippity-snip whatever, nurse.

Jason: So yeah, so they —

Kathy: in here —

Jason: well, they made the incisions and they

[10:16] closed them up and they didn’t do anything. And guess what?

Kathy: People got better.

Jason: They got better. Is that legal?

Kathy: In a study environment.

Jason: So people knew they were possibly getting the sham surgery.

Kathy: Yes. Some people knew that they weren’t going to actually receive surgery. Some people knew that they could possibly receive surgery. Nobody knew which was which.

Jason: And so that’s called a blinded study,

[10:46] right? A double-blinded study, which you can’t really do in this situation. A double-blinded study is when not only do the people receiving the treatment not know what they’re getting, the people who are providing the treatment don’t know what they’re getting.

Kathy: I don’t know how you could do that with surgery, but

Jason: yeah, so people knew that they could maybe get a surgery, but a lot of them got better whether they had the actual surgery or not. And so what this tells us is that surgery is of course a scam,

[11:17] right?

Kathy: Well, no.

Jason: No. Okay.

Kathy: No, no, no. That’s a broad blanket you’re putting on surgery.

Jason: Yeah. See, and this is the mistake that people make whenever they’re talking about placebo and whether it’s a good thing or a bad thing, right? And so it’s important to understand the difference, because otherwise it’s easy to come to that conclusion where it’s like, hey, you could have a fake knee surgery and you’re just as

[11:47] good, so obviously that’s just crap, right? Now culturally, we are reticent — that’s the word I’m going to use. Reticent.

Kathy: I like it. Wow, that’s a big word.

Jason: Or reluctant.

Kathy: Yes.

Jason: Or reserved. Hesitant to apply that placebo effect to things that are associated with mainstream medicine. I’m not trying to get all conspiracy theorist and I don’t want a bunch of hate mail and stuff like that, but it’s just the facts. Culturally, we have

[12:18] a high level of trust for what goes on in allopathic medicine — with surgeons and medications and everything like that. And so we tend not to apply the term placebo to that, even though it is associated with absolutely everything that we do.

Kathy: Every treatment.

Jason: Yep. Every —

Kathy: Now there’s a flip side to that too. I think that I talked about nocebo.

Jason: You mentioned — said the word, right?

Kathy: It’s kind of like — you ever play Super Mario and you have Mario and then you have Wario, which is like the — yeah. So nocebo

[12:51] is the opposite.

Jason: Yeah. So I can expect something bad to happen and my brain’s going to make it happen,

Kathy: right?

Jason: So, I’m sure that you are always talking with people about should I get a surgery, should I not?

Kathy: Right.

Jason: And I don’t know, what have you observed with people who have really negative attitudes about surgery?

Kathy: That’s a really good question.

[13:21] The people that don’t — the people that really, really, really want surgery to fix them are very disappointed if somebody will not do surgery on them. Kathy: Mhm. Jason: Right. Kathy: Mhm. Jason: And so I mean, occasionally those people come out of surgery and they’re not fixed too. Kathy: Yeah. Jason: Yeah. Yeah. And then there’s some people that they probably need a surgery and then they’re just like, “I really don’t want it. I really—” and they go and they get it anyway and they get their

[13:52] way, right. Kathy: Surgery didn’t work. Jason: It didn’t work. Kathy: Yeah. Jason: Told you it wasn’t going to work. Kathy: Exactly. And so our attitudes towards things, they make a big difference. Like, I’m sure you’ve probably had the experience of seeing a patient who was cured by MRI. Jason: Oh yeah. Kathy: Yeah. Yeah. Which — I mean, to be clear, MRIs don’t cure anything. Literally don’t. Jason: But there’s people who they’ll have chronic pain and they’re like, “I just — I just need — if I can get an MRI, we can find out what’s going on.” They get an

[14:22] MRI and it’s like, yeah, and it doesn’t matter what you find, right? Oh, yep, there’s a tear. Kathy: Told you. Jason: Oh, there’s no tear, right? It’s like, okay, now I’m better. Yep. Kathy: Yeah. They just needed to know. That’s what was — that’s what was hurting. Jason: Yeah. So it’s a crazy thing. Brains are so dang powerful. Kathy: Yeah. Jason: Okay, now here’s where this really gets crazy. And this is — I’m going to say, like, on a scale of 0 to five, five being the craziest, I’m going to put this at maybe

[14:52] four. Kathy: Okay. Jason: Okay. Because there’s something crazier than four out of five. Kathy: Okay. Jason: Yeah. But at a four out of five for placebo craziness, there is something called an honest placebo pill. Kathy: Mhm. Jason: So they’ve done studies where they have given somebody a medication and they’re like, “This is a placebo and we want you to take it,” and what happens is, sometimes if you take a placebo, you just get better. Kathy: Okay. Jason: And do you want to know — people who take that honest placebo — can you guess

[15:24] Kathy: they get better? Jason: They get better. Isn’t that great? So you can even know that what you’re doing is a placebo and it helps you get better. Kathy: Freaking weird, right? Jason: So weird. Um, and then there is an effect where if you take a placebo and then you take more of the placebo — like you take two sugar pills instead of one sugar pill — you get double the effect. Kathy: Do you actually get doubly better? Jason: Yes. Kathy: Wow. Jason: Yeah. So they’ve done this in terms of

[15:54] pain relief studies, right? Where somebody takes a placebo and then they up the dose of the placebo, and they find that the effect is even larger. Kathy: Wow. Jason: Right. And they know it’s a placebo. Both. So they’ve done it with honest placebo, they’ve done it with blinded placebo, and the double-down effect is real. Isn’t that crazy? Kathy: Yeah, that is. So they believed — somebody told them that you’re going to get better if you take this. Jason: Mhm. Kathy: And so they believed it. Jason: Mhm. Kathy: And they got better. Jason: They got better. Okay.

[16:24] Right. So I think we need to be careful what we’re saying with “better” though, because again it doesn’t fix everything. Kathy: No. If you need antibiotics, yeah, there — there’s not an antibiotic placebo out there that’s really going to help you. Jason: Please go get real antibiotics. Kathy: Need some antibiotics. Jason: But this tends to be most effective with things like pain, well-being, depression, focus, those types of things that can be regulated by neurotransmitters, because that tends to be what the brain can and

[16:54] cannot up- and downregulate. Okay. So that’s a thing. Also, the size of the placebo matters. Kathy: Yeah. Jason: So a teeny tiny placebo tends to be less effective than a great big placebo, right? Um, and so those are also a big deal. Um, one interesting area where placebo can make a difference with a pretty serious disease is actually

[17:24] Parkinson’s disease, because Parkinson’s disease — you have a decreased sensitivity to dopamine. Kathy: Yeah. Jason: And so that neurotransmitter is really important in terms of being able to control your physical functions. It controls your happiness. Right. A lot of people out there, they spend all day just dopamine chasing — why people are doom-scrolling TikTok. So, but you know, that neurotransmitter is a feature of this disease — placebo tends to be pretty effective for

[17:55] Parkinson’s treatment, which is crazy, right? So, yeah. Kathy: Would you also then say the opposite — because the brain is so powerful — that if you want to feel sick, you can make yourself feel sick? Jason: Absolutely. Kathy: Right. Give yourself chronic pain. Jason: Mhm. Yes. And it’s real — like, you actually feel it. This elbow is killing me. Kathy: Yes. Jason: You can make that happen. Kathy: And it’s a huge deal. And that’s a really complex mechanism too. You know, there’s somebody that I want to try and get to come on the podcast. Her name is Annie O’Connor. She wrote — she collaborated on a really great

[18:26] book called — oh my gosh, what is it called? I can’t remember the name of it off the top of my head. You’re looking it up, I can see it. Um, but it’s a book about pain and like a whole bunch of pain research. Jason: World of Hurt. Kathy: World of Hurt. That’s a really good title. Jason: Yeah. It’s a really good book and it’s really interesting. And one of the things that it talks about in there is that there’s actually — they compare chronic pain to a campfire.

[18:59] Oh. So if you want to have a campfire, you need three things, right? You’re going to need fuel, oxygen, and heat. Kathy: Okay. Jason: Those are the things that make a fire. Same thing with chronic pain. If you want to have chronic pain, you’re going to need a stimulus. You’re going to need a functioning nervous system. And the last thing — you know what the last thing is? Kathy: Brain. Jason: A brain. But a specific part of the brain. You need emotion. Kathy: Oh, which is weird. People are like, “Nah, I’m turning off your podcast. It’s stupid.” That was it.

[19:29] Jason: Right. But it’s true. So, and like to kind of illustrate this — and this is an aside, but let’s go here. If I step on a rusty nail and I get tetanus, okay, and now I have to spend some time in the hospital and I have to worry about potentially losing my foot or getting lockjaw or whatever, and I have to miss some work and I own my own business and now it’s costing me a whole bunch of money to miss work. And I recover from that — like, that hurt, right? To step on that nail, that

[20:00] hurt a normal amount, and it’s because I have those three things, right? I have a stimulus — that nail — I have a working nervous system to get the information to my brain, and then on top of that it’s like hitting me in the pockets and everything. Next time I step on a nail it’s going to hurt even more. Kathy: Yeah. Jason: Yeah. And so people wonder with that, can I turn off Kathy: pain by just fixing my emotions? Jason: The answer is yes. Kathy: Yeah. Jason: Yeah. It is. And there are people out there that can meditate

[20:30] away pain, and you know, they’re good. You can also destroy somebody’s nervous system and they don’t feel pain. That’s paralysis. We don’t like that. Kathy: No. No. Jason: Or opioids, right? Yeah. So yeah, that’s the thing about pain, right? It’s all in the brain. Kathy: It is. It’s the only place that we experience — brain or brain — Jason: brains and pains. Yeah. So that’s one of the reasons that placebo works, though, is because at that brain level where we have our

[21:00] cognition tied in with our emotions tied in with the dispensers for all of the neurotransmitters that make us feel certain ways and make our body behave certain ways — you know, this is like ground zero for our health. Kathy: Yeah. Jason: Yeah. Yeah. So, um, yeah, it’s really, really interesting stuff. Kathy: Okay. Do we want to bust some myths? Jason: Yeah, let’s bust some myths. But Kathy: before we do, I think there’s one more

[21:31] thing that I should talk about. Jason: Okay. Kathy: Because one thing that people wonder about is, is it ethical to use something that you know is placebo, right? And we talked about this — like, you had a patient, right? And so if you know that something is largely a placebo effect, is it ethical to use it with a patient? I mean, what do you think? Jason: I’m okay with it. First, do no harm. So I know that whatever I’m going to treat this person with is not going to harm them, right?

[22:01] If they believe that this one thing is going to help them, why not give it a try? Kathy: I can do it for eight minutes. I can bill for eight minutes. Jason: Yeah. And I think that that’s a good outlook on it. Yeah. Kathy: Right. And what we already learned is that you can be honest about it. Yeah. Jason: Say, “Hey, you know, this tends to be effective for some people and that might be because of a placebo effect, but if you want to try

[22:31] this, we can try this.” Certainly, though, you don’t want to do that if you’re going to introduce harm to somebody. Kathy: Right. Right. Jason: Yeah. So, that’s a really, really powerful thing, though, because some people — they’re dealing with this stuff and they’re at the end of their rope. Kathy: Yeah. Jason: And so it’s important that we’re always honest with people about what we think the odds are that this is going to be dangerous or is going to cause you harm, or the

[23:01] odds are that you’re going to pay money for this and it’s just not going to work. And again, people who are really, really negative, they tend to get less benefit from a placebo. So, you know, there’s sometimes I’ll talk with people and I’m like, “Hey, we can do this thing,” or you can go here, you can do that, but you just don’t think that it’s going to work. And so it’s probably not — Kathy: Yeah, it’s likely not going to work. Jason: There are sometimes when we can get unethical with that. So, for example,

[23:31] promising a cure, right? If we’re charging exorbitant amounts for it, there’s something called an opportunity cost where it’s like, if I’m taking away your opportunity to get a more effective treatment that I know exists, right? Especially if your situation is going to deteriorate. So, for example, if I’m like, you know what, you should take these Tic Tacs instead of going and getting chemotherapy, you know, and let’s just see how these

[24:01] Tic Tacs work for a while. Meanwhile, the tumor in your brain is growing. Kathy: Yeah. That’s unethical. That’s bad. Jason: That would be prison. Kathy: Mm-hm. Exactly. Jason: Yeah. But, you know, if somebody’s like, “Hey, I don’t really want to take Advil.” Kathy: Right. But I have a lot of pain. Mm-hm. Jason: You have something I could take instead? I said, “Well, you could take these Tic Tacs.” Kathy: Yeah. Jason: What’s in the Tic Tacs? It’s mostly sugar, but some people get benefit from it. Kathy: Sure. Yeah, you could do that. If I charge you $90 for the Tic Tacs,

[24:32] that’s unethical. But if I tell you, go to 7-Eleven, get yourself some Tic Tacs, see if that helps — it helps you? Cool. Kathy: Yeah. Jason: I’m House, right? I’m Dr. House. Kathy: That’s right. Jason: Yeah. I mean, you and I both do manual therapy as part of our treatment, and you know, there’s conflicting evidence on whether — are we actually moving that one spinal segment? Or when I massage that calf muscle, am I really increasing circulation? I mean, you could probably find research articles that would

[25:02] support yes and no of that, right? But what I’ll justify to myself sometimes — when I feel like I need to work on this muscle, but it might not be doing exactly what I think it’s doing, especially with manual therapy — I am helping calm their nervous system. Jason: Yeah. Kathy: I’m helping them, giving them hope like this is gonna help. And so it might not be — I might not be changing chemically what’s happening in that muscle,

[25:33] but I am changing how they think about it. I’m giving them hope and, you know, like I said, calming their nervous system down, and that can help with pain. Jason: Absolutely. And you know, I think the best indicator that a treatment is going to be useful for somebody is if they are interested in that treatment. Kathy: Right. Jason: So I get people who — they’re like, “Hey, what do you think, should I get Reiki?” Kathy: Yeah, Jason: to help this. I have a friend who does Reiki, which, if you’re not familiar

[26:04] with Reiki — it is a no-contact energy healing thing. And I ask people, “Well, what do you think? Like, how do you feel about it?” They’re like, “I think it might work. I know some people have had good results with it.” So I say, “Yeah, go for it.”

Kathy: Right. Yeah.

Jason: If I know that they’re going to a $500-an-hour Reiki master, I just tell them, “You could probably find somebody who does Reiki cheaper,

Kathy: or you can do YouTube Reiki, something like that.”

Jason: But that person’s probably going to get good results from Reiki, right? Honestly. Yeah. And

[26:34] I’m not trying to disparage Reiki or anything like that, but I think it’s a good example because it’s energetic healing and placebo is energetic, right? It’s your energy around — what am I doing? How am I getting better, recovering, all that kind of stuff — and so it really fits well, right? People who show up to my clinic and they don’t want to see a chiropractor. They don’t believe in chiropractic, which I think is so funny. “I don’t believe in chiropractors.” Well, we exist.

[27:04] Kathy: You are. Yes.

Jason: Yeah.

Kathy: Here he is.

Jason: Here I am. There’s one right there.

Kathy: Yeah. I mean, those aren’t people that should be at a chiropractor, right?

Jason: People — I get people that are like, “Well, I’ve had PT and it’s not worked.” Then, you know, going to see a different physical therapist might be the trick, but in general they might need something else, or we need to talk — you have to be realistic about your expectations. There are things that are proven to help or could help, and those are the things you want to trend

[27:34] towards. This other stuff is maybe potentially harmful, right? So those are important.

Now, I did tell you that there was a five out of five.

Kathy: Oh yeah, and I — that we should talk about this. This is really crazy. All right, so

Jason: we know that there are some things out there that have real effects, right? They maybe beat placebo in terms of the effect that they have. And so they have done studies

[28:04] where they have given somebody a treatment, and that treatment — let’s say it’s a blood pressure treatment, okay? And they are taking this blood pressure medication, and then in the course of the study they swap out the blood pressure medication and they’re now taking placebo. Guess what happens?

Kathy: Blood pressure is fine.

Jason: Blood pressure stays regulated. Yes. They’ve done this with blood pressure, they’ve done it with pain medication, they’ve done it with

[28:36] dopamine. They’ve done it with several things. And what they find is that the body will start to release the substances that they’re supposed to be getting from the medication.

Kathy: Wow.

Jason: Yeah. That’s incredible. Yeah. So the thinking around that is that it’s not just the medication that you’re taking. It is what’s called the healing ritual.

Kathy: Okay.

Jason: Right. So people who have maybe had the experience of having to go to the ER.

[29:06] Kathy: Yeah. Right. Yeah.

Jason: Maybe they’re at home. They’re in some sort of crisis, or maybe a lot of pain.

Kathy: Did they fall?

Jason: They probably fell, right? It was the brandy. So yeah, maybe they’ve had a fall. They’ve got to go and they call 911

Kathy: right away. They start feeling better.

Jason: The ambulance shows up. The paramedics are there. They get them on some oxygen. The oxygen — oxygen’s in the freaking air, right? You were already getting oxygen, ma’am. Okay. But

[29:38] all of this starts them feeling better. They get to the hospital, they see doctors in white coats, there’s nurses there.

Kathy: Now I’m hooked up to some machines, right? And they start feeling better, right?

Jason: Yeah. Now, this isn’t the case with everybody. I’m not saying you get to the hospital and additionally there’s no more pain, right? But it’s the ritual of these things that help the body to kind of get in the mode to do it. And eventually your body can get to the place where it doesn’t need the medication,

[30:08] right? It needs the ritual.

Kathy: Wow.

Jason: Yeah. And it’s crazy. Now, I’m not saying stop taking your blood pressure medication. I’m not saying you don’t need pain medication anymore. I’m just telling you that this is what a body does and it’s freaking cool.

Kathy: Body is amazing.

Jason: Yeah. It’s really, really crazy. So yeah. Myths — you wanted me to bust some myths.

Kathy: Yeah.

Jason: What’s the myth?

Kathy: Love it. Yes.

Jason: First myth.

Kathy: Okay.

Jason: It’s placebo. It’s not real.

[30:38] Kathy: Yeah. Placebo is very real, right? It’s very real. It is a fake or a sham treatment, but it is a real treatment. And like I just said, that ritual of the treatment sometimes is enough to get us what we want.

Jason: Yeah. Like if you were a really powerful, dialed-in person, you could be your own pharmacy,

Kathy: my own placebo,

Jason: your own dispensary, right? You would find a way to make the THC in your body, right? So I think we’ve all

[31:10] met people that we think are just perpetually high on life.

Kathy: No doubt.

Jason: So —

Kathy: No doubt.

Jason: Mm-hm. All right. How about myth number two? Only gullible people respond.

Kathy: Yeah. I think if you believe that, you are pretty gullible — and you probably don’t think that you are. So, but no, this is human physiology. It’s not just gullible people. There are some people that tend to be more susceptible to placebo than others,

Jason: and it doesn’t have to do with gullibility. It has to do with

[31:41] positivity.

Kathy: That’s funny.

Jason: Yeah. Yeah. So if you’re a really negative person, you’re probably less susceptible to placebo. Even if you are, you know, fairly levelheaded — really gullible — you could be a very gullible, negative person, and you’re probably still going to feel like crap. So I’m so sorry. I’m so sorry. Yeah. Put a smile on your face. Maybe that’ll make you just feel better. Smile more. And Kathy, this is a big part of — I

[32:12] Don’t know if — if you go back to episode one of the PTCH Podcast where we’re — we’re meeting the doctor. Kathy: We’re introducing each other. Yes. Jason: Well, this is why in my clinic, one of the most important things that happens is I want people to laugh, Kathy: because if you are — even if you’re having a really bad day, like you’re in a ton of pain, you’re super negative, it’s going to be hard to get you feeling better. Even if I like give a really sweet adjustment, Jason: like if — if I can get people to laugh, if I can get people to smile, they are going to — they’ve already got the

[32:43] ball rolling. It’s so much easier. Kathy: They’re going to release some endorphins. Jason: Absolutely. Morphine. Kathy: Yes. Morphine. I want to get more of that. Jason: Okay. Kathy: Any more myths? Jason: Yeah. Kathy: Okay. Doctors using placebos means they’re lying. Jason: Yeah. So, it could be right if — if they’re doing it unethically, like if they know that they’re selling snake oil, right? Kathy: Which — little historical backtrack here, people are like, “Oh, that’s snake oil,

[33:15] right?” And like I have been called a snake oil. Jason: Oh, right. Kathy: But the thing about snake oil is that snake oil worked. Jason: Does it? Kathy: It did. It did. Jason: For what? Kathy: It was great for all kinds of things. Inflammation, pain, all kinds of stuff. The reason is because snakes — the oil they were using — it was, I think, a Chinese remedy and they were using this snake oil which was high in omega-3 fatty acids, which is anti-inflammatory. Jason: Yeah. And so it’s like, then people

[33:45] started thinking, well, any kind of oil, not just snake oil, and so then the commercialization of it — then people started using stuff that was not actually snake oil, right? It didn’t have the same properties. Now, we know that placebo would make some people still get better even with the snake oil, right? The stuff that wasn’t the real thing, right? The snake oil. Exactly. But it started as something that actually was helpful and then it became a euphemism for somebody

[34:15] who is trying to pull a fast one. So, there’s definitely some people out there who are marketing things that they know — that they know — don’t contain the real deal, and it’s unethical and it’s dishonest, right? Kathy: But you also have a lot of people out there that folks are just skeptical about, and they’re like, well — and they just want to put them down, like they don’t understand what they’re doing or why, or it’s not mainstream medicine, and so they’re like, yeah, that’s a snake oil salesman — this person is using placebo, and it’s like, so are you. Okay.

[34:46] Jason: Do we talk more about — we did — no nocebo. Kathy: No nocebo. Yeah. So — Jason: Yeah, there is — there is a little bit more that we should say here because, like, I talked about how you can kind of program some negative effects, and you know you can even take a good proven treatment and your body can work against it. Um, one of the ways that we have to be careful as providers with nocebo is in how we talk to people, right? Kathy: Yeah.

[35:16] And I think that we’ve brought this up before — like some examples of some damaging language that we can use with people, like — I don’t know — what is it in the PT world that PTs are telling people that actually hurts them rather than helps them? Kathy: Well, you have the spine of an 80-year-old. Jason: Oh gosh, I love that one. Kathy: And they look at the X-ray report. Jason: Yeah. Yeah. Or — bone on bone. Kathy: Oh, the bone on bone. You can’t — you have bone on bone. Sorry, sir. You’ve got bone on bone.

[35:47] Would you like to call somebody? Right. Yeah. So, there’s all kinds of things like that. Man, and you get — I’m sure your clinic is probably the same — where you have a high input of people that have been kind of damaged by some of this language. You’ve got degenerative this, or you have a torn this, or a ruptured that. And so, the challenge with it is that those things aren’t always inaccurate, right?

[36:17] They’re just not helpful, right? Because there’s a way that you can talk about these things and you can do it in a way that’s helpful. So, I’ll give you an example. Let’s say that I’m going to put you on a medication, okay? Because I’m not a chiropractor — I’m a medical doctor now, okay? Not in real life, but we’re just pretending. Okay? I’m going to put you on this medication, Kathy. Now, 30% of the people who take this medication experience extreme nausea. Okay? But you know it’s 30%. And so I want to put you on the medication.

[36:48] Now, from what I’ve told you, if you’re already geared a little bit towards negativity, you have a higher chance of experiencing nausea than the average person. Kathy: Mhm. Jason: So, what’s a way that I could reframe that to still give you accurate information, but give you a better chance of not having nausea? Kathy: 70% don’t experience nausea. Jason: Yeah. Yeah. So, 70% of people take this medication, they have no side effects at all, right? And so, the odds are actually in your favor,

[37:19] right? It’s like — so that’s good news, right? Chances are you’re going to take this, you’re going to feel great. Kathy: Yeah. Jason: And that’s setting somebody up for success. But you — as a patient — you have to be careful of providers who are doom-and-glooming you, because — whether — and they typically do not intend to — like I would say 99.9% of any provider you see has the best of intentions. They want to see you get better. Kathy: Right. Jason: There’s a small percentage out there who

[37:50] use this sort of language because it’s a sales tactic. Kathy: Yeah. Um, chiropractors are guilty of this a lot of times — I won’t say a lot of times because I don’t have the stats on it, right? Jason: Sometimes they’re guilty of this where it’s like, well, you know, look at this. This is your spine and look at this — this is your spine deteriorating, degenerating. If you don’t get a thousand adjustments, this is you. And we were able to see this on X-ray because you were brought

[38:20] here on a stretcher that had a wheelchair on it, and you’re blind too, because you’re not — falling — Kathy: because you didn’t get the adjustments and take my supplements. Jason: It’s like — and so there’s people out there that are like that. They’re using these negative consequences and hanging them over people as a tactic to get them to buy things, right? Um, I bring up chiropractors, but it’s not unique. Kathy: No. Jason: Surgeons do this. Kathy: Absolutely. Jason: Right. Um, sometimes it’s done with

[38:53] primary care providers and vaccines. Now, okay, slippery slope here. We’re talking about vaccines. Yeah. Careful. But I am vaccinated. Okay. My kids have vaccines. So, I’m not anti-vaccine. But I think that we do need to do some things about how we have this vaccine conversation with people because there’s people that are really like,

Jason: you know, they’re — what’s the word I’m looking for?

Kathy: Hesitant.

Jason: Hesitant.

Kathy: Yes. I think that’s actually what it’s called. Vaccine hesitancy.

[39:23] There it is. Yeah. And so doctors are like, “Well, if you don’t get this, you’re going to bleed out with measles and bumps and, you know, and all that kind of stuff.” And so it’s like — are vaccines useful? Well, I think yes. I think science says yes. And I know there’s people that disagree with me and that’s fine. But the thing is, when you’re using scare tactics to get people to do that, like — is what you’re doing different than chiropractors like, yeah, you’re going

[39:54] to end up in a wheelchair and blah blah blah? Because even though we’ve seen some outbreaks and some recurrences of some of these diseases, it is still a very, very low chance that you’re going to get any of these things. But there’s just more positive ways to have that conversation, right? Like, we want to see you be healthy and strong. Most of the people who get this, they do just fine, right? And so it’s helpful for you, for everybody around you if you do this, and so on. And then if people have questions, then you talk about those

[40:24] questions. But if you’re coming at people with doom and gloom and, you know, your eyes are going to melt out of the socket unless you take this magical shot, then all you’re doing is fueling people’s hesitancy.

Kathy: So yeah.

Jason: So yeah.

Kathy: Okay.

Jason: I think I beat that one to death.

Kathy: I think we know what the —

Jason: I said the V word. Yeah. Uh-huh. So — vaccine — said it again. Vaccines are good.

[40:54] Kathy: Yep. So, let’s see. Did we get all the myths?

Jason: Got all the myths.

Kathy: They’ve all been busted.

Jason: They’ve been busted.

Kathy: Is it game time?

Jason: I think it is game time.

Kathy: Okay.

Jason: Let’s go. All right. I’ve got a good one. This is fun. We’re going to play a game that I am calling Trick or Treatment.

Kathy: Oh god.

Jason: So, Trick or Treatment. All right. I’m going to name off some treatments and you’re going to just tell me — is it

[41:24] mostly placebo, or is it not? Trick would be placebo. Treatment would be — there’s some science that says that it’s better than placebo. Now, for this I think it’s important to bring up that sometimes when we’ve researched things we are attributing effects to placebo and it’s not actually placebo. It’s effects that we haven’t been able to detect accurately, right? So, more research needs to be done, more science, but

[41:54] there might be an effect. We don’t know what the effect is. And so we say placebo because we can’t identify exactly what it is, right? Needs more research. So, I will say that there’s some on this list that probably fit in that category. Okay. Hit me. So, that’s the thing. We’re going to go through a few of these. Reiki was on the list, but I already burned that one. So, that would be called, in this game, a

Kathy: treatment —

Jason: trick, actually.

[42:24] Kathy: Yeah, there’s not a lot of science for it. Not a lot of science for it. And I’m not saying that Reiki doesn’t help you.

Jason: I don’t want to offend Reiki. So, it’s a trick.

Kathy: Yeah, they might put the mojo on you. Okay. Here — oh, okay. Trepanation. Do you know what that is?

Jason: It’s old school. It’s an ancient —

Kathy: Trepanation.

Jason: No, I don’t know.

Kathy: This is when they would drill a hole in your head to release spirits.

Jason: Okay. Is that trick or treat?

[42:55] That is a trick. Right. So, there are some cases where putting a hole in the skull would help, but it’s not for releasing evil spirits, right? So the intent matters. Good. That was a softball. Yes. All right. See? Yes. How about this? Therapeutic ultrasound for musculoskeletal pain. Why are we laughing so hard, Kathy?

Kathy: That’s a treatment.

[43:25] Jason: Okay. Yeah. Now, see, this is one where it’s a gray area.

Kathy: It is a gray area,

Jason: but it’s actually probably a trick more than a treatment. And as a treatment for musculoskeletal pain, there’s been a lot of studies that have been stacking up that show that ultrasound doesn’t beat placebo, right? For the most part, I don’t use it a whole ton, but the people that I use it with — like what you talked about when you used it with somebody — what was the circumstance?

Kathy: It’s a treatment and she wanted it.

[43:55] Jason: She wanted ultrasound

Kathy: and she believed it was going to work.

Jason: Exactly. And so

Kathy: who am I to dash hopes?

Jason: Yep. And so the likelihood is that she is going to get a good result from it.

Kathy: It’s not my main treatment. And I’m not telling her this is exactly why you’re getting better. I’m integrating other things and educating her while I’m doing it.

Jason: Yes. The ultrasound’s not going to hurt her.

Kathy: No. Right. Exactly. And it’s not like ultrasound is incredibly expensive or anything like that. But with the science, there are more and more insurances that aren’t covering

[44:26] ultrasound for that reason — because the science isn’t really heavy in the favor of ultrasound.

Kathy: It’s not.

Jason: Penicillin — trick or treatment?

Kathy: That’s a treatment.

Jason: It is a treatment. Very good. That was a soft —

Kathy: It’s a world-changing treatment, right?

Jason: That was — that’s a trick question.

Kathy: Okay. How about this one? Vitamin C mega doses for the common cold.

Jason: That’s a trick.

Kathy: That is a trick. Yes. And with, you know, people are like, “Oh, vitamin C, you just pee it out, right?” And that doesn’t necessarily

[44:56] mean that it’s not good for anything. So, there’s there’s things that you can mega dose of vitamin C for orally, you know, like for example, you want to you want to try something fun, you want to clean out all of your gastrointestinal flora, take a whole bunch of vitamin C orally, and yeah, it will it will flush you clean. In my in my functional medicine training, that’s that’s that’s a tactic that you can use if people have GI flora problems. So that is not medical advice. It’s just it’s just a fact of life. It’s it’s not fun.

[45:28] Jason: But intravenous vitamin C megadosing can have some other effects, right? Because it scavenges free radicals and things like that. So but for the common cold — trick. Okay. What about Ginkgo Biloba for memory and dementia?

Kathy: I’m going to go trick.

Jason: That is also a trick. That’s right. There there aren’t really any studies that that support Ginkgo Biloba for memory and dementia. They’ve tried it in people with Alzheimer’s dementia, and they just they just don’t predictably get

[46:00] better. Now, does that mean that Ginkgo Biloba is crap? No. There’s other things that it’s good for, right? It just left my mind. But peripheral artery disease, for example, that’s that’s one that Ginkgo tends to be good for. It increases blood flow to the hands, the fingers and stuff like that. The fingers.

Kathy: What about over-the-counter cough syrup for children, colds, and coughs?

[46:30] Jason: Trick or treatment. Over-the-counter. Mhm.

Kathy: It doesn’t have alcohol in it for kids.

Jason: It’s a trick.

Kathy: What?

Jason: Yes. In fact, they have stopped recommending cough syrups for children.

Kathy: Why?

Jason: Well, for the simple fact that it’s not effective.

Kathy: That’s that’s the water.

Jason: It doesn’t coat the throat.

Kathy: It sure it does, but you know what else does?

Jason: Simple syrup.

Kathy: Yeah. So you can — I mean you can boil

[47:00] some water, put some sugar in there, make a syrup, and it’s going to do the same thing as the over-the-counter cough syrup. The reason they’ve stopped recommending it for children is because some of the medications that are in the cough syrup can actually have some negative effects.

Jason: So you might be better off with just like, you know, a syrup and tell the kid, “Hey, this is going to help your cough.” They’re going to be like, “Oh, yay.” Yeah, it’s grape flavored. That was my favorite. The grape cough syrup.

Kathy: Yeah. The cherry stuff. Yeah. You know, yeah.

Jason: Yeah. Yeah. Yeah.

[47:30] Kathy: Cough syrup is a little more effective for adults, but it’s still not very — so, yeah.

Jason: Do you ever have to take Dimetapp?

Kathy: Oh, yeah.

Jason: That was grape flavored.

Kathy: Well, and what was that?

Jason: Yeah. And like it would get kind of crystallized sometimes, and so then when you’re opening the thing, it was like —

Kathy: Yeah. Yeah. I think I think we grew up in the same era.

Jason: We did. All right. What about this? Willow bark tea. That is a trick.

Kathy: No, that’s actually a treatment.

[48:00] Jason: But is it real?

Kathy: White willow bark is actually where we started to get salicylic acid. Salicylic acid is aspirin.

Jason: Yep.

Kathy: So it was an old remedy. They would take the white willow bark, they boil it into a tea. Really great for blood thinning and also for pain relief. So yeah, that that is a treatment. What about homeopathy? Trick or treatment? Let’s go.

Jason: Treatment.

Kathy: It’s literally sugar pills.

Jason: Darn.

[48:30] Kathy: It’s literally sugar pills,

Jason: which is a treatment.

Kathy: Yeah. And then they dilute a substance. The theory behind it is they dilute a substance down to where there’s no more of the substance left and you capture that essence in a sugar pill and then that is the treatment. And so homeopathy, I would put it in a category with some of the energetic things. And so there’s people out there that are listening to this and they’re like, “You’re wrong, you’re wrong.” It’s good and it works for them and I’m not denying that. I grew up in a

[49:01] family where my mom leaned heavily on homeopathic remedies and they work for us. I got some good effects from it, but they’re literally sugar pills. And so does it work? Yeah. Is it harmful? No.

Kathy: Is it expensive? Sometimes. So that’s that’s the only place where you might kind of wander into some harm and stuff like that. But you know, if you’re getting a lot out of your homeopathy, cool, more power to you, right? If you’re just ragging on people that are like, “Oh, homeopathy is stupid and so you’re a stupid person. You shouldn’t

[49:32] have the ability to vote” — then it’s like, just settle down, buddy. Okay. Right. Go eat an apple, you know. But anyway, okay. I think that I think that we’ve killed enough. I think we did good.

Jason: Yeah. It’s such a fascinating topic. I think I could literally talk all day about it.

Kathy: Yeah.

Jason: Mhm.

Kathy: We just did.

Jason: I did. I probably did. Yeah.

Kathy: That was excellent.

Jason: Cool.

Kathy: Yeah. Placebo is real.

[50:03] Jason: It is, people. And it’s okay. It’s okay. We love us a little bit of placebo. It’s good for you. It is the the original natural medicine.

Kathy: It is. So it’s a big deal. Well, are we down to like the what have you learned today, the takeaways? You want to start?

Jason: Take us away, Kathy.

Kathy: Well, what did I learn from you today?

[50:34] Jason: Yeah, this is usually the quickest part. Yeah,

Kathy: I did.

Jason: I didn’t learn anything.

Kathy: I did learn that I have the spine of an 80-year-old. No. I did learn that people that are more positive will be more susceptible to the placebo effect. So positive thinking leads to positive results.

Jason: Yeah. And it’s kind of interesting because culturally we would say that

[51:04] somebody who’s more susceptible to placebo is an idiot, right? That’s somebody who’s weak. Yeah, or somebody who — but no, that is somebody who is more receptive to treatment. They’re probably going to be stronger,

Kathy: healthier, happier,

Jason: right, able to bounce back from things. They have less pain. And so being susceptible to placebo is actually I think kind of a gift.

Kathy: Yeah, somebody who has hope, right?

Jason: Yes. And then one of my takeaways, just in kind of reviewing and preparing for this, it was just — man, it just, this is going to

[51:35] Kathy: Sound weird maybe, but it just filled me with gratitude, actually. Like, it’s like, how weird is some of this stuff, right? And I’m so grateful for a body that is so freaking amazing. Like, stuff where it’s like, I can’t even trick it with my conscious mind into not taking care of itself, not trying to overcome some of these natural obstacles. Like, I think the human body, 90% of the time, is just miraculous.

[52:05] Jason: Really is. That other 10% of the time, like, what are you doing? Kathy: Be a disaster? Jason: No, but it’s pretty amazing. So, it was a good, good reminder of that. So, do we have any other reminders that we want to give people? Kathy: Let’s think about — what’s the last episode that we just did? Jason: Oh, yeah. What was it? That was the balance and falls. Kathy: Yes. Jason: So, you know, we talked about preventing Kathy: Mhm. Jason: falls and how you train your

[52:35] balance. So yes, make sure you go back and listen to that episode if you didn’t listen to it. Kathy: Listen to that episode, all the episodes before it, and then go back and listen to them all again. Jason: And then repeat this one three times. Kathy: Now, and as always, definitely remember to like and subscribe. You know what I hear is that if you hit that subscribe button, it actually decreases your pain intensity. Jason: Yeah. Kathy: And it helps to regulate your blood sugar. And this is not medical advice. Jason: And blood pressure — Kathy: and the blood pressure and — yeah.

[53:07] And it’s free. Jason: Yep. Kathy: Yeah. So, yeah, it’s fine. And all that is placebo. Jason: Laughter is the best. That’s what — that’s Scott’s takeaway. Laughter is the best medicine. Kathy: Yes. And since we lean heavily on it, we’re the best doctors. Jason: That’s right. So — oh, and there’s I think one more thing that we should remind everybody, and that’s that there’s no “I” in PTCH.