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This is a remarkable little pill.

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It comes in all shapes and sizes.

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It can relieve pain,

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treat depression,

5
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and has even helped ease the
symptoms of Parkinson's Disease.

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And yet, it isn't a wonder drug.

7
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In fact, there isn't anything in it.

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As a scientist, it's unbelievable!

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These pills are placebos.

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Dummy pills. Sugar pills.

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I'm thinking, "He wants me to take
sugar pills?

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"This isn't going to work."

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But the latest research is starting
to show why placebos do work.

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And how you could make
the most of them.

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At the home of British cycling,
at the Manchester velodrome,

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some of the country's top cyclists
have gathered together.

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They're elite.

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Many are national champions,
past or present.

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They've been brought together
by Dr Chris Beedie.

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He wants to see if he can give them
some pills to help them

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do something that would normally
take months of training.

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He wants to see if he can make them
cycle faster than ever before.

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We're going to get all the riders
onto the track

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to do a sprint time trial,
to get an idea from that

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of their baseline speed,

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and then four hours later we're
going to give them a couple of these.

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And we're expecting them to have
an effect on their performance.

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The cyclists have been invited to
take part in an experiment

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looking at the effect of legal
performance-enhancing supplements.

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We're looking at testing a new
ergogenic aid.

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Half of you will be getting what
we'd call a standard ergogenic aid,

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which is caffeine.

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The other half will be getting
caffeine,

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with some nitrate and some
bicarbonate in those capsules.

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And we're expecting that to do
slightly better.

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So to evaluate this we need two
time trials from you,

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absolutely 100%,

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absolutely everything you've got
in both time trials.

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The cyclists' baseline performance
is measured

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to get a sense of their natural
competitive time.

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And then - it's time for the pills.

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OK, we've got the baseline
performance,

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we now are going to give them some of
these and see what effect these have.

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One by one, the cyclists receive
their performance-enhancing capsules

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from members of Chris' team.

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Hi, Lisa, you've been randomised
today to receive the caffeine.

47
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Today you've been randomised to take
the mixed supplement.

48
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Hannah, today you've been randomised
to receive the pure caffeine.

49
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Today you've been randomised to
receive the new supplement.

50
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But nothing about today is
quite as it seems.

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Both sets of pills are exactly
the same.

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The cyclists are actually taking
part in a very different experiment.

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These are the capsules we're
going to be using today.

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We've got a couple of red ones
and a couple of red and white ones.

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They're fairly large and they
look like they mean business.

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They are, however,
filled with cornflour.

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Chris wants to see if the cornflour
can improve the cyclists' times,

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even though they already do all
they can to be as fast as possible.

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But, having raced just a couple
of hours ago, the riders are tired.

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The thought of doing two in one day,
it would never happen.

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You'd normally sort of race one,

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and then a day or so, you'd start
again... Two in one day's going to
be interesting!

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It's fair to expect that their
second race of the day would
be slower.

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It's time to see what
the pills can do.

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Do you feel that the second ride
felt easier?

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The first one, it got progressively
harder during the ride.

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The second ride, after about a lap
and a half out of the four laps,

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it kind of got to a point
where it was hurting
but then it never got any worse.

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The second ride felt better, yes.

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I went half a second quicker, which
is quite a lot over that distance.

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I felt as if I was a little bit
quicker second time round.

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I felt really tired
before I took it.

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I think it may have started to
kick in whilst I was warming up

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and I got a bit of a burst of energy
and I felt ready to go again.

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In spite of the fact that the riders
were tired from their earlier race,

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analysis of today's times
shows that more than half of them

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were quicker with the cornflour.

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The placebo has even helped
one cyclist

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to ride faster than ever before.

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It was really good,

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really surprised to go quicker
in the second run.

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And a personal best as well
by two tenths of a second,

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and to beat a couple of the lads that
are here today that normally beat me,

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big surprise, yeah, really happy.

85
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So, you did a PB, you felt
the effects of the substance. Yeah.

86
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Um, the capsule we gave you
was a placebo.

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Oh, right, OK.

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Really?
SHE LAUGHS

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Really? Wow.

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Today's trial is just
a demonstration
of what placebos can do.

91
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But it's typical
of what Dr Beedie has found

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in over a decade of experiments
with hundreds of athletes.

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Every study we've done
we found a mean placebo effect.

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In sports performance generally,

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we can see improvements quite
frequently of two to three per cent.

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Well, three per cent in many sports
is probably the difference between

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first place in the Olympics
and not being in the top ten.

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So we're talking
quite a substantial difference.

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It's a little bit like
your car's going a little bit faster

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but you're not using
any more petrol.

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Why that's happening, however,
is still open to question.

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It seems the pills
that the cyclists took

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have the potential to make
a real difference -

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and it's clearly nothing to do
with the cornflour in them.

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So how can a pill with nothing in it

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help someone to cycle
faster than ever before?

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Since the advent of modern medicine,

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placebos have been treated
with scepticism.

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It's been assumed
that they can do nothing.

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They've been used
only as dummy pills

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that new drugs have to beat
to be considered effective.

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But in recent years
a number of studies have shown

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that there may be more
to a placebo than we thought.

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A few years ago,

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Dr David Kallmes decided to do
a rather controversial experiment.

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For 15 years, he's been fixing
broken backs by injecting them

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with a special kind
of surgical cement.

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We saw terrific results
from the procedure,

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really amazing results
from the procedure.

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But then Dr Kallmes noticed
something

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that made him question
how effective the procedure was.

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I was aware of some rare cases
where, believe it or not,

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the wrong vertebral body was treated,
for whatever reason,

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and patients seemed to get
some relief from that.

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So there was some reason to suspect
that there were numerous factors

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at play in the apparent effectiveness
of the cement.

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He decided to do something unusual.

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He decided to put this established
procedure to the test.

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He designed a trial in which
some patients would be given

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the real procedure...

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and some would be given a placebo.

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But in this case, the placebo
couldn't be a dummy pill -

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it would have to be
a fake operation.

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There was scepticism
from many people

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about whether this was worth doing.

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I recall being at a meeting
and I remember being screamed at

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and then later on being called
a heretic for raising the spectre

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of the placebo effect
in interventional procedures.

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Nevertheless
he went ahead with the trial.

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All he needed was to recruit
some patients.

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A few years ago,
Bonnie Anderson had an accident

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that led her to join the trial.

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Well, when I slipped on
the tiled floor in the kitchen here,

144
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I went complete...
feet went out from underneath me,

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I went flat on my back.
I could not move.

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And I thought, oh, dear,
I told Don, I said,

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"I'm afraid I broke my back."
The pain was just very, very severe.

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I couldn't stand up straight,
I'd have to hold onto something.

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She was in pain all the time,
she could do very little.

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I'd help him with the dishes,

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but he did all the vacuuming,
he did more of the workload.

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That part hasn't really changed
that much! Oh, shut up!

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When Bonnie saw the doctor,
a vertebral fracture was confirmed.

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She was enrolled on the trial.

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On a cold October morning,
Bonnie arrived at the hospital,

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ready for her operation.

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She couldn't know whether
she was having a vertebroplasty

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or the pretend procedure -
the placebo.

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Dr Kallmes developed
an elaborate ruse

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to ensure that patients wouldn't
work out which group they were in.

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The patient was brought into the
room, was given medication by vein,

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was sterilely prepped
and local anaesthesia was given.

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And only after the anaesthesia
was given onto the bone

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did we press the button to see
whether the patient was randomised

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to the full vertebroplasty
or to the placebo.

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In both cases, no matter
how they were randomised,

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we then opened the cement,
which has a very strong odour
like nail polish remover,

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to really simulate it
for everybody in the room.

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And if they were randomised
to vertebroplasty,

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we then injected cement
down into the bone.

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If they were randomised to placebo...

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..we opened the cement,

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we had a script that we followed...

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..we pressed on the back and said,

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"OK, ma'am, the cement is going
in now, everything's going fine,

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"things are going well, few more
minutes here. OK, we're all done."

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So we really simulated the procedure
for the patient.

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Bonnie felt better immediately.

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The surgery did work
very, very well for me.

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It did so much for me.
I was really active.

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The procedure transformed her life.

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Within a week of the injection,
I was able to play golf.

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I took it a little easy, but I was
able to play golf almost every day.

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And I returned to some of my duties,
as far as...

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Well, I don't vacuum,
but as far as dishes and stuff.

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He won't say that, but it's true.

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But Bonnie didn't have
the real procedure.

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She was in the placebo group.

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And what made her so interesting

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was that she'd already had
a real vertebroplasty once before.

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Which meant she was uniquely able

192
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to compare the real thing
with the placebo.

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I thought they were both
so successful

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that I could go ahead and do what
I wanted to do without any problem.

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And it wasn't just Bonnie that
responded so well to the placebo.

196
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When the results of the other
130 patients on the trial came in,

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they surprised everyone.

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There was no statistically
significant difference

199
00:14:57,080 --> 00:14:59,040
in degree of pain relief

200
00:14:59,040 --> 00:15:03,120
between the patients who underwent
vertebroplasty and placebo,

201
00:15:03,120 --> 00:15:07,800
and more importantly there was no
statistically significant difference

202
00:15:07,800 --> 00:15:10,360
in improvement in function

203
00:15:10,360 --> 00:15:14,080
between the patients who underwent
vertebroplasty and placebo.

204
00:15:17,760 --> 00:15:21,440
This study and another in Australia
both suggest

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that a pretend procedure can be
as effective as vertebroplasty -

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00:15:26,600 --> 00:15:29,520
which has been carried out
on over a million people.

207
00:15:31,640 --> 00:15:35,800
Both the real thing and the placebo
made patients better

208
00:15:35,800 --> 00:15:37,960
than if they'd received
no treatment.

209
00:15:39,280 --> 00:15:43,160
So how could a pretend procedure
be so effective?

210
00:15:49,240 --> 00:15:54,360
Around the world, scientists are
investigating how a placebo works.

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00:15:55,760 --> 00:16:00,400
They're trying to find out what's
happening inside your body and brain

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00:16:00,400 --> 00:16:03,080
when you experience
a placebo effect.

213
00:16:22,520 --> 00:16:25,520
It's a public holiday
in the Italian Alps.

214
00:16:25,520 --> 00:16:27,400
Tourists are heading up the mountain

215
00:16:27,400 --> 00:16:30,800
to spend a day skiing
in the shadow of the Matterhorn.

216
00:16:34,760 --> 00:16:39,280
But, for Fabrizio Benedetti,
it's just another day in the office.

217
00:16:42,640 --> 00:16:46,520
Instead of driving to the lab,

218
00:16:46,520 --> 00:16:50,800
instead of taking a bus or a train,
we take a cable car.

219
00:16:50,800 --> 00:16:55,000
# On days like these

220
00:16:55,000 --> 00:16:57,400
# When skies are blue... #

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00:16:57,400 --> 00:17:01,240
The landscape is beautiful,
it's a beautiful day.

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00:17:05,640 --> 00:17:09,240
But Fabrizio's laboratory
isn't at the top of the mountain

223
00:17:09,240 --> 00:17:11,480
just for the sake
of a pleasant commute.

224
00:17:14,520 --> 00:17:17,840
He's using the low oxygen levels
at high altitude

225
00:17:17,840 --> 00:17:21,480
to conduct an unusual experiment.

226
00:17:21,480 --> 00:17:25,840
He's trying to find out whether
a placebo effect is imagined,

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00:17:25,840 --> 00:17:31,000
or whether somehow a placebo can
cause real changes in our bodies.

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00:17:32,800 --> 00:17:35,520
OK, so here we are
inside the station.

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00:17:35,520 --> 00:17:37,720
There are a couple of labs.

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00:17:37,720 --> 00:17:41,760
We have a living area, we have two
bedrooms, the kitchen, the bathroom.

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00:17:41,760 --> 00:17:45,360
Italian-Swiss border
is more or less here.

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00:17:45,360 --> 00:17:47,680
We work in Switzerland,
we sleep in Italy.

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For the past few years, Fabrizio
has been bringing volunteers,

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00:17:53,160 --> 00:17:57,640
like Marco, to his mountain-top
laboratory to be studied.

235
00:17:57,640 --> 00:18:02,200
He's conducting an experiment to see
if anything happens to people

236
00:18:02,200 --> 00:18:07,600
when they expect extra oxygen,
but don't actually get it.

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00:18:07,600 --> 00:18:13,000
So what we do is we give
real oxygen or placebo oxygen -

238
00:18:13,000 --> 00:18:15,840
the tank of the oxygen is empty -

239
00:18:15,840 --> 00:18:20,280
and we compare the effect of
real oxygen with placebo oxygen.

240
00:18:23,840 --> 00:18:28,520
Fabrizio gives Marco a canister
of what he's told is oxygen,

241
00:18:28,520 --> 00:18:30,920
and sets him off
on a 30-minute hike.

242
00:18:38,320 --> 00:18:43,320
Even mild exercise,
that's pretty tiring and difficult.

243
00:18:45,160 --> 00:18:47,600
That's the reason
why we are here, of course.

244
00:18:50,200 --> 00:18:53,080
Fabrizio wants to know
as much as possible

245
00:18:53,080 --> 00:18:56,920
about what's going on
inside Marco's body and brain.

246
00:18:56,920 --> 00:18:59,600
His heart rate, brain activity,

247
00:18:59,600 --> 00:19:04,760
and even the neurotransmitters in
his system, are all being monitored.

248
00:19:04,760 --> 00:19:09,280
At this altitude,
extra oxygen would be a great help.

249
00:19:09,280 --> 00:19:14,600
If there is extra oxygen, of course,
the muscles get more oxygen

250
00:19:14,600 --> 00:19:16,680
so their performance improves.

251
00:19:29,400 --> 00:19:30,680
As they hike further,

252
00:19:30,680 --> 00:19:35,120
Marco is easily able to outpace
Fabrizio's team of scientists.

253
00:19:38,360 --> 00:19:41,680
You can see I cannot see him
any more, actually.

254
00:19:44,080 --> 00:19:47,120
But, of course, Marco doesn't have
any extra oxygen.

255
00:19:49,800 --> 00:19:52,680
So, has the fake oxygen
just given him

256
00:19:52,680 --> 00:19:54,760
some kind of psychological boost?

257
00:19:57,520 --> 00:20:00,080
Or has it changed
something in his body?

258
00:20:02,760 --> 00:20:04,920
By analysing the data he's gathered

259
00:20:04,920 --> 00:20:07,640
from Marco and the other
subjects he's studied,

260
00:20:07,640 --> 00:20:09,680
Fabrizio has the answer.

261
00:20:13,000 --> 00:20:17,880
It's all to do with the level
of a neurotransmitter called PGE2.

262
00:20:21,120 --> 00:20:22,880
When we come to high altitude,

263
00:20:22,880 --> 00:20:27,080
the low oxygen levels cause
our blood oxygen levels to fall.

264
00:20:27,080 --> 00:20:30,640
This makes our PGE2 levels go up.

265
00:20:31,800 --> 00:20:34,680
And that leads us to feel some of
the familiar symptoms

266
00:20:34,680 --> 00:20:36,880
of altitude sickness, like pain.

267
00:20:39,120 --> 00:20:42,760
But extra oxygen can ease
the problems.

268
00:20:42,760 --> 00:20:47,840
When we give oxygen, there is
a dramatic decrease in PGE2.

269
00:20:47,840 --> 00:20:49,880
This is the typical response

270
00:20:49,880 --> 00:20:53,160
after oxygen administration
with real oxygen.

271
00:20:54,840 --> 00:20:58,600
The lower PGE2 level
that comes from giving oxygen

272
00:20:58,600 --> 00:21:03,080
helps us to feel less pain,
and therefore work harder.

273
00:21:03,080 --> 00:21:06,000
But if you give someone fake oxygen

274
00:21:06,000 --> 00:21:09,480
you wouldn't expect
the PGE2 levels to change.

275
00:21:11,600 --> 00:21:15,480
In this case we give fake oxygen,
which means placebo oxygen,

276
00:21:15,480 --> 00:21:19,320
and there's no change in blood
oxygen saturation, you see -

277
00:21:19,320 --> 00:21:23,560
we have 84% of blood oxygen
saturation -

278
00:21:23,560 --> 00:21:26,440
but there's a decrease
in PGE2 anyway.

279
00:21:28,880 --> 00:21:35,000
This means that this decrease is not
due to oxygen in the body,

280
00:21:35,000 --> 00:21:37,920
but is due to expectation,
to a placebo effect.

281
00:21:46,160 --> 00:21:49,920
The fake oxygen is causing
real physiological changes

282
00:21:49,920 --> 00:21:51,840
in Fabrizio's subjects -

283
00:21:51,840 --> 00:21:55,280
decreasing their levels of PGE2,

284
00:21:55,280 --> 00:22:00,000
causing them to feel less pain,
and allowing them to work harder.

285
00:22:00,000 --> 00:22:04,560
It's not imagination, it's not
pure psychological effect,

286
00:22:04,560 --> 00:22:07,480
it's a real neurobiological effect.

287
00:22:09,520 --> 00:22:13,000
Somehow, fake oxygen is producing

288
00:22:13,000 --> 00:22:15,880
real chemical changes
in people's bodies.

289
00:22:17,440 --> 00:22:20,280
It shows us just how real
and measurable

290
00:22:20,280 --> 00:22:22,080
the placebo effect can be.

291
00:22:23,320 --> 00:22:27,360
What it doesn't tell us
is how that's happening.

292
00:22:37,960 --> 00:22:41,800
Boulder, Colorado...in the foothills
of the Rocky Mountains.

293
00:22:44,480 --> 00:22:46,640
Tor Wager is trying to figure out

294
00:22:46,640 --> 00:22:49,840
how a placebo can change
the chemicals in our bodies.

295
00:22:51,760 --> 00:22:56,000
He's getting ready for another day
inflicting mild torture on someone.

296
00:22:59,640 --> 00:23:02,840
We do the thermal pain test a lot
because it's not damaging

297
00:23:02,840 --> 00:23:04,960
and it's safe, but it is painful.

298
00:23:07,960 --> 00:23:11,240
Right, Jake, come on in,
you can have a seat right here.

299
00:23:11,240 --> 00:23:13,960
Tor is hoping to fool Jake
into believing

300
00:23:13,960 --> 00:23:18,360
that a standard moisturiser is
a powerful pain relief cream.

301
00:23:20,080 --> 00:23:23,240
He begins by applying
some moisturiser to Jake's arm,

302
00:23:23,240 --> 00:23:25,480
and tells him what it is.

303
00:23:25,480 --> 00:23:27,920
This is just to have
something on your skin.

304
00:23:27,920 --> 00:23:32,360
It won't provide any pain relief,
and will serve as a control.

305
00:23:32,360 --> 00:23:33,600
OK.

306
00:23:33,600 --> 00:23:36,400
On a different spot,
he applies some lidocaine -

307
00:23:36,400 --> 00:23:41,040
a local anaesthetic - which will
dampen the pain that Jake feels.

308
00:23:41,040 --> 00:23:44,680
We already know that it blocks pain,
but we're just going to look

309
00:23:44,680 --> 00:23:48,320
and see whether it changes
pain in your brain. OK.

310
00:23:48,320 --> 00:23:51,800
And finally,
there's more moisturiser.

311
00:23:51,800 --> 00:23:54,720
But Jake is told that it's also
a local anaesthetic.

312
00:23:59,200 --> 00:24:02,240
We'll do the analgesic
on both of these spots.

313
00:24:07,480 --> 00:24:10,400
We'll just wait just a minute
for that to take effect.

314
00:24:11,640 --> 00:24:15,640
Jake will then be subjected to
heat pain on the different sites

315
00:24:15,640 --> 00:24:17,840
and be asked to rate them.

316
00:24:17,840 --> 00:24:20,080
Meanwhile his brain will be scanned,

317
00:24:20,080 --> 00:24:24,080
allowing Tor to learn
more about how a placebo works.

318
00:24:24,080 --> 00:24:28,000
So we're going to give you a series
of your level 8 temperatures, Jake.

319
00:24:28,000 --> 00:24:30,880
And just use the trackball there,
and just rate what you feel,

320
00:24:30,880 --> 00:24:33,200
moment by moment,
track your pain continuously.

321
00:24:33,200 --> 00:24:34,720
OK, so we're ready to go in.

322
00:24:44,680 --> 00:24:48,400
This is the pain rating scale,
he's rating his pain continuously,

323
00:24:48,400 --> 00:24:53,680
and the anchors here are no sensation
to strongest imaginable sensation.

324
00:24:53,680 --> 00:24:57,160
Jake's first heat treatment
is on the control area.

325
00:24:57,160 --> 00:24:59,120
All right, Jake, we've got it tuned

326
00:24:59,120 --> 00:25:01,760
and ready to go
for the first task here, OK?

327
00:25:03,160 --> 00:25:06,640
With no anaesthetic,
it's not a pleasant experience.

328
00:25:06,640 --> 00:25:08,640
It's going up

329
00:25:08,640 --> 00:25:12,120
and it's just above very strong.

330
00:25:12,120 --> 00:25:13,760
Oh, that's big, that's good!

331
00:25:13,760 --> 00:25:17,360
That was the control,
this is with the lidocaine,

332
00:25:17,360 --> 00:25:19,800
just rate what you feel,
we'll be scanning.

333
00:25:22,440 --> 00:25:26,320
On the lidocaine site,
the pain is noticeably reduced.

334
00:25:28,640 --> 00:25:31,840
So with the control cream,
they were between very strong

335
00:25:31,840 --> 00:25:35,280
and strongest imaginable,
so they were pretty high.

336
00:25:35,280 --> 00:25:37,080
And with the actual lidocaine cream

337
00:25:37,080 --> 00:25:39,120
they were between strong
and very strong,

338
00:25:39,120 --> 00:25:40,800
so there was a substantial drop.

339
00:25:40,800 --> 00:25:43,400
But how will Jake fare
when the same heat is applied

340
00:25:43,400 --> 00:25:46,640
on the moisturiser
that Tor has said is lidocaine?

341
00:25:46,640 --> 00:25:48,280
Last one, lidocaine number 2.

342
00:25:51,360 --> 00:25:54,480
When he felt this temperature
on the control area,

343
00:25:54,480 --> 00:25:58,440
he rated his pain above very strong.

344
00:25:58,440 --> 00:25:59,760
Let's see what happens.

345
00:26:11,160 --> 00:26:13,680
Oh, this one is
the lowest so far actually,

346
00:26:13,680 --> 00:26:17,520
so that trial is lower than any
of his lidocaine trials actually.

347
00:26:18,960 --> 00:26:22,480
The basic conclusion is that here
the placebo response for him

348
00:26:22,480 --> 00:26:25,120
is about as large
as the lidocaine responses.

349
00:26:26,640 --> 00:26:29,880
OK, Jake...
so how did that feel, by the way?

350
00:26:29,880 --> 00:26:32,640
Feels less painful.
Feels less painful? Yeah.

351
00:26:34,600 --> 00:26:39,400
So I told you before that we were
applying the real lidocaine
on all four sites, right?

352
00:26:39,400 --> 00:26:42,720
But actually we didn't apply
the lidocaine on all the sites.

353
00:26:43,920 --> 00:26:46,960
So what we actually did is
we applied the control here,

354
00:26:46,960 --> 00:26:49,360
so this is where your pain ratings
were highest.

355
00:26:49,360 --> 00:26:52,160
These two were both
the real lidocaine,

356
00:26:52,160 --> 00:26:54,720
and these two were the placebo.
Interesting.

357
00:26:54,720 --> 00:26:57,120
So, knowing that,
do you feel like it worked?

358
00:26:57,120 --> 00:26:59,040
Or do you feel like, um...

359
00:26:59,040 --> 00:27:02,520
The lidocaine or the placebo?
The placebo. Definitely, yes!

360
00:27:05,000 --> 00:27:07,440
The significance of Tor's work

361
00:27:07,440 --> 00:27:10,960
is that by scanning the brains
of people as they experience

362
00:27:10,960 --> 00:27:17,480
a placebo effect, he's revealed
clues about how a placebo works.

363
00:27:17,480 --> 00:27:22,520
So when we've given people a placebo
treatment, what we see is the release

364
00:27:22,520 --> 00:27:26,560
of endogenous opioids,
which is the brain's own morphine,

365
00:27:26,560 --> 00:27:28,200
in a number of brain areas

366
00:27:28,200 --> 00:27:31,080
including this area here
which is the periaqueductal grey,

367
00:27:31,080 --> 00:27:35,720
which is really a critical site
for opioid-mediated pain control.

368
00:27:40,600 --> 00:27:43,720
What that means is
that the placebo effect

369
00:27:43,720 --> 00:27:47,400
is tapping into some of
the same pain control circuitry

370
00:27:47,400 --> 00:27:49,640
as opiate drugs, like morphine.

371
00:27:52,400 --> 00:27:54,040
What Tor has shown

372
00:27:54,040 --> 00:27:58,000
goes to the heart of the mechanism
of how a placebo works.

373
00:27:58,000 --> 00:28:02,520
A dummy pill or cream
or surgery can release

374
00:28:02,520 --> 00:28:06,000
the naturally-occurring painkillers
in our brains.

375
00:28:07,800 --> 00:28:11,560
And it isn't just painkillers
that a placebo can activate.

376
00:28:16,760 --> 00:28:21,200
Our brains are capable of producing
countless chemicals that we need -

377
00:28:21,200 --> 00:28:23,680
to stop pain or to feel it,

378
00:28:23,680 --> 00:28:27,000
to energise us
or to help us sleep.

379
00:28:29,480 --> 00:28:34,600
And a placebo can mimic many
of them - from aspirin to alcohol.

380
00:28:36,800 --> 00:28:39,680
The placebo effect
taps into our natural pharmacy.

381
00:28:40,920 --> 00:28:43,800
Drugs work because we have
receptors for the drugs,

382
00:28:43,800 --> 00:28:46,640
and that means that there's
some endogenous chemicals

383
00:28:46,640 --> 00:28:49,480
that our brains are producing
that act on those receptors -

384
00:28:49,480 --> 00:28:54,120
the receptors evolved to respond
to those natural chemicals.

385
00:28:55,440 --> 00:28:58,120
So, a placebo can produce
real results

386
00:28:58,120 --> 00:29:02,600
by tapping into the chemical systems
that our bodies have evolved.

387
00:29:04,280 --> 00:29:09,240
Just like modern medicines, a
placebo effect relies on chemicals -

388
00:29:09,240 --> 00:29:11,800
the chemicals in our brains.

389
00:29:20,320 --> 00:29:24,360
Scientists want to know just
how much a simple sugar pill can do.

390
00:29:26,000 --> 00:29:30,080
Can it only affect conditions
which rely on self-reporting -

391
00:29:30,080 --> 00:29:34,240
like pain -
or could it do much more?

392
00:29:49,320 --> 00:29:53,040
Paul Pattison
lives on the outskirts of Vancouver.

393
00:29:53,040 --> 00:29:55,880
It gives him easy access
to the woods and mountains

394
00:29:55,880 --> 00:29:57,680
on the edge of the city.

395
00:29:57,680 --> 00:30:01,960
But 12 years ago
life took a turn for the worse,

396
00:30:01,960 --> 00:30:05,800
when he started to develop
some unsettling symptoms.

397
00:30:06,920 --> 00:30:09,840
I started to notice I was not...
my stride wasn't right,

398
00:30:09,840 --> 00:30:13,760
and I-I-I...my doctor referred me
to a podiatrist,

399
00:30:13,760 --> 00:30:16,440
thinking something was wrong with
my ankle, my foot, whatever.

400
00:30:20,000 --> 00:30:23,120
So the podiatrist had me in there
a couple of weeks later and he goes,

401
00:30:23,120 --> 00:30:26,320
"Oh, my gosh, you don't need a
podiatrist, you need a neurologist."

402
00:30:27,360 --> 00:30:30,400
So I went back to my GP,
got referred to a neurologist

403
00:30:30,400 --> 00:30:35,680
and he took one look at me and said,
"OK, you have Parkinson's."

404
00:30:37,320 --> 00:30:39,560
Well, holy smoke! That was...

405
00:30:39,560 --> 00:30:42,280
that was quite traumatic,
I was in tears for sure.

406
00:30:45,520 --> 00:30:48,880
It came as a complete shock
to Paul and his family,

407
00:30:48,880 --> 00:30:51,880
and eventually forced him
to give up his job.

408
00:30:54,840 --> 00:30:59,640
Parkinson's is caused by
an inability of the brain
to release dopamine.

409
00:31:00,800 --> 00:31:02,800
As well as affecting our mood,

410
00:31:02,800 --> 00:31:05,160
dopamine helps
to regulate our movement.

411
00:31:06,600 --> 00:31:09,840
With medication,
Paul can get the dopamine he needs

412
00:31:09,840 --> 00:31:12,040
to keep his symptoms under control.

413
00:31:13,280 --> 00:31:17,800
So I take Sinemet CR,
control release, is the pink one.

414
00:31:17,800 --> 00:31:22,280
And the two white ones are
2.5mg each of Bromocriptine

415
00:31:22,280 --> 00:31:26,280
and as you see, I'm upright,
I'm mobile, my shoulders are back.

416
00:31:31,000 --> 00:31:35,080
A few years ago, Parkinson's
researcher Professor Jon Stoessl

417
00:31:35,080 --> 00:31:39,080
decided to test this effective
medication against a placebo.

418
00:31:41,000 --> 00:31:42,200
We've always known

419
00:31:42,200 --> 00:31:47,800
that how people do when they have
a serious condition

420
00:31:47,800 --> 00:31:50,240
has a lot to do with their attitude

421
00:31:50,240 --> 00:31:52,480
and that's intriguing to me.

422
00:31:53,880 --> 00:31:56,960
Paul was recruited onto Jon's trial.

423
00:31:56,960 --> 00:32:01,000
It would require him
to stop taking his medication.

424
00:32:01,000 --> 00:32:04,040
Without it,
even walking can be difficult.

425
00:32:05,480 --> 00:32:11,080
About a year and a half ago, I guess,
I was about 50 feet from my house,

426
00:32:11,080 --> 00:32:13,680
I could literally see the front door.

427
00:32:13,680 --> 00:32:17,480
I was sitting on the sidewalk,
on the kerb, and I couldn't get home.

428
00:32:18,560 --> 00:32:20,920
That was...that was something else.

429
00:32:22,120 --> 00:32:26,160
Took me about a half-hour
to get home...from a hundred feet.

430
00:32:26,160 --> 00:32:27,400
Yeah.

431
00:32:34,560 --> 00:32:37,280
Paul headed into hospital
for the trial,

432
00:32:37,280 --> 00:32:39,640
without having had his medication,

433
00:32:39,640 --> 00:32:42,480
his Parkinson's symptoms
in full flare-up.

434
00:32:43,880 --> 00:32:46,120
And that's when they gave me
this capsule.

435
00:32:48,000 --> 00:32:50,960
And they gave you a half-hour,
45 minutes, you know,

436
00:32:50,960 --> 00:32:53,720
a normal period of time
for the meds to kick in.

437
00:32:57,880 --> 00:33:00,720
And boom, I was thinking,
ah, this is pretty good.

438
00:33:00,720 --> 00:33:04,400
My body becomes erect,
my shoulders go back

439
00:33:04,400 --> 00:33:07,600
and I needed to go to the bathroom

440
00:33:07,600 --> 00:33:10,640
so I said, "I don't need any help,
I'm fine."

441
00:33:10,640 --> 00:33:14,960
And I heel-struck my way down
the hall and went to the bathroom.

442
00:33:16,600 --> 00:33:20,240
But Paul hadn't been given
any active medication.

443
00:33:20,240 --> 00:33:21,760
He'd been given a placebo.

444
00:33:26,320 --> 00:33:27,720
Well, I was shocked.

445
00:33:27,720 --> 00:33:29,840
There's no way
I could have done that.

446
00:33:29,840 --> 00:33:33,640
I fully understand the effects
of my medicine.

447
00:33:33,640 --> 00:33:37,280
So how could a nothing create
those same feelings?

448
00:33:38,680 --> 00:33:40,160
Yeah, I was really shocked.

449
00:33:44,520 --> 00:33:49,160
Brain scans of patients
with Parkinson's that were
responding to the placebo

450
00:33:49,160 --> 00:33:53,560
helped to explain
how Paul's symptoms had faded.

451
00:33:53,560 --> 00:33:59,600
This slide shows three scans
all taken from the same person

452
00:33:59,600 --> 00:34:01,880
with Parkinson's disease.

453
00:34:01,880 --> 00:34:04,760
So, now you see the activity
at baseline.

454
00:34:04,760 --> 00:34:07,160
When they come in
with no medication,

455
00:34:07,160 --> 00:34:10,640
their Parkinson's
is not well controlled,

456
00:34:10,640 --> 00:34:12,840
there's a loss of dopamine
in the brain,

457
00:34:12,840 --> 00:34:14,880
so we see lots of activity here.

458
00:34:16,080 --> 00:34:17,760
With so little dopamine,

459
00:34:17,760 --> 00:34:21,560
someone with Parkinson's would be
struggling to move and function.

460
00:34:22,680 --> 00:34:25,240
Now we look at the middle slide

461
00:34:25,240 --> 00:34:30,320
and this is after the person is told
that they're going to get

462
00:34:30,320 --> 00:34:33,960
active drug,
but in fact they receive placebo.

463
00:34:33,960 --> 00:34:38,280
And you can see a striking reduction
in activity here

464
00:34:38,280 --> 00:34:42,680
which indicates that their brains
have released a lot of dopamine.

465
00:34:44,200 --> 00:34:48,680
The intense red colours
in the striatum area of the brain

466
00:34:48,680 --> 00:34:51,720
show how little dopamine
is present at baseline.

467
00:34:53,040 --> 00:34:55,040
The decrease in the red colouring

468
00:34:55,040 --> 00:35:00,080
shows how the placebo can release
dopamine just like the real drugs.

469
00:35:04,280 --> 00:35:08,080
What we found is that, in somebody
with Parkinson's disease,

470
00:35:08,080 --> 00:35:13,560
a placebo can release as much
dopamine as amphetamine or speed can

471
00:35:13,560 --> 00:35:16,640
in somebody
with a healthy dopamine system.

472
00:35:16,640 --> 00:35:18,480
So it's a very dramatic response.

473
00:35:20,280 --> 00:35:24,080
There are physical things that
change in me when I take my meds

474
00:35:24,080 --> 00:35:28,080
and I didn't think a placebo
would be capable of, you know...

475
00:35:28,080 --> 00:35:31,600
There's no way - you know,
how could a sugar pill or whatever,

476
00:35:31,600 --> 00:35:34,480
you know, make me feel like
I had taken my Sinemet?

477
00:35:34,480 --> 00:35:36,920
I'm thrilled to death to know
that I still have the ability

478
00:35:36,920 --> 00:35:39,600
on a short-term basis to produce
dopamine and get going, right?

479
00:35:42,000 --> 00:35:45,640
Several studies have now shown
that a placebo can ease

480
00:35:45,640 --> 00:35:49,520
the symptoms of Parkinson's -
even if only in the short term.

481
00:35:50,720 --> 00:35:53,000
Once again, the placebo works

482
00:35:53,000 --> 00:35:55,840
by tapping into the brain's
internal pharmacy.

483
00:35:57,560 --> 00:36:00,800
All these studies raise another
intriguing question.

484
00:36:04,160 --> 00:36:09,120
For a placebo to work, why do we
need to believe that it's real?

485
00:36:20,200 --> 00:36:22,600
Pull your body into the rock,
that's nice.

486
00:36:24,240 --> 00:36:27,800
For Tor Wager,
it's all about our expectations.

487
00:36:31,880 --> 00:36:34,880
They can make a difference
to what happens in our bodies -

488
00:36:34,880 --> 00:36:37,520
and that's true
whether you take a pill,

489
00:36:37,520 --> 00:36:42,040
undergo an operation
or climb a mountain.

490
00:36:42,040 --> 00:36:44,360
Stand up on that back foot, Tor.

491
00:36:47,360 --> 00:36:50,680
Climbing is a dangerous sport.

492
00:36:50,680 --> 00:36:55,960
One false move, and things could go
badly wrong for Tor -

493
00:36:55,960 --> 00:36:58,360
except, of course,
that he's got a rope.

494
00:37:00,000 --> 00:37:02,240
And that changes everything.

495
00:37:02,240 --> 00:37:06,120
Going right. Watch me here. Good.

496
00:37:06,120 --> 00:37:08,240
He expects to be safe.

497
00:37:08,240 --> 00:37:10,600
Step through, beautiful, that's it.

498
00:37:12,000 --> 00:37:15,280
And yet, without his belief
that everything will be OK,

499
00:37:15,280 --> 00:37:17,880
he'd be so nervous
he could barely climb.

500
00:37:20,280 --> 00:37:23,440
When I was up there on the rock,
my heart started beating,

501
00:37:23,440 --> 00:37:27,200
blood flow changed to my fingers,
my brain's releasing opioids,

502
00:37:27,200 --> 00:37:30,560
releasing dopamine, and all those
things are helping me perform,

503
00:37:30,560 --> 00:37:33,720
and they're also having
various impacts on my body.

504
00:37:34,880 --> 00:37:38,600
Those impacts depend on the feeling,
the knowledge that I'm safe.

505
00:37:38,600 --> 00:37:41,640
Take off that rope, it would be
a completely different world -

506
00:37:41,640 --> 00:37:46,200
my heart rate would go crazy,
I'd be sweating, and so forth.

507
00:37:48,920 --> 00:37:53,840
Ultimately, it's about the link
between our minds and our bodies.

508
00:37:55,680 --> 00:38:00,160
Whether it's fear or hope,
our thoughts and expectations

509
00:38:00,160 --> 00:38:04,200
can trigger chemical reactions
that change our bodies.

510
00:38:06,720 --> 00:38:10,000
So, if we expect a placebo
to do something,

511
00:38:10,000 --> 00:38:15,160
it can release chemicals in our
brains and change our physiology.

512
00:38:19,440 --> 00:38:21,400
Scientists are now exploring

513
00:38:21,400 --> 00:38:24,120
just how much our expectations
are capable of.

514
00:38:25,320 --> 00:38:30,800
As well as pain, they've found that
placebos can alleviate conditions

515
00:38:30,800 --> 00:38:33,320
from depression to insomnia,

516
00:38:33,320 --> 00:38:36,080
nausea to attention-deficit
disorder.

517
00:38:38,760 --> 00:38:43,280
And because it's all about your
expectations, even the size

518
00:38:43,280 --> 00:38:47,040
and shape of a pill can make
a difference to how well it works.

519
00:38:48,360 --> 00:38:53,520
Studies have shown that capsules
are more effective than tablets.

520
00:38:54,640 --> 00:38:57,600
A large capsule is better
than a small capsule.

521
00:38:57,600 --> 00:39:02,680
Expensive medications are more
effective than cheap medications.

522
00:39:02,680 --> 00:39:04,920
Colour makes a difference -

523
00:39:04,920 --> 00:39:08,600
red pills are more effective
for treating pain,

524
00:39:08,600 --> 00:39:11,960
blue pills are more effective
for treating anxiety.

525
00:39:14,080 --> 00:39:16,520
Unless you happen to be male
and Italian,

526
00:39:16,520 --> 00:39:20,320
in which case blue is the colour
of your national football team,

527
00:39:20,320 --> 00:39:25,640
and a symbol of immense excitement,
passion, and heartache.

528
00:39:25,640 --> 00:39:28,080
In that case, according to research,

529
00:39:28,080 --> 00:39:32,160
a blue pill won't help relax you -
it will do the opposite.

530
00:39:34,920 --> 00:39:37,640
But there are clear limits
to what placebos can do.

531
00:39:38,840 --> 00:39:43,120
They certainly won't fix a broken
leg or help to shrink a tumour.

532
00:39:44,360 --> 00:39:46,840
But in the areas
where they seem effective,

533
00:39:46,840 --> 00:39:51,840
scientists are beginning to wonder
how we can make the most of them.

534
00:40:01,200 --> 00:40:05,680
There is, however, a problem with
dummy pills and sham surgeries.

535
00:40:05,680 --> 00:40:07,520
They rely on deception.

536
00:40:08,720 --> 00:40:11,240
You're not told the truth.

537
00:40:11,240 --> 00:40:15,800
That seems to be why they work -
because you think they're real.

538
00:40:16,920 --> 00:40:20,520
Obviously doctors don't want
to lie to their patients.

539
00:40:20,520 --> 00:40:25,160
So how do we harness the power
of the placebo effect without lying?

540
00:40:30,000 --> 00:40:35,720
It's a question that one of
the most prestigious medical schools
in the world is hoping to answer.

541
00:40:37,360 --> 00:40:42,840
In 2010, Harvard established
a Program in Placebo Studies.

542
00:40:42,840 --> 00:40:47,480
It aims to work out how we can use
the placebo effect

543
00:40:47,480 --> 00:40:49,160
to make people better.

544
00:40:49,160 --> 00:40:52,000
Ted Kaptchuk is the Director.

545
00:40:52,000 --> 00:40:53,440
In the last 15-20 years,

546
00:40:53,440 --> 00:40:56,520
there's been an explosion of
research in placebo studies.

547
00:40:56,520 --> 00:40:59,440
We've learnt so much,
but there's so much more to do.

548
00:41:01,320 --> 00:41:05,280
The underlying goal is how do
we learn to harness it and use it

549
00:41:05,280 --> 00:41:08,640
to help people get better,
healthier and stronger lives?

550
00:41:10,560 --> 00:41:13,240
Recently, Ted decided to challenge

551
00:41:13,240 --> 00:41:16,320
one of the most basic assumptions
about placebos.

552
00:41:16,320 --> 00:41:19,400
He decided to conduct
an experiment to see

553
00:41:19,400 --> 00:41:24,080
whether we really need to be duped
for a placebo to work.

554
00:41:24,080 --> 00:41:27,720
The conventional wisdom was that
you have to use either deception

555
00:41:27,720 --> 00:41:30,960
or concealment in order
for a placebo to work.

556
00:41:30,960 --> 00:41:35,440
We decided to test whether or not
you could still get a placebo effect

557
00:41:35,440 --> 00:41:38,680
if you gave a person a placebo
and told them it was a placebo.

558
00:41:40,160 --> 00:41:45,680
Linda Buonanno has suffered
from irritable bowel syndrome
for 16 years.

559
00:41:45,680 --> 00:41:48,440
At times,
the symptoms are bad enough

560
00:41:48,440 --> 00:41:50,880
that she doesn't want to leave home.

561
00:41:50,880 --> 00:41:53,360
Along with 80 other
sufferers of IBS,

562
00:41:53,360 --> 00:41:56,760
she was recruited onto Ted's trial.

563
00:41:56,760 --> 00:42:00,640
She was given some pills
and told they were a placebo,

564
00:42:00,640 --> 00:42:03,080
with no active ingredient,

565
00:42:03,080 --> 00:42:08,760
but that they might work, thanks to
her own self-healing processes.

566
00:42:08,760 --> 00:42:10,320
I said, "What? A placebo?"

567
00:42:10,320 --> 00:42:13,440
Because I'd just finished college
as a medical assistant

568
00:42:13,440 --> 00:42:16,880
and I'm thinking,
"He wants me to take sugar pills?

569
00:42:16,880 --> 00:42:18,360
"This isn't going to work."

570
00:42:18,360 --> 00:42:22,160
But I said I'd do it, so I went home,
I started taking 'em...

571
00:42:33,160 --> 00:42:37,320
..and after three days I realised
I wasn't in any pain any more.

572
00:42:39,440 --> 00:42:41,480
I didn't have any intestinal pain,

573
00:42:41,480 --> 00:42:45,920
I didn't keep running to the bathroom
or anything like that.

574
00:42:45,920 --> 00:42:49,200
I didn't have any stomach cramps,
I had nothing, all the symptoms,

575
00:42:49,200 --> 00:42:51,600
the severe symptoms I had,
were gone.

576
00:42:54,680 --> 00:42:56,760
I thought, no, this is not happening,

577
00:42:56,760 --> 00:43:00,560
this can't be, a sugar pill does not
get rid of the problems, right?

578
00:43:02,000 --> 00:43:05,200
Linda wasn't the only
study participant who reported

579
00:43:05,200 --> 00:43:09,080
improved symptoms from a pill
she knew to be inactive.

580
00:43:10,280 --> 00:43:13,040
I was taken aback
when we finished the trial

581
00:43:13,040 --> 00:43:15,200
and our statisticians showed us
the results

582
00:43:15,200 --> 00:43:17,240
and it was much stronger
than we expected.

583
00:43:17,240 --> 00:43:20,080
62 per cent said
they got adequate relief

584
00:43:20,080 --> 00:43:22,240
from being on the placebo pill.

585
00:43:22,240 --> 00:43:26,360
People who got nothing,
I think it was around 30%, said
they had adequate relief,

586
00:43:26,360 --> 00:43:29,000
so there's a real big difference,
it was easy to detect.

587
00:43:30,400 --> 00:43:33,880
But the study -
and the supply of placebo pills -

588
00:43:33,880 --> 00:43:35,800
only lasted a few weeks.

589
00:43:36,880 --> 00:43:40,160
When the pills ran out,
Linda's problems returned.

590
00:43:41,400 --> 00:43:44,640
It was three weeks, I think it was,
and everything was fine,

591
00:43:44,640 --> 00:43:47,480
and then all of a sudden
I'm not taking 'em any more

592
00:43:47,480 --> 00:43:49,640
and all the symptoms came back.

593
00:43:49,640 --> 00:43:51,320
It was horrible, it was like,

594
00:43:51,320 --> 00:43:53,680
oh, man, I've got to suffer
with this again?

595
00:43:58,680 --> 00:44:02,120
Linda decided to try and buy
some more placebo pills.

596
00:44:05,360 --> 00:44:07,760
I tried to go to one of
the health food stores

597
00:44:07,760 --> 00:44:10,440
to buy the placebo pills
but they didn't have them.

598
00:44:14,000 --> 00:44:16,080
The fella in the store was,
you know,

599
00:44:16,080 --> 00:44:19,600
thought it was kind of odd why
I would be asking for placebo pills.

600
00:44:19,600 --> 00:44:21,680
They had nothing else
that would replace it,

601
00:44:21,680 --> 00:44:24,440
so I couldn't do anything,
I was really disappointed.

602
00:44:24,440 --> 00:44:29,320
Well, several patients actually
asked us for more placebo pills.

603
00:44:29,320 --> 00:44:32,600
Our Ethics Committee only gave us
permission for three weeks

604
00:44:32,600 --> 00:44:35,880
of treating people with placebo
pills, and, as you can imagine,

605
00:44:35,880 --> 00:44:41,320
I don't believe they're listed as a
labelled drug in the United States.

606
00:44:41,320 --> 00:44:43,800
So we weren't able
to prescribe after that.

607
00:44:43,800 --> 00:44:47,880
It's hard to know
why Linda's symptoms disappeared,

608
00:44:47,880 --> 00:44:52,080
when she took something that
she knew was chemically worthless.

609
00:44:53,480 --> 00:44:56,960
The study only looked at
whether it would work, not why.

610
00:44:56,960 --> 00:44:59,360
But Ted has a theory.

611
00:45:00,520 --> 00:45:06,600
What I think happened is that
just seeing our study physician...

612
00:45:08,120 --> 00:45:13,240
..taking pills two times a day,
in some way your body feels,

613
00:45:13,240 --> 00:45:16,680
recognises, moves in a way
that's moving towards health.

614
00:45:16,680 --> 00:45:20,720
This is the body knowing something
that's beyond their ability

615
00:45:20,720 --> 00:45:23,160
to consciously be aware of.

616
00:45:23,160 --> 00:45:26,720
I don't understand it, I don't know
why and probably never will.

617
00:45:26,720 --> 00:45:30,120
But there's something.
I think I'm wishing for a cure

618
00:45:30,120 --> 00:45:33,280
and I'm wishing for something
to make this all disappear.

619
00:45:33,280 --> 00:45:36,360
I think if I wish hard enough,
it'll work, I guess.

620
00:45:39,000 --> 00:45:42,720
Exactly why the pills worked
remains a mystery.

621
00:45:42,720 --> 00:45:47,600
And a small, short-term study
like this certainly doesn't mean

622
00:45:47,600 --> 00:45:51,280
that we can simply replace
real drugs with placebos.

623
00:45:51,280 --> 00:45:53,440
But it does call into question

624
00:45:53,440 --> 00:45:56,480
the fundamental assumption
about placebos -

625
00:45:56,480 --> 00:46:00,440
the idea that we need to be duped
for them to work.

626
00:46:02,360 --> 00:46:05,800
At Harvard, other scientists
are searching for ways

627
00:46:05,800 --> 00:46:09,720
that we can use the power
of the placebo without deception.

628
00:46:09,720 --> 00:46:14,360
One of Ted's colleagues has studied
something you might have thought

629
00:46:14,360 --> 00:46:17,400
wouldn't have anything
to do with placebos.

630
00:46:17,400 --> 00:46:19,400
And that is hypnosis.

631
00:46:20,720 --> 00:46:24,520
There's a lot of overlap
between the idea of placebo

632
00:46:24,520 --> 00:46:25,920
and the idea of hypnosis.

633
00:46:27,360 --> 00:46:29,600
Separate the two index fingers.

634
00:46:29,600 --> 00:46:32,440
And lift your hands and your arms up.

635
00:46:32,440 --> 00:46:38,000
First of all, they're all based on
belief, expectation and suggestion.

636
00:46:40,160 --> 00:46:42,440
A hypnotic induction is a procedure

637
00:46:42,440 --> 00:46:46,920
that has no active ingredient
except for the person's belief

638
00:46:46,920 --> 00:46:49,680
and understanding about
what it is supposed to do.

639
00:46:52,200 --> 00:46:55,280
Mike Gow is a dentist
and a hypnotist.

640
00:46:56,560 --> 00:46:59,880
He's preparing David
for a major procedure.

641
00:46:59,880 --> 00:47:02,080
He's going to extract
his wisdom tooth.

642
00:47:04,120 --> 00:47:08,040
So, as you can see from his X-ray,
a lower wisdom tooth never developed

643
00:47:08,040 --> 00:47:11,000
in the first place and that's why
the upper tooth is actually

644
00:47:11,000 --> 00:47:14,400
erupting down into the space
where that tooth would've been.

645
00:47:14,400 --> 00:47:17,240
When that happens, the tooth starts
rubbing into the cheek,

646
00:47:17,240 --> 00:47:19,360
it starts biting down
on the gum below,

647
00:47:19,360 --> 00:47:22,560
it also becomes very difficult
for David to clean,

648
00:47:22,560 --> 00:47:25,120
and actually he's got some decay
in this tooth,

649
00:47:25,120 --> 00:47:29,520
so almost impossible to get in to do
a standard filling or restoration,

650
00:47:29,520 --> 00:47:33,400
and the tooth is in danger of
breaking down and decaying further.

651
00:47:33,400 --> 00:47:36,480
Normally, removing a wisdom tooth
would require

652
00:47:36,480 --> 00:47:39,680
the injection of a strong
local anaesthetic.

653
00:47:39,680 --> 00:47:42,080
But David doesn't want one.

654
00:47:42,080 --> 00:47:44,400
I don't like getting the injections

655
00:47:44,400 --> 00:47:46,960
and having the numb mouth
afterwards.

656
00:47:46,960 --> 00:47:51,240
So I had the opportunity
to have hypnosis as a treatment

657
00:47:51,240 --> 00:47:54,880
for getting the wisdom tooth removed
and I thought I'd give it a go.

658
00:47:58,840 --> 00:48:02,800
David is having no pharmacological
anaesthetic today.

659
00:48:02,800 --> 00:48:06,080
He's not taking anything,
he's not having any injections,

660
00:48:06,080 --> 00:48:10,120
this is going to be just hypnosis.
This is the plan, of course.

661
00:48:10,120 --> 00:48:12,560
If we need to use anaesthetic,
then we have it.

662
00:48:12,560 --> 00:48:16,440
The only active ingredient
in David's pain relief will be

663
00:48:16,440 --> 00:48:19,360
the way Mike interacts with him -

664
00:48:19,360 --> 00:48:21,320
his hypnotic induction.

665
00:48:23,120 --> 00:48:27,200
Just notice
this wave of relaxation now,

666
00:48:27,200 --> 00:48:33,080
more and more in control
of your thoughts and feelings,

667
00:48:33,080 --> 00:48:35,720
calmer and calmer.

668
00:48:37,400 --> 00:48:39,760
And if I lift the left hand
all the way up...

669
00:48:41,640 --> 00:48:47,720
The act of inducing hypnosis
is a way of giving the person

670
00:48:47,720 --> 00:48:50,360
permission, disinhibiting them,

671
00:48:50,360 --> 00:48:55,120
so that they can now believe in
their own abilities to block pain,

672
00:48:55,120 --> 00:48:57,080
to experience things differently.

673
00:48:58,880 --> 00:49:03,240
Just notice how the index finger
and thumb just feel kind of dull

674
00:49:03,240 --> 00:49:05,160
and insensitive, don't they?

675
00:49:06,480 --> 00:49:07,400
Yeah?

676
00:49:08,640 --> 00:49:12,040
Are you happy now to transfer
that feeling around the tooth?

677
00:49:14,640 --> 00:49:16,760
Cold...

678
00:49:16,760 --> 00:49:18,360
dull, and insensitive.

679
00:49:26,480 --> 00:49:29,200
David's wisdom tooth is
firmly encased

680
00:49:29,200 --> 00:49:31,600
in the bone that surrounds it.

681
00:49:31,600 --> 00:49:35,440
Mike's first job is to gradually
enlarge the socket.

682
00:49:38,920 --> 00:49:42,400
DISTORTED: And just notice now,
as you allow the mouth to open,

683
00:49:42,400 --> 00:49:45,800
just feeling that pressure.

684
00:49:45,800 --> 00:49:48,200
Relaxed...

685
00:49:50,040 --> 00:49:52,000
..and comfortable.

686
00:49:52,000 --> 00:49:53,440
Throughout the procedure,

687
00:49:53,440 --> 00:49:58,520
David has been told to rate his pain
on a zero to ten scale.

688
00:49:58,520 --> 00:50:00,600
And just write down a wee number now.

689
00:50:01,640 --> 00:50:03,080
A zero, that's excellent.

690
00:50:07,320 --> 00:50:10,800
As you allow the mouth
to open again,

691
00:50:10,800 --> 00:50:14,120
just pushing and pressure,

692
00:50:14,120 --> 00:50:19,000
comfortable...sensations.

693
00:50:19,920 --> 00:50:23,200
Again, just write down
any little number.

694
00:50:23,200 --> 00:50:25,600
A one.

695
00:50:27,040 --> 00:50:29,480
Clearly, David's pain scores
aren't low

696
00:50:29,480 --> 00:50:32,920
because of any painkilling drugs
he's received.

697
00:50:32,920 --> 00:50:37,280
It's his own internal painkilling
systems that are working -

698
00:50:37,280 --> 00:50:41,280
the same as those that can be
activated by a placebo.

699
00:50:41,280 --> 00:50:46,760
You might think of hypnosis
as a procedure that allows people

700
00:50:46,760 --> 00:50:52,320
to turn on their own ability
to produce a placebo effect.

701
00:50:53,640 --> 00:50:56,080
Having widened the socket
sufficiently,

702
00:50:56,080 --> 00:50:58,920
Mike is ready for
the critical moment -

703
00:50:58,920 --> 00:51:02,320
tearing the tooth from the ligament
that holds it in place.

704
00:51:02,320 --> 00:51:04,640
Calm...

705
00:51:04,640 --> 00:51:06,040
control.

706
00:51:18,600 --> 00:51:20,640
Eyes open. Wide awake.

707
00:51:20,640 --> 00:51:22,800
That was awesome. Very well done.

708
00:51:24,480 --> 00:51:27,600
Good. So, the final moment
of removing the tooth,

709
00:51:27,600 --> 00:51:29,400
there's a lot of pressure,

710
00:51:29,400 --> 00:51:33,040
and I'd be interested to know
what number you were at.

711
00:51:33,040 --> 00:51:36,600
It was...probably a four-ish.

712
00:51:36,600 --> 00:51:39,600
About a four.
In the final moment, yeah.

713
00:51:39,600 --> 00:51:43,840
Without any form of pain relief,
I would expect it to be an 8 or a 9,

714
00:51:43,840 --> 00:51:51,120
without anything at all,
so I think a number 4 is excellent.

715
00:51:51,120 --> 00:51:53,520
It's such a different sensation.

716
00:51:53,520 --> 00:51:55,680
I didn't really feel anything,

717
00:51:55,680 --> 00:52:00,440
just the point at which it pulled
out, it was quite a sudden thing,

718
00:52:00,440 --> 00:52:04,200
but it wasn't anything more
than that, I would have thought.

719
00:52:04,200 --> 00:52:08,280
By changing his expectations
about what he would feel,

720
00:52:08,280 --> 00:52:12,240
Mike enabled David to release
the painkillers in his brain.

721
00:52:13,880 --> 00:52:15,920
He gave him a placebo effect,

722
00:52:15,920 --> 00:52:20,760
not with a dummy pill
or a sham surgery, but with words.

723
00:52:22,320 --> 00:52:25,000
Hypnosis may not be the only way

724
00:52:25,000 --> 00:52:28,520
to get a placebo effect
without deception,

725
00:52:28,520 --> 00:52:31,280
but it's certainly an excellent way
to do that

726
00:52:31,280 --> 00:52:37,480
and you can think of it as an extra
strength, non-deceptive placebo.

727
00:52:37,480 --> 00:52:41,200
It seems that
something about the relationship

728
00:52:41,200 --> 00:52:43,160
between practitioner and patient

729
00:52:43,160 --> 00:52:48,000
lies at the heart of inducing
a placebo effect without deception.

730
00:52:54,520 --> 00:52:59,680
So, is it possible for doctors
to give patients a placebo effect

731
00:52:59,680 --> 00:53:03,680
by changing nothing more than their
relationship with their patient?

732
00:53:04,760 --> 00:53:07,800
Answering that question could help
provide the key

733
00:53:07,800 --> 00:53:12,200
to unlock our body's potential
to heal itself.

734
00:53:12,200 --> 00:53:15,640
Ted Kaptchuk set up an experiment
to find out.

735
00:53:19,200 --> 00:53:22,040
People with irritable bowel syndrome
were recruited

736
00:53:22,040 --> 00:53:24,200
to be treated with acupuncture.

737
00:53:24,200 --> 00:53:27,000
They were divided
into different groups.

738
00:53:27,000 --> 00:53:28,360
In one group,

739
00:53:28,360 --> 00:53:33,160
the acupuncturist's interaction with
their patient was strictly limited.

740
00:53:33,160 --> 00:53:37,280
We did not allow the practitioner
to have an interaction
with the patient.

741
00:53:43,160 --> 00:53:46,600
And that meant the patient came in,
the practitioner said,

742
00:53:46,600 --> 00:53:48,320
"My name is...I've read the charts,

743
00:53:48,320 --> 00:53:50,440
"I'm going to treat you
with acupuncture.

744
00:53:50,440 --> 00:53:55,440
"I've been asked by the research
scientists not to interact, to not
confuse the scientific question."

745
00:53:55,440 --> 00:53:58,520
Hi, Mr Casey, come on in.

746
00:53:59,720 --> 00:54:02,560
In another group,
the patients were treated

747
00:54:02,560 --> 00:54:05,840
in as caring
and supportive a manner as possible.

748
00:54:08,680 --> 00:54:11,440
We added a warm supportive
relationship,

749
00:54:11,440 --> 00:54:14,960
which included delving deeply
into a patient's life,

750
00:54:14,960 --> 00:54:16,960
how does this affect your life,

751
00:54:16,960 --> 00:54:19,200
what's your relationship
to these symptoms,

752
00:54:19,200 --> 00:54:23,120
how does it affect your being able
to have family, friends, work.

753
00:54:23,120 --> 00:54:26,320
And tell me what kind of
improvements you'd like to see,

754
00:54:26,320 --> 00:54:28,360
so I get a good sense of that.

755
00:54:28,360 --> 00:54:32,520
Empathy, expressing how we
understood how difficult this was.

756
00:54:32,520 --> 00:54:35,120
Some way, we had to touch
the patient.

757
00:54:35,120 --> 00:54:37,680
Thoughtful silence -
we tried to have the practitioner

758
00:54:37,680 --> 00:54:40,600
think for a moment
and then ask to repeat a question

759
00:54:40,600 --> 00:54:43,520
and some statement of confidence,
"I think this is going to work."

760
00:54:43,520 --> 00:54:47,120
I'm pretty sure these treatments
will be very helpful for you,

761
00:54:47,120 --> 00:54:49,680
and I hope they push you along
to the next level.

762
00:54:49,680 --> 00:54:54,760
All Ted was interested in was the
placebo effect of this interaction -

763
00:54:54,760 --> 00:54:57,560
so all active treatment was removed.

764
00:54:58,720 --> 00:55:01,040
The patients would
receive acupuncture

765
00:55:01,040 --> 00:55:04,360
with needles that couldn't
even puncture their skin.

766
00:55:05,480 --> 00:55:09,400
The needle is... It looks like
an acupuncture pin,

767
00:55:09,400 --> 00:55:12,240
it's impossible to tell
the difference unless you have...

768
00:55:12,240 --> 00:55:14,160
I can barely see any difference.

769
00:55:14,160 --> 00:55:15,160
Watch it go in.

770
00:55:16,280 --> 00:55:17,320
See it go in.

771
00:55:18,520 --> 00:55:21,800
And what happened is that it went up
the shaft of the needle,

772
00:55:23,160 --> 00:55:25,280
like a magic sword.

773
00:55:25,280 --> 00:55:28,880
It's no surprise that a patient
treated in a caring way

774
00:55:28,880 --> 00:55:30,800
might feel more looked after.

775
00:55:30,800 --> 00:55:32,960
You feel it yet? I do. OK.

776
00:55:32,960 --> 00:55:35,800
But it's not bad, right?
It's not bad.

777
00:55:35,800 --> 00:55:38,480
But could it really
make them better?

778
00:55:38,480 --> 00:55:41,680
After all,
it's just about being nice.

779
00:55:45,600 --> 00:55:49,160
But Ted's results show that
the relationship between a doctor

780
00:55:49,160 --> 00:55:52,440
and their patient is significant.

781
00:55:52,440 --> 00:55:54,880
With no doctor/patient relationship,

782
00:55:54,880 --> 00:55:58,360
42% had adequate relief.

783
00:55:58,360 --> 00:56:02,680
And on the full monty, the...
everything, with doctor/patient

784
00:56:02,680 --> 00:56:05,440
and the practitioner relationship
and all the other arms

785
00:56:05,440 --> 00:56:08,120
we got 62% reporting
adequate relief.

786
00:56:09,920 --> 00:56:13,760
What it's telling us
is that a practitioner interaction

787
00:56:13,760 --> 00:56:16,400
dramatically optimises
the placebo effect.

788
00:56:19,880 --> 00:56:25,200
Ted's study shows that a doctor can
potentially create a placebo effect

789
00:56:25,200 --> 00:56:28,920
just by changing the way they behave
and the things they say.

790
00:56:31,840 --> 00:56:34,720
It's still early days
for the research at Harvard,

791
00:56:34,720 --> 00:56:39,120
but it suggests that we can use
the power of the placebo effect

792
00:56:39,120 --> 00:56:42,640
to help make drugs and surgery
more effective.

793
00:56:51,560 --> 00:56:55,000
Placebo research is still
in its infancy.

794
00:56:55,000 --> 00:56:57,600
There's much more to learn.

795
00:56:57,600 --> 00:57:00,920
Why do some people respond
better than others?

796
00:57:00,920 --> 00:57:02,360
Do genetics play a role?

797
00:57:04,360 --> 00:57:08,800
What exactly does a doctor need
to do to harness the placebo effect?

798
00:57:10,640 --> 00:57:14,680
But one thing we know for sure
is that it's real.

799
00:57:15,560 --> 00:57:18,520
Even the most sceptical people
now accept

800
00:57:18,520 --> 00:57:21,120
that there is something
in the placebo effect.

801
00:57:22,480 --> 00:57:25,680
And that's a sea-change
on 20 or 30 years ago where people

802
00:57:25,680 --> 00:57:30,560
were routinely describing the
placebo as an experimental artefact.

803
00:57:30,560 --> 00:57:34,200
The placebo effect is real,
quantifiable

804
00:57:34,200 --> 00:57:38,080
and in fact you're doing quite well
with an active therapy

805
00:57:38,080 --> 00:57:41,800
if you can get as good a response
as the placebo response.

806
00:57:41,800 --> 00:57:45,600
The pills and procedures
of modern medicine

807
00:57:45,600 --> 00:57:48,040
have brought us
unprecedented good health.

808
00:57:49,040 --> 00:57:52,280
But in many cases
it seems they're not acting alone.

809
00:57:53,720 --> 00:57:59,040
The placebo effect is intertwined
with everything we do in healthcare.

810
00:57:59,040 --> 00:58:03,120
It was there from the beginning,
it'll be there to the end.

811
00:58:04,480 --> 00:58:06,680
The challenge facing researchers now

812
00:58:06,680 --> 00:58:10,360
is to better understand
the mechanisms by which it works.

813
00:58:11,600 --> 00:58:13,920
So that ultimately we can use it

814
00:58:13,920 --> 00:58:18,120
and make the most of
the power of the placebo.