Dec 28, 2009


With new research demonstrating the startling power of the placebo effect, this hour of Radiolab examines the chemical consequences of belief and imagination.

Could the best medicine be no medicine at all? We take stock of the pharmacy in our brains, consider the symbolic power of the doctor coat, and visit the tent of a self-proclaimed faith healer.

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Speaker 3: 00:53 You're listening to Radiolab.

Speaker 4: 00:55 From New York Public Radio.

Speaker 5: 00:57 Public Radio. WNYC

Speaker 6: 01:03 WNYC.

Speaker 7: 01:03 And NPR.

Jad Abumrad: 01:04 I'm Jad Abumrad.

Robert Krulwich: 01:05 And I'm Robert Krulwich.

Jad Abumrad: 01:06 And this is Radiolab, Season Three. And let me start with a story.

Robert Krulwich: 01:09 Okay.

Jad Abumrad: 01:09 1893, an anthropologist Franz Boas goes to the woods of British Columbia. He has a giant wax cylinder recorder with him, and he records this guy singing a healing song.

Robert Krulwich: 01:27 Who is this?

Jad Abumrad: 01:28 This gentleman is an Indian from the Kwakiutl tribe and his name, we're told, is [Kesalid 00:01:34], or Kesalid.

Daniel Moerman: 01:37 I've always pronounced it [Kesalid 00:01:39], I don't know ... I'm not quite sure how it would be pronounced in Kwakiutl.

Jad Abumrad: 01:43 That's Daniel Moerman, he's an anthropologist. He's written a lot about Kesalid because it's a neat story. And it goes like this. The young Kesalid begins as a skeptic.

Daniel Moerman: 01:52 He was skeptical about the activities of the shaman. He thought they were tricking people in some way.

Jad Abumrad: 01:59 The shaman are the village healers. Very, very powerful men.

Daniel Moerman: 02:02 They were scary men.

Jad Abumrad: 02:04 And he'd see them doing these dramatic healing rituals. And he thought they were full of it.

Daniel Moerman: 02:08 And so he decided ...

Jad Abumrad: 02:10 ... To go undercover. One day Kesalid approaches some of these shaman and asks if he can apprentice with them.

Daniel Moerman: 02:15 Yeah, the three or four of them take him out into the woods, into a clearing or something, and they tell him a bunch of things. And they taught him the songs.

Daniel Moerman: 02:21 And he learned that stuff.

Jad Abumrad: 02:29 And eventually, after he'd gained their trust a little, they taught him their best trick of all.

Daniel Moerman: 02:34 The trick that's widespread in the world of shamanism where you find variations on it all over the world.

Jad Abumrad: 02:39 "Here's what you do," they told him. Get some feathers, some down feathers, and just tuck it in your cheek right ...

Daniel Moerman: 02:43 Just stick it in your mouth.

Jad Abumrad: 02:45 Secretly.

Daniel Moerman: 02:45 So that nobody knew that it was there.

Jad Abumrad: 02:47 Then during the ritual, let's say the patient is there and they're on the ground, maybe their chest hurts. You lean down.

Daniel Moerman: 02:52 Literally, get down ...

Jad Abumrad: 02:54 Put your mouth on the patient's chest.

Daniel Moerman: 02:56 And suck.

Jad Abumrad: 02:57 And here's the last step. While you're sucking, you bite the inside of your cheek to get some blood in there, which mixes with the feathers. Then, at the pivotal point, you throw your head back and ... Cough out the feathers, which were now bloody and nasty.

Daniel Moerman: 03:11 So, you end up with this bit of bloody down in the palm of your hand, which you would then say is the disease which you have sucked out of the body of the patient.

Jad Abumrad: 03:20 Kesalid learned all this and thought, "I knew it. Those liars."

Daniel Moerman: 03:25 The problem was that part of the obligation of his apprenticeship was that whenever anybody asked, he had to go and treat them for free. That was sort of part of the deal of being an apprentice. And somebody from a famous family called him to come and treat a daughter who was sick.

Jad Abumrad: 03:40 Very sick, according to the written account.

Daniel Moerman: 03:42 And so he went to see this family, and he treated the girl and he went through the songs that he sang.

Speaker 10: 03:48 [inaudible 00:03:48].

Jad Abumrad: 03:50 And then he did the feather trick, which he knew was false. He put the feathers in his mouth, bit the inside of his cheek, pretended to suck, coughed the whole thing out.

Daniel Moerman: 03:58 And lo and behold, she was healed. She was fine. She was ...

Jad Abumrad: 04:01 Fine fine?

Daniel Moerman: 04:02 Yeah, and it was a great success.

Jad Abumrad: 04:04 Wow. And what did he think?

Daniel Moerman: 04:05 Well, he clearly indicates a kind of ambiguity. He knows that he was tricking her but he also knows that she's better.

Jad Abumrad: 04:14 Not convinced, Kesalid tries the trick again and again and again. And every time he does it, it works. So, at the end of the story, he decides to become a healer. Does that mean that he ends up believing in the lie that he set out to disprove?

Daniel Moerman: 04:29 I think that he realizes that truth and lies are not that fundamentally different as we might think they are.

Jad Abumrad: 04:35 Today on Radiolab, we look at that. The true healing power of lies, which in medicine we call the placebo effect.

Robert Krulwich: 04:45 No. No, we don't.

Jad Abumrad: 04:45 What do you mean no we don't?

Robert Krulwich: 04:47 Well, it's actually called placebo, placebo.

Jad Abumrad: 04:50 Who calls it that?

Robert Krulwich: 04:51 Latin scholars, I think. I mean, it's a Latin word.

Jad Abumrad: 04:53 Whatever.

Robert Krulwich: 04:54 Placebo is originally a Latin word.

Jad Abumrad: 04:55 God. Alright, while you call it the placebo effect I'm going to try and figure out how it works.

Robert Krulwich: 04:59 And then I'm going to tell some stories including one about a dramatically dressed gentleman. He dressed entirely in purple, and maybe it was lilac, who used a placebo effect to make the ladies feel real good.

Jad Abumrad: 05:08 That's all coming up on Radiolab.

FabrizioBenedet: 05:09 [inaudible 00:05:09].

Jad Abumrad: 05:09 Dr. Benedetti?

FabrizioBenedet: 05:09 Yes, speaking.

Jad Abumrad: 05:08 Can you hear me?

FabrizioBenedet: 05:24 I am Fabrizio Benedetti, but I cannot hear anything.

Jad Abumrad: 05:27 We had a little trouble with the phone connection. Fabrizio Benedetti is a doctor at the Turin Medical Center in Italy, and he's one of the most expert experts on the placebo effect.

Jad Abumrad: 05:37 Is this better?

FabrizioBenedet: 05:38 Yeah, now I can hear you, yes.

Jad Abumrad: 05:39 So we thought we'd start with him. He's been studying the placebo effect for about 15 years.

FabrizioBenedet: 05:44 Yes. I got interested in the placebo effect because I realized that sometimes the Placebo group gets much better than the active treatment group.

Jad Abumrad: 05:56 Much much better?

FabrizioBenedet: 05:57 Yes, sometimes. Sometimes.

Robert Krulwich: 05:58 For what kind of stuff?

Jad Abumrad: 05:59 Well, he saw it first in pain.

Speaker 13: 06:01 Pain.

Robert Krulwich: 06:01 Pain?

Jad Abumrad: 06:04 Pain trials.

Robert Krulwich: 06:05 Oh.

Jad Abumrad: 06:06 And then he saw it in depression.

Speaker 13: 06:06 Depression.

Jad Abumrad: 06:08 As in anti-depressants. Right, and then digestion.

Speaker 13: 06:11 Digestion.

Jad Abumrad: 06:11 Immune Response.

Speaker 13: 06:12 Immune Response.

Jad Abumrad: 06:14 All of these places where placebos were doing things they just were not supposed to do.

FabrizioBenedet: 06:17 Yeah, it's really amazing. Particularly for some conditions like ...

Jad Abumrad: 06:22 And this one's a little surprising.

FabrizioBenedet: 06:23 Parkinson's Disease.

Speaker 13: 06:24 Parkinson's Disease.

Jad Abumrad: 06:26 Serious neurological disorder. People with Parkinson's have shakes, they have tremors. Dr. Benedetti treats a lot of these folks. And in the really bad cases, the only treatment that really seems to work at all is surgery.

FabrizioBenedet: 06:38 So this patient ...

Jad Abumrad: 06:38 You open up the patient's skull and implant a little stimulator.

FabrizioBenedet: 06:41 Stimulator.

Jad Abumrad: 06:43 Deep into their brain.

FabrizioBenedet: 06:44 Deep into the brain in two brain regions.

Jad Abumrad: 06:47 Essentially what that does is it hot-wires the parts of the brain that aren't working. And when you do that and you turn the stimulator on, the shakes go away. It's a real treatment.

FabrizioBenedet: 06:55 Yes. So, we can switch the stimulator on or off and the patient doesn't know that the stimulator is on or off.

Jad Abumrad: 07:04 And that is where the trickery comes in. In one experiment, he stood in front of his patient with the stimulator and said ...

FabrizioBenedet: 07:10 Now we are going to switch your stimulator on.

Jad Abumrad: 07:14 Except he didn't.

FabrizioBenedet: 07:15 No, of course. Of course, it is a sham turning on.

Jad Abumrad: 07:18 He only pretended to turn it on, but that's the weird thing. It didn't matter. Pretending to turn it on worked just as well as turning it on for real. The tremors disappeared.

Robert Krulwich: 07:27 Really?

Jad Abumrad: 07:27 He even has a video of this where he's with a Parkinson's patient and he says those words.

FabrizioBenedet: 07:32 Now, we are going to switch your stimulator on.

Robert Krulwich: 07:35 Which is a lie, by the way.

Jad Abumrad: 07:36 Yeah, but it doesn't matter because what you see on the video screen is a shaking hand go completely still.

FabrizioBenedet: 07:42 Yeah, that's correct. In a few seconds, you see that there is a dramatic improvement in motor performance even though the stimulator is still off.

Jad Abumrad: 07:52 Just from words.

Robert Krulwich: 07:55 And this is an equivalency? The lie is as good as the medicine?

Jad Abumrad: 08:00 For a while.

Robert Krulwich: 08:02 What do you mean for a while?

Jad Abumrad: 08:04 Coming out of the gate, a placebo seems to be 100% as effective as say, a real Parkinson's drug.

Robert Krulwich: 08:10 Yeah.

FabrizioBenedet: 08:10 But it lasts only about 25% the duration of the actual drug.

Robert Krulwich: 08:17 Oh. Oh.

Jad Abumrad: 08:17 Still, it's just words. Come on. Words are cheap.

Robert Krulwich: 08:18 Yeah, your words are cheaper than ...

Speaker 14: 08:21 Overstatement.

Robert Krulwich: 08:23 25%? That is so different from 100%.

Jad Abumrad: 08:26 I never said it as 100%. I didn't.

Robert Krulwich: 08:27 You did too. Roll the tape [inaudible 00:08:29].

Jad Abumrad: 08:29 What is wrong with you? The fact that it happens at all. That words, that's what we're talking about. Words can be as effective as surgery. Doesn't that intrigue you? Don't you want to know how that works?

Robert Krulwich: 08:39 Yes, actually. I do. How does it work?

Jad Abumrad: 08:42 We have no idea. But for the first time, we can see it.

Robert Krulwich: 08:48 See what?

Jad Abumrad: 08:50 Well, see it in action. See the placebo effect in action. Testing testing. Dr. Benedetti referred us to a guy actually right here in New York.

FabrizioBenedet: 08:56 In New York, probably, you have talked with Tor Wager?

Jad Abumrad: 09:00 No. Should we?

FabrizioBenedet: 09:01 Yes.

Jad Abumrad: 09:01 Tor Wager, are you?

Tor Wager: 09:03 [inaudible 00:09:03] Yeah.

Jad Abumrad: 09:05 Hey, how are you?

FabrizioBenedet: 09:05 Tor Wager is a very good neural imager.

Jad Abumrad: 09:08 Well, you should introduce yourself.

Tor Wager: 09:09 Okay. I'm Tor Wager. I'm assistant professor of Psychology at Columbia University.

Jad Abumrad: 09:13 And here's what Tor Wager does. He puts subjects in the brain scanner, puts a hot pad on their arm, like I'm doing to you right now. It's getting hot, right? Right?

Robert Krulwich: 09:22 So, that's very ... Yes, it's quite hot.

Tor Wager: 09:22 We'll give them these pulses of heat.

Jad Abumrad: 09:26 Ow. And then he'll give you some pain relief cream.

Robert Krulwich: 09:30 Ah. This cream here?

Jad Abumrad: 09:31 Yes.

Tor Wager: 09:31 A cream that we tell you is Lidocaine. We say, "This is going to be really effective. This is going to block pain."

Jad Abumrad: 09:36 It's going to take away the pain. Really, it's just Vaseline, but you don't know that.

Robert Krulwich: 09:41 I'm having a hard time playing this role.

Jad Abumrad: 09:44 In any case, right as you're putting on this fake cream and feeling better, having a placebo effect in other words, he takes a picture of your brain.

Tor Wager: 09:51 So, I have many things I can show you.

Robert Krulwich: 09:53 Come on, Tor. Show it to him.

Jad Abumrad: 09:54 He does. He shows me one on his computer. It's very pretty.

Jad Abumrad: 09:57 Oh, now we have a brain in front of us.

Tor Wager: 09:59 [inaudible 00:09:59].

Jad Abumrad: 09:58 A brain scan of a person right in the middle of being placebo-ed, meaning that they've just been given the placebo cream and now they're expecting to feel better. Those expectations ...

Tor Wager: 10:08 The placebo expectations ...

Jad Abumrad: 10:10 First of all, they seem to start ...

Tor Wager: 10:11 Here.

Jad Abumrad: 10:12 In your forehead.

Tor Wager: 10:13 Kind of on the sides of your forehead, above your temples.

Jad Abumrad: 10:15 When you believe that you're going to feel better, the belief seems to live kind of near your temples. But then, once that belief is there, it seems to turn on.

Tor Wager: 10:23 Turn on this.

Jad Abumrad: 10:26 This other part.

Tor Wager: 10:26 The membrane.

Jad Abumrad: 10:27 He points to it on the screen. It's a little nugget deep in the center of the brain.

Tor Wager: 10:31 And what's important about this area is that it's one of the major centers for the production of opioids in the brain.

Jad Abumrad: 10:39 Oh. Opioids like opium, painkiller.

Tor Wager: 10:43 Yes, right. Like opium.

Jad Abumrad: 10:47 Opium, as in ...

Robert Krulwich: 10:53 Jad.

Jad Abumrad: 10:54 What? The greatest painkiller known to man. There it was inside our heads. Doesn't it strike you as weird, by the way, that that stuff actually is inside our heads? I can't get over that, that these illicit substances are actually inside us.

Tor Wager: 11:06 Right. Well, you know there's kind of a neat story about that.

Jad Abumrad: 11:08 And here is where Tor blows my mind right out my face, as he explains that every drug out there in the world, every single one, even the ones you see on TV are in a sense already inside our heads.

Tor Wager: 11:23 Your brain must have its own internal chemical.

Jad Abumrad: 11:26 The only reason those drugs work, he says, is because our brain has receptors for them and why would it have those receptors? Because it can already make them in house.

Tor Wager: 11:34 Every pharmacological agent or drug that there is, there is a chemical that's produced by your own brain that essentially does that thing.

Jad Abumrad: 11:42 That's ... Wait a second, internal pharmacy in there just stocked full of drugs.

Tor Wager: 11:48 Right.

Jad Abumrad: 11:48 And we just have to figure out how to unlock it in a way.

FabrizioBenedet: 11:50 We have a sort of, as you said, internal pharmacy. But we don't know why sometimes it does not work.

Robert Krulwich: 11:59 What? What does that mean?

Jad Abumrad: 12:00 Well, what he means is that the placebo effect, though it can be incredibly powerful, it's rarely consistent. It's hard to predict who's going to get a placebo effect under what circumstances. But just imagine if we could figure this out. We could have all the drugs we ever need without those nasty side effects.

FabrizioBenedet: 12:17 Oh yes, absolutely. Yes. We are working a lot with drug companies in this direction.

Jad Abumrad: 12:23 What Doctor Benedetti is looking at now, which could be huge for patients with chronic pain, is to take ...

FabrizioBenedet: 12:28 ... A toxic drug like morphine.

Jad Abumrad: 12:30 And gradually replace it with a placebo substitute. So, say on Monday, he would give you some morphine. And then on Tuesday, he'd slip in a placebo.

FabrizioBenedet: 12:38 And you get morphine again on Wednesday, and the placebo on Thursday, and so forth. In the long run, you can have a reduction of morphine by 50%.

Jad Abumrad: 12:47 Aha. And perhaps one day ... I'm sorry, I can't contain my enthusiasm, we won't need drugs at all. Maybe one day we'll have a little box that I can plug directly into my mid-brain, and I could just spend all day hitting the joy button. Joy. Joy. Joy.

Speaker 16: 13:03 Joy. Joy. Joy. Joy. Joy. Joy.

Jad Abumrad: 13:14 Sorry about that.

Robert Krulwich: 13:17 Well, while we're waiting for your glorious drug-soaked future, you can do it much more simply by simply telling a story. I'll tell you a story about telling stories. How about that?

Jad Abumrad: 13:29 I have no idea what you're talking about.

Robert Krulwich: 13:30 Alright, well let me start. It's a story I learned from Daniel Carr.

Daniel Carr: 13:32 Daniel B. Carr, MD.

Robert Krulwich: 13:34 He told me about a guy who's really the father of placebo research. His name is Henry ...

Daniel Carr: 13:40 Henry.

Robert Krulwich: 13:40 Unangst.

Daniel Carr: 13:41 Unangst.

Robert Krulwich: 13:41 Unangst.

Daniel Carr: 13:43 Unangst is his original name.

Robert Krulwich: 13:45 German, as Doctor Carr will tell you.

Daniel Carr: 13:46 Which, given the poor quality of my German, I would roughly scan as meaning anti-anxiety or perhaps anti-pain.

Robert Krulwich: 13:56 This may be one of those cases where the name shapes the man.

Daniel Carr: 14:00 It may well be. It may well be.

Robert Krulwich: 14:02 Because even though he ends up changing his name.

Daniel Carr: 14:04 To Beecher.

Robert Krulwich: 14:05 Henry Knowles Beecher. He does go into medicine.

Daniel Carr: 14:08 To become a doctor.

Robert Krulwich: 14:09 And then during World War II, he joined the army as a doctor and found himself at the Great Battle of Anzio, where the Americans landed in Nazi Europe. And he was right there.

Daniel Carr: 14:19 He was on the beach. Bullets were flying. Soldiers were being killed. And some were being wounded.

Speaker 18: 14:29 Sarge, I'm hit.

Robert Krulwich: 14:31 And since Beecher was the doctor, it was his job to treat them.

Daniel Carr: 14:34 That's correct. The treatment at that time for pain, as it still is nowadays, was morphine.

Robert Krulwich: 14:43 One problem, though. Beecher's division was cut off from supplies and reinforcements, and he began to run low on morphine. He had to figure out which soldiers needed it the most.

Scott Podolsky: 14:55 And he's talking to them and he's asking them about how much pain they're actually having.

Robert Krulwich: 14:59 And this is Scott [Podolsky 00:15:00], who's a doctor and a historian.

Scott Podolsky: 15:01 And he would go up to these patient and say to them ...

Speaker 20: 15:05 Soldier?

Speaker 18: 15:06 Yes?

Speaker 20: 15:07 As you lie there ...

Scott Podolsky: 15:07 As you lie there, are you having any pain?

Speaker 20: 15:09 Are you having any pain?

Scott Podolsky: 15:10 Quote unquote.

Robert Krulwich: 15:11 So imagine, Jad, you're a soldier. You're lying there with shrapnel stuck in your gut.

Scott Podolsky: 15:16 These were severe injuries.

Robert Krulwich: 15:16 And you haven't had any morphine for, I don't know ...

Scott Podolsky: 15:19 At least seven hours previously.

Robert Krulwich: 15:20 Yeah, seven hours. So, what would you say?

Jad Abumrad: 15:22 What would I say? Well, I'd say give me some morphine. I'm in pain.

Robert Krulwich: 15:27 Well, you want to know something?

Scott Podolsky: 15:28 The striking finding was that in 75% of them, they'd say ...

Speaker 18: 15:30 No.

Scott Podolsky: 15:31 No.

Speaker 18: 15:32 No, doc.

Scott Podolsky: 15:33 I'm okay.

Speaker 18: 15:34 I'm okay. I don't need any morphine right now.

Robert Krulwich: 15:35 Three quarters of them said that.

Jad Abumrad: 15:37 Wow.

Robert Krulwich: 15:37 This didn't make a whole lot of sense to Beecher, because he knew about pain. Before the war, he ran a clinic in Boston. So, he would see people with bullet injuries and gut injuries, more or less the same kind of injuries he saw in the battlefield. But back in Boston ...

Speaker 21: 15:50 Doc ...

Robert Krulwich: 15:51 They really hurt.

Speaker 21: 15:52 Could I have more morphine, please?

Speaker 20: 15:54 Nurse.

Robert Krulwich: 15:55 For some strange reason, says Daniel Carr ...

Daniel Carr: 15:58 The intensity of the pain associated with being shot was lower in the battlefield than in civilian life.

Robert Krulwich: 16:05 What could explain that?

Jad Abumrad: 16:06 Well, you know, maybe soldiers are just ... They're tough guys. They don't ... They suck it up. They don't ...

Robert Krulwich: 16:10 Well ...

Daniel Carr: 16:11 No.

Robert Krulwich: 16:12 No. Context. Context. That was Beecher's very simple explanation.

Daniel Carr: 16:16 Context. Context.

Robert Krulwich: 16:18 Meaning that the pain that you feel when you're hit by a bullet, it's not just about the bullet. It's just as much about the story that comes with the bullet. So, consider these two different stories.

Robert Krulwich: 16:29 Story number one, you are a soldier and you've been shot. As the bullet passes through you, the first thing you think is, "Well, man. I'm shot."

Daniel Carr: 16:41 And second thing you think is ...

Robert Krulwich: 16:42 Wait a second. I'm alive.

Daniel Carr: 16:44 If I can be evacuated from here, I'll have a period of recuperation.

Robert Krulwich: 16:48 They'll take me to a hospital. There'll be nurses there.

Daniel Carr: 16:50 I may get a medal.

Robert Krulwich: 16:50 And a pension.

Daniel Carr: 16:51 Or a bonus. And I'll certainly be acclaimed.

Robert Krulwich: 16:53 They'll send me home. Throw me a parade.

Daniel Carr: 16:57 I'll be a hero.

Robert Krulwich: 16:59 Now, consider the civilian story. This time you're a regular guy, civilian, in Boston. Maybe you own a shop.

Speaker 22: 17:06 Can I help you, sir?

Speaker 23: 17:06 This is a stick up. Give me your money.

Speaker 22: 17:08 Oh my god, no.

Robert Krulwich: 17:09 And you've been shot. As the bullet passes through you, this time the thoughts flashing through your head have nothing to do with glory.

Daniel Carr: 17:19 That's right.

Robert Krulwich: 17:20 Instead you think, "Yeah, I'm alive, but what's going to happen to me now?"

Daniel Carr: 17:23 You wouldn't get a medal. You were in trouble.

Robert Krulwich: 17:25 How am I going to pay the doctor bills?

Daniel Carr: 17:26 Going to be out of commission.

Robert Krulwich: 17:27 I'm going to lose my job. How do I pay the rent?

Daniel Carr: 17:29 And if your family was depending up on you, they suffered.

Robert Krulwich: 17:32 Nothing good is going to come of this. One bullet, two very different stories. And it's the difference in the stories, said Doctor Beecher, that explains the difference in the experience of pain.

Jad Abumrad: 17:43 Those stories you're saying are somehow filtering the pain even before it's felt?

Robert Krulwich: 17:48 Yeah.

Daniel Carr: 17:49 That even as the bullet enters the skin ...

Robert Krulwich: 17:51 Right away.

Daniel Carr: 17:52 Or within seconds thereafter.

Robert Krulwich: 17:53 You spin yourself a story about what's going to happen to you next. Not consciously, but way down deep in your head. And the story you tell, that makes all the difference.

Daniel Carr: 18:06 Scientists currently view our whole identity as something that we construct. One fraction of a second to another. You are the unfolding of an ongoing narrative, but it's not just a narrative in words. It's a narrative that involves touch, color, odors. We use all those inputs to generate the next frame from the last frame.

Jad Abumrad: 18:28 Well, if that's true, let me talk for a second about color. He just mentioned color, right? Daniel Moerman ...

Daniel Moerman: 18:43 Yeah, okay.

Jad Abumrad: 18:44 ... Told me something really interesting about color and pills.

Daniel Moerman: 18:47 Cool colored pills. Blue pills or purple pills, as placebos, make better sleeping tablets than yellow or red pills, which tend to wake people up.

Jad Abumrad: 18:58 That's been shown?

Daniel Moerman: 18:59 Oh yeah. Yeah, yeah, yeah. There's a whole ...

Jad Abumrad: 19:00 Okay. Take two pills that are the same, he says. Color one blue, color the other red. And the people that take the blue pill will sleep longer, they will sleep better than the people who took the red. This has been shown, he says, all over the world except ... and here's the cool part, except in Italy.

Robert Krulwich: 19:15 Italy?

Daniel Moerman: 19:16 Yep. In Italy, blue sleeping tablets have the paradoxical effect of being sleep inducing for women but not for men.

Jad Abumrad: 19:22 What? How does that work?

Daniel Moerman: 19:24 Well, I'm not really sure, but my speculation is that the Italian national football team is called Azzurri, which is blue. And so what blue evokes in an Italian man is the World Cup and soccer and screaming and hollering.

Speaker 24: 19:43 [inaudible 00:19:43]. Goal.

Daniel Moerman: 19:46 And it's hardly something that's likely to put them to sleep.

Jad Abumrad: 19:51 Whereas by contrast ...

Daniel Moerman: 19:52 Blue ...

Jad Abumrad: 19:52 For Italian women ...

Daniel Moerman: 19:53 Is the color of the virgin.

Jad Abumrad: 19:54 Oh.

Speaker 25: 19:57 Ave Maria.

Daniel Moerman: 19:58 The virgin is, of course, always presented in blue. And the virgin is a very comforting and protective figure for women in Italian culture.

Speaker 25: 20:11 [inaudible 00:20:11].

Daniel Moerman: 20:13 Language and meaning are the most crucial dimensions of our lives.

Speaker 25: 20:21 [inaudible 00:20:21].

Jad Abumrad: 20:24 This is Radiolab. I'm Jad Abumrad. Robert Krulwich and I will continue in a moment.

Jennifer: 20:30 This is Jennifer, from Tampa. Radiolab is supported, in part, by the National Science Foundation and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at

Robert Krulwich: 20:50 Hi, I'm Robert Krulwich. Radiolab is supported by Zip Recruiter. I don't know if you know anything about Zip Recruiter. Let's suppose you need to recruit somebody for your business, for your office. You could, I guess, ask friends. You could put an ad out for everybody in the world to read. Zip Recruiter's idea is they have what they call a matching technology that presumably finds the right people for you and then goes and gets them to apply. And right now, Radiolab listeners can try Zip Recruiter for free at Once again, that's

Alec Baldwin: 21:34 I'm Alec Baldwin, and join me for a live taping of Here's the Thing with my special guest Itzhak Perlman. I'll be talking with the legendary violinist about his life and his music. And we'll hear live performances from some of the talented students in the Perlman Music Program. Monday, February 18th at NYU's Skirball Center. Tickets at

Jad Abumrad: 22:05 This is Radiolab. I'm Jad Abumrad.

Robert Krulwich: 22:06 And I'm Robert Krulwich. And this hour, we've been talking about the placebo effect.

Jad Abumrad: 22:10 Yes, about the power of belief and suggestion. And thus far, we've looked at it from the perspective of the patient. But certainly the doctor has a role to play in all of this.

Robert Krulwich: 22:19 And so I have a story to tell you.

Albert Mason: 22:20 Five, four, three, two, one, zero.

Robert Krulwich: 22:25 It happens to be about a doctor.

Albert Mason: 22:26 Yeah, I'm Doctor Albert Mason, and I was trained in medicine in Guy's Hospital.

Robert Krulwich: 22:32 Back in the 1950s, Albert Mason was delivering babies at a hospital in London. He was a young guy, an anesthesiologist. And he was looking for a new way to anesthetize his patients, the moms. Some of them may be safer than drugs. And one day, he ran across a book about medical hypnosis.

Albert Mason: 22:48 Medical hypnosis. And I just read the technique and tried it out on some friends.

Robert Krulwich: 22:54 And under what circumstances? You would put a watch and have it swing back and forth, left and right?

Albert Mason: 23:00 No. No. Just lay them down on a couch and say, "Now I want you to let your whole body go loose, let your arms go loose, let your legs go loose." And it worked on some people and not on others.

Robert Krulwich: 28:37 But the more he practiced, the better he got. Putting his friends under ...

Albert Mason: 28:37 To a trance state.

Robert Krulwich: 28:37 Getting them to remember stuff from their fifth birthday.

Albert Mason: 28:37 And all sorts of games that we played as medical students.

Robert Krulwich: 28:37 And so he took this little party trick into the delivery room, and it worked.

Albert Mason: 28:37 That's right. I delivered about 20 babies under hypnosis. And the moment you start to do hypnosis, you start to get a reputation as being somebody who has power.

Robert Krulwich: 28:37 Well, I would think you'd get two reputations. The patients might think you have power and the doctors might think you're a quack.

Albert Mason: 28:37 Well both of those are true, but at that time it was kind of fun.

Robert Krulwich: 28:37 Because the hospital administrators were kind of curious about this young doctor slash hypnotist. Maybe he was on to something, who knows? So, they started to send him all kinds of patients.

Albert Mason: 28:37 Skin disorders, asthma.

Robert Krulwich: 28:37 And he'd hypnotize them, which led to a weird little discovery. Of all things that hypnosis might help, the one that seemed to work the best was warts.

Jad Abumrad: 28:37 Warts?

Robert Krulwich: 28:37 Warts, yeah.

Albert Mason: 28:37 To my delight, I found that if you hypnotized them and told them that the warts would go, they went in a certain number of cases.

Robert Krulwich: 28:37 Let's fast forward a little bit. Doctor Mason is treating lots of these warts patients and things are going pretty well.

Albert Mason: 28:37 And one day, a young boy came to this hospital. He was wheeled in on a gurney, and the first thing I saw was his arm. I could have dropped through the floor because this wasn't a dozen warts. This was millions. This was the entire surface of the skin. It's cracked and got infected and his life was impossible. He couldn't go to school because he smelled. Now, I don't know if you've ever seen the photographs of this boy.

Robert Krulwich: 28:37 Just check this out. Look at these pictures here.

Jad Abumrad: 28:37 Oh my god. It looks like he has a black hide over his whole body.

Albert Mason: 28:37 It looked like an elephant skin. That's what it looked like.

Jad Abumrad: 28:37 Geez.

Robert Krulwich: 28:37 Yeah, well, so they take this poor boy to surgery.

Albert Mason: 28:37 The surgeon, a man called Jerry Moore was trying to graft healthy skin onto the hands and when I saw the skin, I said to him, "Mr. Moore, why don't you treat him by hypnosis?" And he looked at me and he said, "Well, why don't you?" And he walked out.

Robert Krulwich: 28:37 Was he ... "Why don't you" in despair or in contempt?

Albert Mason: 28:37 I think a mixture of both.

Robert Krulwich: 28:37 And by the way, when you asked that question, you're the kid asking the senior practitioner, so ...

Albert Mason: 28:37 I was cheeky.

Robert Krulwich: 28:37 Yeah, you were a little cheeky. So there's Albert Mason, cheeky, alone with this boy with a million warts and Albert asks him, "Do you mind if I hypnotize you?"

Albert Mason: 28:37 And this kid who was 15 said, "Okay."

Robert Krulwich: 28:37 Didn't you have to tell the parents?

Albert Mason: 28:37 No. Couldn't have got away with it today, could I? So, I hypnotized this kid. I told him, "The warts on your right arm will shrivel up and die, and new skin will grow, which ..."

Robert Krulwich: 28:37 And why did you choose the right arm?

Albert Mason: 28:37 Oh, I had to start somewhere. And I sent him away. He came back in a week, and one arm was clear.

Robert Krulwich: 28:37 Totally clear. I mean, imagine this. The left arm is black and scaly like elephant skin. And the right arm is totally normal.

Jad Abumrad: 28:37 Totally normal looking?

Robert Krulwich: 28:37 Yes. Well, here's the photo.

Jad Abumrad: 28:37 Come on.

Robert Krulwich: 28:37 No, look. No, it's a real photo. This is verifiable.

Albert Mason: 28:37 It looked like a normal skin, but rather pinker than usual. Slightly pink. And soft and supple.

Jad Abumrad: 28:37 Whoa. This is for real?

Robert Krulwich: 28:37 Yes. It's like all those thousands and thousands of warts that covered the right arm, I guess they just fell off.

Robert Krulwich: 28:37 And what were you thinking when you first saw it?

Albert Mason: 28:37 I was thinking how wonderful. I was thinking, "Oh, wait 'til Mr. Moore sees this."

Robert Krulwich: 28:37 So, he takes the boy. He runs down the hall to the operating room when Mr. Moore is in the middle of an operation. He takes the boy up to the big, the glass window.

Albert Mason: 28:37 And I held up both his arms.

Robert Krulwich: 28:37 One black and scaly, the other pink and raw.

Albert Mason: 28:37 And Moore put down his scalpel. He came out of the theater. And he looked and he said, "My god. Look at that." And I said, "Well, I told you warts could go ... " And he looked at me pityingly. He said, "This isn't warts. This is congenital icthyosiform erithrodermia of Brocq."

Robert Krulwich: 28:38 Well now, for those of us who are uninitiated, what is [inaudible 00:28:38]?

Albert Mason: 28:38 It's a hopeless condition. Never been known to change.

Robert Krulwich: 28:38 The surgeon informed Albert Mason that he had just hypnotized away a condition that never once in medical history had been known to go away for any reason whatever.

Albert Mason: 28:38 So he says, "We're going to take him to the Royal Society of Medicine to show him to all the dermatologists in London."

Speaker 30: 28:38 Gentlemen, please take your seats.

Albert Mason: 28:38 So Moore took me up there with the boy.

Speaker 31: 28:38 Thank you, Dr. Moore, and to the Royal Society for this opportunity.

Albert Mason: 28:38 And I demonstrated. First of all, I demonstrated how to hypnotize.

Speaker 31: 28:38 Hypnosis is quite easily achieved. You simply lie the patient down and say, "Now, I want you to let your whole body go loose. Let your arms go loose. Let your legs go loose."

Albert Mason: 28:37 And then I showed his arm.

Speaker 31: 28:39 Please, sir, if you don't mind, raise both arms.

Albert Mason: 28:45 They were staggered. In fact, the President ...

Speaker 32: 28:49 Gentlemen, this is absurd.

Albert Mason: 28:50 ... Said that it's inconceivable ...

Speaker 32: 28:52 This is inconceivable.

Albert Mason: 28:52 ... That this gets well, because ...

Speaker 32: 28:54 We all know that congenital icthyosis is incurable.

Albert Mason: 28:58 Incurable.

Robert Krulwich: 29:00 That was the exact word he used. Incurable.

Albert Mason: 29:03 Incurable.

Speaker 32: 29:03 Incurable.

Robert Krulwich: 29:07 Incurable. And the thing was since all this took place at a hospital, every stage of it was documented. There are photographs every step along the way. Before shots, after shots, closeups, all available to reporters. You could imagine what happened.

Albert Mason: 29:21 It was picked up in every newspaper, Time Magazine.

Robert Krulwich: 29:24 Big media story.

Albert Mason: 29:25 In fact the first I heard about it, I was in bed one morning a year after I'd sent the paper in for publication. And the phone rang, and a voice said, "This is Whipsnade Zoo. We have an elephant with a skin like a little boy. Can you cure him?" And I said, "What the ... What the hell are you talking about?" And then the phone started to ring and ring and ring and hundreds of calls, hundreds of letters came in from all over the world. And I had people coming in with the most terrifying illnesses wanting to be cured.

Robert Krulwich: 29:59 Especially people with that very rare skin condition.

Jad Abumrad: 30:03 Congenital icthy ... Whatever it's called?

Robert Krulwich: 30:05 Yes. They flocked to him from all over the world, and that's ... Now, here's where the story takes a turn. He would see these patients. He would hypnotize each one, one at a time, and then send them away hoping, of course, that they'd get better. And they would come back a week later and ...

Albert Mason: 30:21 None of the others ever got well.

Robert Krulwich: 30:24 At all?

Albert Mason: 30:26 No.

Robert Krulwich: 30:26 Not in any way?

Albert Mason: 30:27 No improvement. I've spent the rest of my life trying to understand this phenomenon, because I gave up anesthesia ...

Robert Krulwich: 30:34 Just a few years later, Albert Mason quit medicine and he decided to become a psychiatrist. He wanted to understand why he had the touch the first time and why after that, it just didn't work. So the central question in your mind was not what happened to the kid, but what happened to me?

Albert Mason: 30:52 That's right. That's right.

Robert Krulwich: 30:54 And what do you think the answer to that is?

Albert Mason: 30:56 Well, there is a condition called infantile omnipotence, that we all suffer from when we're kids. We think we can do anything. Unconsciously, I knew this was incurable.

Robert Krulwich: 31:11 Wait, wait, wait, wait a second, because incurable would mean that it had never been cured. But you had just ...

Albert Mason: 31:17 That's right. That's right.

Robert Krulwich: 31:17 You had just created an exception. So ...

Albert Mason: 31:20 Look. When you're 25 and the President of the Royal Society of Medicine tells you it's incurable, it has an effect.

Robert Krulwich: 31:30 That's his best guess. He thinks that that word, incurable, changed him. Just a little bit.

Albert Mason: 31:36 I lost my crazy confidence, even though I had the evidence. But it didn't work.

Robert Krulwich: 31:45 Confidence is a hard thing to measure. You can't put it on a scale. You can't weigh it, but you can sense it, because it's conveyed in a million little ways. How you stand, whether you look your patient in the eye, when you pause, where you pause, what you say, what you don't say. All these things are like signals. They say to the patient, they murmur to the patient, "I can help you. I can do this."

Albert Mason: 32:10 You know, you go to a doctor, and you've got this horrible rash all over you. And he says, "Oh, that's erythema multiforme." And you feel better immediately, because he's named it. Well, all he said is, "many red spots" in Latin. But the thing is that he knows what it is and you feel that, "Oh, he knows. Now, I'll be okay."

Robert Krulwich: 32:35 Because when you're feeling terrible, what you just want to do is hand over the authority for you situation to someone else who's got information, power ...

Jad Abumrad: 32:44 Yeah, and who's going to tell you you're going to be fine.

Anne Harrington: 32:46 And maybe that comes out from early childhood when it seems to us that our parents have that capacity.

Jad Abumrad: 32:52 Harvard historian, Anne Harrington.

Anne Harrington: 32:54 I have a two year old and we're already now at the stage where he gets a little bump and he comes to me and holds the bit of his body out that's been hurt and I kiss it. And it's okay. And there is a way that mommies is kind of a placebo effect.

Jad Abumrad: 33:13 Testing testing.

Anne Harrington: 33:14 And now imagine that you're sick. You know when you're sick, there's a strong impulse to kind of revert back to that way of interacting with people.

Jad Abumrad: 33:23 Yeah, say something just to ...

Jad Abumrad: 33:26 That's Arabic for "what do you want?"

Naji Abumrad: 33:28 Hi, Jad. How are you?

Jad Abumrad: 33:31 I'm good, Dad. How are you?

Naji Abumrad: 33:32 I'm doing very well.

Jad Abumrad: 33:33 This is my dad. Do you see how your voice goes on the thing? He's the guy that I would bring my boo-boos to as a kid. Tell me what you do. Actually, I still do ... Your title, and that kind of thing ... Because he happens to be a doctor.

Naji Abumrad: 33:43 I'm the Chairman of the Department of Surgery at Vanderbilt.

Jad Abumrad: 33:47 Vanderbilt is in ...

Naji Abumrad: 33:48 Nashville, Tennessee.

Jad Abumrad: 33:50 Where we grew up for much of our life.

Naji Abumrad: 33:52 Where you grew up for much of your life.

Jad Abumrad: 33:54 Okay, so my dad had no idea why I wanted to follow him around the hospital. I didn't exactly lead with the whole placebo thing. The truth is I feel okay about that, because this show isn't really about lying. It's about healing. The healing process, which doesn't happen in a vacuum. Patient, of course, has to believe in the cure. But the doctor has to create that belief.

Jad Abumrad: 34:16 Okay, wait. You have to walk slower.

Naji Abumrad: 34:17 I can't walk slowly.

Jad Abumrad: 34:19 And how does he do that? Wait. Tell me where we're going now.

Naji Abumrad: 34:21 We're going to the clinic.

Jad Abumrad: 34:23 Be more specific. What happens at the clinic?

Naji Abumrad: 34:25 I have patients scheduled to come and see me today.

Jad Abumrad: 34:28 These days my dad's hair is as white as his white doctor coat, but he still sees patients every Wednesday.

Naji Abumrad: 34:33 Today, I have four patients.

Jad Abumrad: 34:36 And that is why I'm here. One PM, clinic begins.

Naji Abumrad: 34:42 We are in the clinic.

Jad Abumrad: 34:42 And as if to illustrate Anne Harrington's basic point ...

Anne Harrington: 34:47 When you're sick, there's a strong impulse to kind of revert back to that way of interacting with people.

Jad Abumrad: 34:53 As soon as my dad's first patient shows up, a hair stylist from Murfreesboro, Tennessee who, when she walks down the busy hallway and sees him, as soon as she sees him, she bursts into tears.

Naji Abumrad: 35:03 Why are you crying?

Megan: 35:04 Because I ... I don't know. Just scared.

Jad Abumrad: 35:08 He gives her a hug.

Megan: 35:11 Every time I see him, it's kind of like I hold ... I have to be strong, and I feel like when I see him, I can let it down because I know that he's going to hug me and make me feel better.

Megan: 35:24 I'm a single parent and I own my own business, and I've always been in survival mode. And I've always had to be strong. And so that's why this has been so hard for me.

Jad Abumrad: 35:34 They go into a tiny exam room, which is quiet and super intimate compared to the hallway. Dad has Megan sit on a table.

Naji Abumrad: 35:42 Lift up.

Jad Abumrad: 35:44 And he gently presses two fingers to her neck.

Naji Abumrad: 35:46 Swallow a little bit. [inaudible 00:35:49].

Jad Abumrad: 35:50 There's a tiny gland in her neck that should be the size of a pea.

Naji Abumrad: 35:53 Just nod your ...

Jad Abumrad: 35:55 But over the past four years, it's gotten bigger.

Naji Abumrad: 35:58 ... Is now three inches ...

Jad Abumrad: 35:59 And bigger.

Naji Abumrad: 36:00 ... Wide and two and a half inches in the other direction.

Jad Abumrad: 36:04 Now, it's the size of a golf ball. And it presses against her airways.

Megan: 36:09 At night, sometimes I wake up and I'm ... And I think, "Oh god. Should I call 911?" And I keep asking him every week, "Are you sure I'm not going to choke?"

Naji Abumrad: 36:18 It's not going to choke you.

Megan: 36:18 It's not going to choke me.

Naji Abumrad: 36:18 It is not going to choke you.

Megan: 36:22 [crosstalk 00:36:22] Just him reassuring me.

Naji Abumrad: 36:24 It's not going to affect the airway. It will not ...

Megan: 36:26 I try to remember the little things that he says to me when I ... Especially in the middle of the night when I start feeling anxious or panicking. And in the meantime, how do I deal with the anxiety surrounding this thing, because I've got ...

Naji Abumrad: 36:37 Patients are anxious.

Megan: 36:41 I'm having lots of anxiety, but I don't know ...

Naji Abumrad: 36:43 Scared of the unknown.

Megan: 36:45 Part of it is worrying about the future. I think just because I ...

Naji Abumrad: 36:47 It's nothing to worry, Megan.

Megan: 36:49 Well, I know, but I guess it's just because of my personal responsibilities.

Naji Abumrad: 36:54 We'll work with you. You got to put them at ease. There is nothing life threatening today. You have to put them at ease. I'm going to give you a short term plan and longer term plan.

Megan: 37:02 Okay.

Jad Abumrad: 37:03 If medicine were just science, then all of this talk would be just noise because the real business would then happen in the next room where there's this big machine ready to scan Megan's thyroid. But medicine isn't purely science.

Naji Abumrad: 37:17 Yeah. I mean ...

Jad Abumrad: 37:17 Which my dad admits.

Naji Abumrad: 37:18 It's an art. It's communication.

Jad Abumrad: 37:20 Which is why he and Megan talk and talk and talk and talk for over an hour. In a way, it's a kind of negotiation. She wants to know one thing. What if my thyroid has gotten bigger? What if I had to have radiation? Will I have to quit my job? He needs her to focus on anything but the what ifs. To stay focused on what they do know, which unfortunately, is that they won't know anything for another day.

Naji Abumrad: 37:44 We'll draw the blood today and [inaudible 00:37:47] or not, I'd know it within 24 hours.

Megan: 37:49 Okay.

Naji Abumrad: 37:50 I need to know the size of that thyroid, Megan.

Jad Abumrad: 37:54 Somehow in the end, despite all the open questions, he gets her to relax.

Naji Abumrad: 37:59 We're going to work together. We're going to work together.

Megan: 38:02 Well, you got to stop going out of town so much. This is really inconvenient for me.

Jad Abumrad: 38:06 How much performance is in it?

Naji Abumrad: 38:08 What do you mean performance?

Jad Abumrad: 38:10 How much of doctoring is having to play a certain role that the patient needs at that moment?

Naji Abumrad: 38:16 It's just about every bit of it.

Jad Abumrad: 38:19 So, if I were to call it theater, would that offend you or no?

Naji Abumrad: 38:24 It's not a theater. It is ... I'm living that role. It's part of me. It's not part of a fake image that I'm projecting.

Jad Abumrad: 38:36 I think you know what I'm trying to get at.

Naji Abumrad: 38:38 Not really.

Jad Abumrad: 38:38 No? Well, it's just ...

Naji Abumrad: 38:39 Well, I mean ... You call it theater. You can call it theater, but ...

Jad Abumrad: 38:42 I just mean that ... When you don't have the white coat on and you're not in doctor mode, you don't have all the answers. You don't.

Naji Abumrad: 38:50 And I don't have all the answers then.

Jad Abumrad: 38:52 But you seem to, and particularly with her ...

Naji Abumrad: 38:55 No ...

Jad Abumrad: 38:55 That's what I really wanted to know. That magic pixie dust called certainty. How do you project that instantly to a patient the moment you walk into a room even when the patient hits you with questions like, "Doc, am I going to make it?" It can seem kind of mystical, that aura. But then again, there are the props.

Jad Abumrad: 39:15 Okay. You have to tell me what you're doing now. What is this?

Jad Abumrad: 39:17 For instance, to rewind a moment. Here we are before clinic in my dad's office. And he's just opened up his little coat closet.

Naji Abumrad: 39:23 Putting my coat on that I usually, on the day of the clinic, I choose a clean white coat.

Jad Abumrad: 39:29 Really?

Naji Abumrad: 39:29 Yeah.

Jad Abumrad: 39:30 Do you have many to choose from?

Naji Abumrad: 39:33 I have one, two, three, four, five.

Jad Abumrad: 39:35 Five? Five blindingly white, white coats. He flips through them, picks the whitest of the bunch, puts it on, and I swear to you even now when I'm older, supposedly wise to these kinds of things, it's like he changes somehow.

Jad Abumrad: 39:49 Do you ever go to see patients without your white coat on?

Naji Abumrad: 39:53 I don't like to. It's almost like you're naked without it.

Jad Abumrad: 39:57 You do seem taller with it on.

Naji Abumrad: 39:59 I do?

Jad Abumrad: 40:00 Yeah.

Jad Abumrad: 40:00 There is inherent power in the props, especially the coat. And if you have any doubt the doctors don't know this, go to a med school, any med school on the day the new students arrive, and you'll probably find something like this.

Speaker 36: 40:13 Excuse me. If we could all have a seat. We'll start the ceremony.

Jad Abumrad: 40:16 The White Coat Ceremony.

Speaker 36: 40:19 Thank you.

Jad Abumrad: 40:20 It's as close to religious ritual as you can get in medicine. And in fact, the one that we attended at Columbia University in New York ...

Speaker 37: 40:26 I ask the students to please stand with me.

Jad Abumrad: 40:29 ... Included a chaplain.

Speaker 37: 40:32 As you are able, let us pray together. Compassionate God, bless these new medical students of the Columbia University College of Physicians and Surgeons, and bless the white coats that they receive today. May these white coats be for each student a cloak of compassion, a clear statement of purpose, a sign of assurance, and a symbol of respect.

Arnold Gold: 41:03 The ceremony ...

Speaker 37: 41:04 We pray for the strength and for the ...

Arnold Gold: 41:06 ... At time has some almost spiritual component.

Speaker 37: 41:10 ... and the art of healing.

Sandra Gold: 41:10 It's quite moving, I think, I hope you'll find.

Jad Abumrad: 41:13 That's Arnold and Sandra Gold. They began the White Coat Ceremony at Columbia almost 20 years ago.

Speaker 37: 41:18 God be with each student.

Jad Abumrad: 41:20 And they were in the audience the day we were there.

Speaker 37: 41:21 ... God be with each of us.

Jad Abumrad: 41:22 Along with about 250 students and their families.

Arnold Gold: 41:25 First, each student is cloaked individually and called by name.

Speaker 40: 41:29 Eric J. [Arius 00:41:31]. James J. [Attra 00:41:34].

Arnold Gold: 41:34 They then return to their seats, and we see this visual transformation that occurs.

Sandra Gold: 41:40 This is a change that you can actually see. These people come into this room with their coats on their arm, and they're wearing blue and black and green, and yellow. And that's who they are. And you see the room filling up in white, and they see the room filling up in white.

Speaker 40: 41:56 Alexandra J. [Borst 00:41:57].

Sandra Gold: 41:57 And you know, in the old days, doctors wore black.

Jad Abumrad: 42:00 It's true. 100 years ago, doctors wore gothic black coats. But then someone discovered germs, and that the insight that germs live in dirt.

Sandra Gold: 42:09 And because you couldn't see dirt on black ...

Jad Abumrad: 42:12 Coats had to be white.

Sandra Gold: 42:13 They changed for antiseptic reasons.

Jad Abumrad: 42:15 And that is when a certain symbolism took hold.

Sandra Gold: 42:19 When you think about angels, they're never in red. They're never in black.

Speaker 40: 42:23 Please turn around to face the audience. And I present to you the Class of 2010.

Jad Abumrad: 42:32 Radiolab will continue in a moment.

Marley Duncan: 42:41 Hi. I'm Marley Duncan from Brooklyn, New York. Radiolab is supported, in part, by the National Science Foundation and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at Bye.

Jad Abumrad: 43:06 This is Radiolab. I'm Jad Abumrad.

Robert Krulwich: 43:08 And I'm Robert Krulwich.

Jad Abumrad: 43:08 And today we are talking about the placebo effect. The power of suggestion. We're looking at a lot of new research.

Robert Krulwich: 43:16 I don't know about new research. We've done ... Well, it is new research, but the problem has been with us for centuries. Even at the very beginning of the age of reason. Let me take you back. 18th Century, the Enlightenment was in full swing. There was change in the air. Voltaire was denouncing the church.

Speaker 42: 43:32 [inaudible 00:43:32].

Robert Krulwich: 43:34 Ben Franklin was flying kites.

Speaker 43: 43:35 Electricity.

Robert Krulwich: 43:39 Lavoisier was inventing Chemistry. It was the beginning of modern times, modern science, you might say. Reason, inquiry. People were re-examining the big questions. How does the world work? What possibly could hold everything together? And this was new.

Ed Cohen: 43:57 Well, you have to understand that in earlier historical moments, the unification of the universe was not a problem, because it was God that unified everything and everything was a manifestation of God.

Robert Krulwich: 44:09 That's Ed Cohen talking about God. He's a historian.

Ed Cohen: 44:11 But if God isn't the glue that hold the universe together ...

Robert Krulwich: 44:15 Then what does hold the world together? Enter Anton Mesmer.

Jad Abumrad: 44:20 Who?

Robert Krulwich: 44:20 Anton Mesmer. Have you ever said, "You mesmerize me, my darling," have you ever said that?

Jad Abumrad: 44:24 I've said things like that.

Robert Krulwich: 44:27 The word mesmer, mesmerization comes from Anton Mesmer. He was a real historical figure. So, he's part of our narrative.

Jad Abumrad: 44:34 Oh.

Robert Krulwich: 44:34 Now, get out of my way. [inaudible 00:44:34]. In 1778, he moves to Paris and he has a theory. He believes that the world was filled with a kind of fluid that moved through all living things. And he gave it his own kind of sexy name.

Ed Cohen: 44:48 Animal magnetism.

Robert Krulwich: 44:49 Or as they say in the French, "magnétisme animal."

Ed Cohen: 44:52 Right.

Robert Krulwich: 44:53 And as this force flowed through all of life, occasionally it would get stuck, like in a traffic jam. It would bunch up.

Ed Cohen: 44:59 Right. And that is also, the bunching up can also be a cause of a problem.

Robert Krulwich: 45:04 That's what he thought being sick was, blocking the flow.

Ed Cohen: 45:07 Restrictions in the flow of animal magnetism in the organism. I mean, not that dissimilar to the way that we understand traditional Chinese medicine.

Robert Krulwich: 45:15 You know, like qi, with the needles and the acupuncture. Mesmer thought that this life force, when it got stuck, could be released with a little help.

Jad Abumrad: 45:23 From needles?

Robert Krulwich: 45:24 No, no. His approach was lot more theatrical.

Ed Cohen: 45:26 He created a kind of salon. I actually think of it as a prototype for the idea of a happening in the 60s. That's the way I like to think of it. It's sort of like everybody kind of came in and there was this music playing. There was dim lighting, and he would walk around in his lovely purple suit and he had ...

Robert Krulwich: 45:48 Purple?

Ed Cohen: 45:49 Yeah, I think he was ... Lilac was, I believe, actually the shade that was reported.

Robert Krulwich: 45:54 And then he would go over to a particular client, usually it was a woman. Most of his clients were women. And he would ...

Speaker 45: 45:59 Madame.

Robert Krulwich: 45:59 ... Sit across from them and their knees would touch.

Speaker 45: 46:02 Your magnétisme animal, it is, how do you say [inaudible 00:46:08].

Speaker 46: 46:07 No.

Robert Krulwich: 46:10 And then to unblock this flow, he would stare into her eyes, stare ...

Ed Cohen: 46:16 Right.

Robert Krulwich: 46:17 And if he unjammed you, how would you know?

Ed Cohen: 46:21 Oh, because you would have a healing crisis.

Robert Krulwich: 46:23 What was that?

Ed Cohen: 46:25 Simple, they would scream. They would vibrate. He had, actually, a padded room where the ladies could go and loosen their corsets and fling themselves about and bang their heads against the wall and do whatever they needed to do in order to kind of release the dammed up energy. It was apparently quite dramatic.

Robert Krulwich: 46:52 By the looks of it, they were real seizures. And people said they felt better afterwards. So, word spread and soon he had disciples and then more disciples.

Ed Cohen: 47:01 It had a lot of popularity, yes it did.

Robert Krulwich: 47:03 So, he did what any businessman would do.

Ed Cohen: 47:05 He franchised it.

Robert Krulwich: 47:06 He branched out, and I mean this literally. He magnetized trees.

Jad Abumrad: 47:11 Trees. What?

Robert Krulwich: 47:12 Trees. Mesmer, or sometimes his assistants, would take two magnetized iron rods, touch them to a tree in the forest, and that would transfer the magnetism to the tree.

Anne Harrington: 47:23 The tree would then have the kind of therapeutic powers that a mesmerist would have.

Robert Krulwich: 47:29 How convenient. That's Anne Harrington, a Harvard historian.

Anne Harrington: 47:32 And this was quite efficient because then you could sort of have the trees do part of the work for you.

Robert Krulwich: 47:37 So imagine, if you will, lots and lots of people gathered around a tree, touching each other and the tree and allowing the flow to move through them. And they would all have fits together. And the problem was the doctors of the time, who used to have all of these people as their patients, were now losing patients and money. So, they protested to the king.

Anne Harrington: 47:55 The king established a commission. And actually one of the members of that commission was Benjamin Franklin, who at the time, was the ambassador to France. And there were other important scientists on the team.

Ed Cohen: 48:10 Majault, Sallin, d'Arcet, and Lavoisier, Guillotin was one of them.

Robert Krulwich: 48:14 Is that the guillotine we know from the ...

Ed Cohen: 48:16 Right.

Robert Krulwich: 48:16 So, we're talking here about a major, major league panel.

Ed Cohen: 48:19 These were big guys. Big names.

Anne Harrington: 48:21 And they devised a series of experiments to test for magnetic force.

Ed Cohen: 48:27 They weren't concerned whether or not animal magnetism worked. They were concerned whether or not animal magnetism existed.

Robert Krulwich: 48:35 Because they figured it can work even though it may not exist.

Anne Harrington: 48:41 And one of the most dramatic tests that they devised is sometimes identified as the first placebo control trial in history. They were actually down on Benjamin Franklin's estate.

Robert Krulwich: 48:57 This was just south of Paris, and Franklin himself conducted the experiment.

Anne Harrington: 49:01 And it involved blindfolding a young boy.

Speaker 43: 49:05 Is it on too tightly?

Speaker 48: 49:06 No.

Anne Harrington: 49:06 12, 13 years old.

Speaker 43: 49:08 Can you see anything?

Speaker 48: 49:08 No.

Speaker 43: 49:08 Any light at all?

Speaker 48: 49:08 No.

Anne Harrington: 49:12 And he was told that ...

Speaker 43: 49:14 Now, here's the deal, young boy. One of these five oak trees ...

Anne Harrington: 49:17 That one of the trees on the estate had been magnetized.

Speaker 43: 49:20 ... has been magnetized by an actual mesmerist. We'll take you to one tree at a time. Your job is to tell us which one has been magnetized.

Anne Harrington: 49:30 They said one of the trees was magnetized and we'll blindfold you and you tell us when you're up by the magnetic trees, because patients insisted that they could feel the energy. And by the way, I believe them. I'm totally persuaded that the real experiences were happening. They brought the boy to one tree.

Speaker 43: 49:52 This is tree number one.

Anne Harrington: 49:53 And he began to kind of shake and they brought him to another.

Speaker 43: 49:59 Now, we stand before tree number two.

Anne Harrington: 50:03 He began to sweat. And by the time they brought him to the third ...

Robert Krulwich: 50:06 And then the fourth.

Speaker 43: 50:07 Here we are before tree number ...

Anne Harrington: 50:10 He sort of collapsed in convulsions.

Robert Krulwich: 50:13 Which is all very dramatic, except tree number one, tree number two, and number three and number four had never been magnetized.

Anne Harrington: 50:22 So, this was seen as pretty definitive evidence that there was no magnetic force here, but they also didn't think that the boy was sort of faking it. So, what they concluded was that there is no magnetic force, but that all the effects, which they don't deny the reality of, were caused by the imagination.

Robert Krulwich: 50:42 That was Harvard historian, Anne Harrington, and Rutgers historian, Ed Cohen.

Jad Abumrad: 50:47 Our final stop in this hour comes from reporter Gregory Warner, who recently visited a tent revival in upstate New York, a little Adirondack's lakeside community, very rural, to see a faith healing.

Gregory Warner: 51:01 Okay, so I get there and I'm a little bit late and I'm a little bit nervous. There's a lot of mosquitoes. People are restless. They're sitting in their chairs. The tent flaps are still up. The sun is kind of setting and Steve, Steve [Buza 00:51:15] is going on about some verses of scripture, and people are really bored. And he says, "Don't worry, we're going to get to the healing pretty soon. The reading's important too." That kind of thing, teacher-like.

Gregory Warner: 51:27 So then he says, "Okay. Now it's time for some healing." The flaps go down and suddenly the space changes because what was before this kind of people milling in and out becomes this very focused chamber. And it begins.

Steve Buza: 51:44 [inaudible 00:51:44] ministry of any kind, come on up here.

Jad Abumrad: 51:47 This preacher, who is this guy?

Gregory Warner: 51:49 That's Steve Buza. He owns a construction company in Syracuse.

Steve Buza: 51:53 Anything at all that you need. Physical healings, finances ...

Gregory Warner: 51:57 So, he's looking out into the crowd and then a volunteer comes up.

Steve Buza: 52:02 Hi.

Speaker 51: 52:02 Hi.

Gregory Warner: 52:03 Strawberry blonde hair, pink cardigan.

Steve Buza: 52:05 What do you need?

Speaker 51: 52:07 I need my backbone straightened.

Steve Buza: 52:11 You need your backbone straightened? Tell me what's wrong with it.

Jad Abumrad: 52:12 How old is she?

Gregory Warner: 52:13 She's in high school.

Speaker 51: 52:13 It's in an S shape.

Gregory Warner: 52:16 He diagnoses her.

Steve Buza: 52:17 Scoliosis. That's ... Don't let this scare you, now. I'm not trying to scare you. Scoliosis of the spine is 100% of the time demonic, okay. It's not even physical, it's a demon.

Gregory Warner: 52:31 I'm standing next to Steve. And ...

Steve Buza: 52:32 Do you believe it's going to be straightened right now? Give me your hands.

Gregory Warner: 52:35 So, he spins her around.

Steve Buza: 52:36 I break any generational curse off of my sister right now in Jesus' name. You spirit of Scoliosis, I break your power.

Gregory Warner: 52:44 And then all of a sudden ...

Steve Buza: 52:45 Go right now, you spirit. Leave now, in Jesus' name. Backbone be straightened in Jesus' name.

Gregory Warner: 52:50 Just kind of shoves her forward.

Steve Buza: 52:51 Straighten right now in Jesus' name. In Jesus' name. Try it now. Move around. Do what you couldn't do before. Stand back and give yourself plenty of room. Move it. Move it. Move it. Move it. Faith is doing what you couldn't do before.

Gregory Warner: 53:06 I really don't want to say that she was healed or that she wasn't healed.

Steve Buza: 53:10 How does that feel to you?

Speaker 51: 53:11 Better.

Steve Buza: 53:12 There's still pain there?

Speaker 51: 53:14 No.

Gregory Warner: 53:14 Because she was just crying.

Steve Buza: 53:20 Because we're not going for 50% of this ... Is it 100% better?

Gregory Warner: 53:20 But I did ...

Speaker 51: 53:21 Yeah.

Gregory Warner: 53:21 ... Meet a woman who, something ... I think something did happen with this other woman that I met.

Speaker 52: 53:27 I need healing. I have ... I had an X-Ray, and they said there was nothing wrong with it, but my bone sticks out.

Gregory Warner: 53:34 She comes up.

Speaker 52: 53:34 And it's very painful.

Gregory Warner: 53:35 An older woman in her 50s or 60s and she just holds her hands out.

Speaker 52: 53:38 And I'm ... I clean offices and it just hurts when I ... Sometimes when it's ... try to grab something, it hurts, and I ...

Steve Buza: 53:47 Do you have carpal tunnel problems?

Speaker 52: 53:49 Probably.

Jad Abumrad: 53:49 Carpal tunnel. Explain what that is?

Gregory Warner: 53:51 I mean as far as I know, it's an inflammation of the ligaments and it's really, really painful and it's a repetitive stress injury.

Steve Buza: 53:58 [inaudible 00:53:58] I want to show you something, though. Stand right here sideways. Can everybody see?

Gregory Warner: 54:02 So what he does is he basically tells her to grip together ...

Steve Buza: 54:05 I want you to take your little pinky.

Gregory Warner: 54:05 ... Her pinky and her thumb.

Steve Buza: 54:08 And your thumb, and put it right like that.

Gregory Warner: 54:08 And make a ring, like an okay symbol.

Steve Buza: 54:11 Now, I'm going to take my smallest finger, my pinky.

Gregory Warner: 54:13 Then he sticks his finger in the ring.

Steve Buza: 54:15 I want to try to see if I can pull my pinky through your hands.

Gregory Warner: 54:18 And he says, "I'm going to try to break it, and you try to stop me."

Steve Buza: 54:21 And I want you to fight me now. I want to see how much strength you got there. Are you ready?

Gregory Warner: 54:26 He just pops it right open.

Steve Buza: 54:27 You got no strength there at all, dear.

Gregory Warner: 54:29 She can't hold her grip.

Steve Buza: 54:30 That means she got trouble in her carpal tunnel, which is right here. Give me those hands. Give me those hands.

Gregory Warner: 54:36 She gives him her hand and he takes it both of his.

Steve Buza: 54:38 Carpal tunnel, I command you in Jesus' name for all swelling and inflammation to ...

Gregory Warner: 54:42 And he starts rubbing with his thumbs.

Steve Buza: 54:44 I command all the ligaments and tendons to go back to their normal elasticity that's supposed to be in there. I command all pain to be gone out of this carpal tunnel region. I command that healing go into this entire arm and this carpal tunnel and all strength to come back to her in Jesus' name.

Gregory Warner: 54:58 And then ...

Steve Buza: 54:59 Do it again.

Gregory Warner: 55:00 He says, "Okay. Let's do the same demonstration right again." And he has her bring her pinky against her thumb, make that grip.

Steve Buza: 55:06 Okay. Now, I'm going to take my big finger and I'm going to fight you.

Gregory Warner: 55:09 And when he puts his finger in this time ...

Steve Buza: 55:10 And watch what's going to happen.

Gregory Warner: 55:11 And pulls.

Steve Buza: 55:12 You ready?

Gregory Warner: 55:14 He doesn't break her grip. And you can hear, he just drags her right across the stage.

Jad Abumrad: 55:24 So, it worked?

Gregory Warner: 55:26 It maybe did, at least temporarily. She went back to her seat, they gave her a blanket, she was really trembling. I went over to talk to her.

Speaker 52: 55:34 I feel really good.

Gregory Warner: 55:36 Can you describe what the experience was like for you?

Speaker 52: 55:45 Actually, I don't ... Didn't feel anything at first, because I was going by faith. But then when he did that thing, I don't feel the pain.

Jad Abumrad: 55:52 Christian belief is that Christ died for our sins.

Gregory Warner: 55:56 The actual phrase is, which they always repeat is ...

Speaker 52: 55:59 By the stripes of Jesus Christ, I'm healed.

Speaker 53: 56:01 By his stripes, we were healed.

Jad Abumrad: 56:03 By the stripes of Jesus, you were healed.

Speaker 52: 56:04 He healed me when he died on the cross.

Jad Abumrad: 56:07 What does that mean?

Gregory Warner: 56:08 It means that you were healed, meaning he died on the cross for our sins and also for our ailments.

Jad Abumrad: 56:14 So, we've already been healed.

Gregory Warner: 56:16 We've already been healed. We just have to access it and realize it by our connection and relationship to God.

Jad Abumrad: 56:23 Okay, so what happened to Linda afterwards?

Gregory Warner: 56:26 The carpal tunnel came back almost immediately. And I met with her in a coffee shop.

Speaker 52: 56:31 But this is my belief from reading the word of God. The devil, Satan, comes in, tries to talk you out of that healing. He'll say, "You didn't really get healed." Those things come into your mind. And I believe that's just Satan. So, you have to have strong faith to stand against that.

Jad Abumrad: 56:51 Pain is Satan's way of testing her belief?

Gregory Warner: 56:54 I think that's what she thinks.

Speaker 52: 56:55 I talk to Satan. I tell him, you are lying.

Gregory Warner: 56:57 That the pain is part of the test.

Speaker 52: 56:57 The word of God says you're a liar.

Gregory Warner: 56:57 And if the pain is there ...

Speaker 52: 57:02 He wants me to prosper.

Gregory Warner: 57:03 She's not healed. She's seeing this bigger struggle, this bigger battle where pain is just one more kind of obstacle.

Speaker 52: 57:13 Not that there aren't times that I doubt. I do. But I have to repent. I have to say, "I'm sorry, God. I doubted, because I know you've healed my so many times at so many different things. So, I know it's for real." It's not ... fake, on my part, because I know.

Gregory Warner: 57:33 I think that's the crucial point. I mean, if we think of it as a medical encounter, it's about pain and the body. But if we think of it as a spiritual encounter, the way she sees it, it's really a battle against doubt.

Jad Abumrad: 57:55 Reporter Gregory Warner. Thanks to him and you, for listening. We've got to go now.

Robert Krulwich: 58:00 Yep.

Jad Abumrad: 58:01 Don't forget to visit our website for more information on anything you heard. Also, you can sign up for our podcast as or on iTunes. And always, we'd love to hear what you think.

Robert Krulwich: 58:12 Completely.

Jad Abumrad: 58:14 is the address. I'm Jad Abumrad.

Robert Krulwich: 58:17 I'm Robert Krulwich.

Jad Abumrad: 58:17 And we're signing off.

Naji Abumrad: 58:17 Radiolab is produced by Jad Abumrad, Ellen Horne, senior producer, Lulu Miller, assistant producer, production executive Dean Cappello. Production support by Sara Pellegrini, Scott Goldberg, [inaudible 00:58:34], Ryan [inaudible 00:58:34], and Jacob [Weinberg 00:58:39]. And special thanks to me, Jad's dad, Naji Abumrad.

FabrizioBenedet: 58:44 Hello, I am Doctor Fabrizio Benedetti, and I just wanted to say thank you to Nick [inaudible 00:58:49], Mark Phillips, Sam [Dingman 00:58:52], Georgia King, [inaudible 00:58:53]. Radiolab is supported by a grant from the Alfred P. Sloan Foundation.

Anne Harrington: 59:03 Hello, I'm professor Anne Harrington. I just wanted to call and say thanks. Radiolab is produced by WNYC, New York Public Radio, and distributed by NPR, National Public Radio.