JAD ABUMRAD: This is Radiolab. I'm Jad Abumrad.

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

JAD: 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: And so I have a story to tell you.

ALBERT MASON: Five, four, three, two, one, zero.

ROBERT: It happens to be about a doctor.

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

ROBERT: Back in the s, 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: Medical hypnosis. And I just read the technique and tried it out on some friends.

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

ALBERT MASON: 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: But the more he practiced, the better he got. Putting his friends under ...

ALBERT MASON: To a trance state.

ROBERT: Getting them to remember stuff from their fifth birthday.

ALBERT MASON: And all sorts of games that we played as medical students.

ROBERT: And so he took this little party trick into the delivery room, and it worked.

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

ROBERT: 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: Well both of those are true, but at that time it was kind of fun.

ROBERT: 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: Skin disorders, asthma.

ROBERT: 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: Warts?

ROBERT: Warts, yeah.

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

ALBERT MASON: 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: Just check this out. Look at these pictures here.

JAD: Oh my god. It looks like he has a black hide over his whole body.

ALBERT MASON: It looked like an elephant skin. That's what it looked like.

JAD: Geez.

ROBERT: Yeah, well, so they take this poor boy to surgery.

ALBERT MASON: 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: Was he ... "Why don't you" in despair or in contempt?

ALBERT MASON: I think a mixture of both.

ROBERT: And by the way, when you asked that question, you're the kid asking the senior practitioner, so ...

ALBERT MASON: I was cheeky.

ROBERT: Yeah, you were a little cheeky.

ROBERT: 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: And this kid who was said, "Okay."

ROBERT: Didn't you have to tell the parents?

ALBERT MASON: 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: And why did you choose the right arm?

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

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

JAD: Totally normal looking?

ROBERT: Yes. Well, here's the photo.

JAD: Come on.

ROBERT: No, look. No, it's a real photo. This is verifiable.

ALBERT MASON: It looked like a normal skin, but rather pinker than usual. Slightly pink. And soft and supple.

JAD: Whoa. This is for real?

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

ROBERT: And what were you thinking when you first saw it?

ALBERT MASON: I was thinking how wonderful. I was thinking, "Oh, wait 'til Mr. Moore sees this."

ROBERT: 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: And I held up both his arms.

ROBERT: One black and scaly, the other pink and raw.

ALBERT MASON: 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: Well now, for those of us who are uninitiated, what is [inaudible ?

ALBERT MASON: It's a hopeless condition. Never been known to change.

ROBERT: 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: 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 : Gentlemen, please take your seats.

ALBERT MASON: So Moore took me up there with the boy.

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

ALBERT MASON: And I demonstrated. First of all, I demonstrated how to hypnotize.

Speaker : 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: And then I showed his arm.

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

ALBERT MASON: They were staggered. In fact, the President ...

Speaker : Gentlemen, this is absurd.

ALBERT MASON: ... Said that it's inconceivable ...

Speaker : This is inconceivable.

ALBERT MASON: ... That this gets well, because ...

Speaker : We all know that congenital icthyosis is incurable.

ALBERT MASON: Incurable.

ROBERT: That was the exact word he used. Incurable.

ALBERT MASON: Incurable.

Speaker : Incurable.

ROBERT: 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: It was picked up in every newspaper, Time Magazine.

ROBERT: Big media story.

ALBERT MASON: 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: Especially people with that very rare skin condition.

JAD: Congenital icthy ... Whatever it's called?

ROBERT: 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: None of the others ever got well.

ROBERT: At all?

ALBERT MASON: No.

ROBERT: Not in any way?

ALBERT MASON: No improvement. I've spent the rest of my life trying to understand this phenomenon, because I gave up anesthesia ...

ROBERT: 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: That's right. That's right.

ROBERT: And what do you think the answer to that is?

ALBERT MASON: 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: Wait, wait, wait, wait a second, because incurable would mean that it had never been cured. But you had just ...

ALBERT MASON: That's right. That's right.

ROBERT: You had just created an exception. So ...

ALBERT MASON: Look. When you're and the President of the Royal Society of Medicine tells you it's incurable, it has an effect.

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

ALBERT MASON: I lost my crazy confidence, even though I had the evidence. But it didn't work.

ROBERT: 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: 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: 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: Yeah, and who's going to tell you you're going to be fine.

ANNE HARRINGTON: And maybe that comes out from early childhood when it seems to us that our parents have that capacity.

JAD: Harvard historian, Anne Harrington.

ANNE HARRINGTON: 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: Testing testing.

ANNE HARRINGTON: 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: Yeah, say something just to ...

JAD: That's Arabic for "what do you want?"

NAJI ABUMRAD: Hi, Jad. How are you?

JAD: I'm good, Dad. How are you?

NAJI ABUMRAD: I'm doing very well.

JAD: 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: I'm the Chairman of the Department of Surgery at Vanderbilt.

JAD: Vanderbilt is in ...

NAJI ABUMRAD: Nashville, Tennessee.

JAD: Where we grew up for much of our life.

NAJI ABUMRAD: Where you grew up for much of your life.

JAD: 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: Okay, wait. You have to walk slower.

NAJI ABUMRAD: I can't walk slowly.

JAD: And how does he do that? Wait. Tell me where we're going now.

NAJI ABUMRAD: We're going to the clinic.

JAD: Be more specific. What happens at the clinic?

NAJI ABUMRAD: I have patients scheduled to come and see me today.

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

NAJI ABUMRAD: Today, I have four patients.

JAD: And that is why I'm here. One PM, clinic begins.

NAJI ABUMRAD: We are in the clinic.

JAD: And as if to illustrate Anne Harrington's basic point ...

ANNE HARRINGTON: When you're sick, there's a strong impulse to kind of revert back to that way of interacting with people.

JAD: 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: Why are you crying?

MEGAN: Because I ... I don't know. Just scared.

JAD: He gives her a hug.

MEGAN: 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: 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: 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: Lift up.

JAD: And he gently presses two fingers to her neck.

NAJI ABUMRAD: Swallow a little bit. [inaudible .

JAD: There's a tiny gland in her neck that should be the size of a pea.

NAJI ABUMRAD: Just nod your ...

JAD: But over the past four years, it's gotten bigger.

NAJI ABUMRAD: ... Is now three inches ...

JAD: And bigger.

NAJI ABUMRAD: ... Wide and two and a half inches in the other direction.

JAD: Now, it's the size of a golf ball. And it presses against her airways.

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

NAJI ABUMRAD: It's not going to choke you.

MEGAN: It's not going to choke me.

NAJI ABUMRAD: It is not going to choke you.

MEGAN: [crosstalk Just him reassuring me.

NAJI ABUMRAD: It's not going to affect the airway. It will not ...

MEGAN: 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: Patients are anxious.

MEGAN: I'm having lots of anxiety, but I don't know ...

NAJI ABUMRAD: Scared of the unknown.

MEGAN: Part of it is worrying about the future. I think just because I ...

NAJI ABUMRAD: It's nothing to worry, Megan.

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

NAJI ABUMRAD: 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: Okay.

JAD: 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: Yeah. I mean ...

JAD: Which my dad admits.

NAJI ABUMRAD: It's an art. It's communication.

JAD: 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: We'll draw the blood today and [inaudible or not, I'd know it within hours.

MEGAN: Okay.

NAJI ABUMRAD: I need to know the size of that thyroid, Megan.

JAD: Somehow in the end, despite all the open questions, he gets her to relax.

NAJI ABUMRAD: We're going to work together. We're going to work together.

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

JAD: How much performance is in it?

NAJI ABUMRAD: What do you mean performance?

JAD: How much of doctoring is having to play a certain role that the patient needs at that moment?

NAJI ABUMRAD: It's just about every bit of it.

JAD: So, if I were to call it theater, would that offend you or no?

NAJI ABUMRAD: 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: I think you know what I'm trying to get at.

NAJI ABUMRAD: Not really.

JAD: No? Well, it's just ...

NAJI ABUMRAD: Well, I mean ... You call it theater. You can call it theater, but ...

JAD: 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: And I don't have all the answers then.

JAD: But you seem to, and particularly with her ...

NAJI ABUMRAD: No ...

JAD: 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: Okay. You have to tell me what you're doing now. What is this?

JAD: 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: Putting my coat on that I usually, on the day of the clinic, I choose a clean white coat.

JAD: Really?

NAJI ABUMRAD: Yeah.

JAD: Do you have many to choose from?

NAJI ABUMRAD: I have one, two, three, four, five.

JAD: 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: Do you ever go to see patients without your white coat on?

NAJI ABUMRAD: I don't like to. It's almost like you're naked without it.

JAD: You do seem taller with it on.

NAJI ABUMRAD: I do?

JAD: Yeah.

JAD: 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 : Excuse me. If we could all have a seat. We'll start the ceremony.

JAD: The White Coat Ceremony.

Speaker : Thank you.

JAD: 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 : I ask the students to please stand with me.

JAD: ... Included a chaplain.

Speaker : 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: The ceremony ...

Speaker : We pray for the strength and for the ...

ARNOLD GOLD: ... At time has some almost spiritual component.

Speaker : ... and the art of healing.

SANDRA GOLD: It's quite moving, I think, I hope you'll find.

JAD: That's Arnold and Sandra Gold. They began the White Coat Ceremony at Columbia almost years ago.

Speaker : God be with each student.

JAD: And they were in the audience the day we were there.

Speaker : ... God be with each of us.

JAD: Along with about students and their families.

ARNOLD GOLD: First, each student is cloaked individually and called by name.

Speaker : Eric J. [Arius . James J. [Attra .

ARNOLD GOLD: They then return to their seats, and we see this visual transformation that occurs.

SANDRA GOLD: 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 : Alexandra J. [Borst .

SANDRA GOLD: And you know, in the old days, doctors wore black.

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

SANDRA GOLD: And because you couldn't see dirt on black ...

JAD: Coats had to be white.

SANDRA GOLD: They changed for antiseptic reasons.

JAD: And that is when a certain symbolism took hold.

SANDRA GOLD: When you think about angels, they're never in red. They're never in black.

Speaker : Please turn around to face the audience. And I present to you the Class of 2007.

JAD: Radiolab will continue in a moment.

 

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