 This is Think Tech Hawaii. Community matters here. The answer is yes. It is Think Tech Hawaii, and community does matter here. It's very important to us. We want to take it to new levels, both in terms of engagement and in terms of education and in terms of thinking together. So I'm Jay Fidel. This is Think Tech, and more specifically, this is Likeable Science. And I'm your guest host here on Likeable Science. And our host guest is Ethan Housh. Say hi, Ethan. Hi, Jay. How are you doing? We have a very interesting show. We're calling this The New Dichotomy, Placebo versus Nocebo. And you will see how this is a kind of mind expander, literally mind expander, to try to figure out the human brain and human experience. So, okay, what is a placebo first, and then we'll get from that to a Nocebo, okay? So, a placebo is typically some inactive compound, a compound that has no biological activity, that is given to a patient, and the patient is told that it will have some effect on his symptoms, or her symptoms. And this actually works quite well. If the patient actually believes that this compound they're taking, whether it's a cream they rub on them or a pill they take or a shot they receive, if they believe this is going to have a good effect, it typically will actually have a good effect. It will treat pain, it will reduce inflammation, it will cure rashes, whatever it may be. It's a remarkably robust, strong effect, and it's been well understood for years that this happens, you know. But, you know, I thought, now maybe I'm thinking of a different kind of experience there, a scenario, that you give some, you have a test, you have 10 people, you give half of them a real drug, and you give the other half the placebo drug, because you want to see if the real drug really does anything, and the placebo, you know it's not going to do anything. But this is another way of looking at that, isn't it? This, when you describe it that way, the placebo is doing something, but it's mental. This is a show about mental, you see what I mean. So how does that differ from my recollection of the classical model that you want to find out what the real drug is doing, and you know the placebo is not going to do anything? Right. And what you describe is the classic, yes, some sort of balanced design where you have subjects taking a known inactive compound versus an active compound to see does this medicine really work? One issue in that is do the parties involved know what they're taking, and the parties are not just the patients, but it's also the doctors. Ah. And so... Well, doctors are not necessarily relevant to this, right? They only make conclusions after the fact, but when they do the administering of the placebo versus the real drug, you don't even need a doctor in the room. It's a tech, isn't it? Well, you see, it depends. If the patients are given precisely the same directions on how to take the drug, what to expect from a drug, then everything should be good, right? But if the doctor knows, actually, that he's giving this guy a sugar pill and this guy a potent drug, the doctor may well tell the patient that he may communicate too much information. Right, exactly. It turns out when you so-called double-blind studies where neither the patients nor the doctors know what it's getting, you tend to get much more robust effects. I mean, you're very... you're really teasing apart the real impacts of the substance then. Okay, so for this discussion and this analysis for our little show today, and where we examine the dichotomy between placebo and nocebo, we'll treat the scenario as you have suggested. It's that the doctor doesn't know, the patient doesn't know, nobody knows, but half of this group is going to get a real drug and half the group... and actually you have a positive effect. And it's all mental, right? Somehow. Physiologically mental, mentally physiological. It's something happening. Well, you see, again, I mean, it depends on how you set that up, you set up telling all 10 of those patients that they're getting the drug, or you say, look, we're running a test. Some of you are getting this drug and some of you aren't. You see, that makes a difference. Again, patients' expectations. So it's all about expectations. And so, yes, if you tell the 10 patients the same room they're all getting this drug, your five placebo patients are likely... some of them are likely to experience a very good effect from their placebo. Suppose you tell them some of you are going to have an effect and others will not. How's that changing? Then everyone's got sort of the same, well, maybe I'm in a placebo group, maybe I'm in a treatment group, you know. So it's not a persuasive. They don't take the suggestion to the same degree. Right, there is, to some extent, we place higher value on a sort of a known belief. So you're likely to have some people say, all right, I've felt that. And other people say, no, I didn't feel that. Because they... Okay, right. So now let's go for a moment. Let's go over to the other side of this dichotomy. The nocebo. Until today, actually, I never heard the term before. What in the world is a noce... N-O-C-E-B-O. What was a nocebo? So a nocebo is basically the same thing as a placebo effect, but it's sort of the unintended side effect. So it is most drugs that you take, treatments that you go through, have potential bad side effects. Indeed, nowadays, if you see any of the ads on television for any compounds, they spend 20 minutes spewing up this long list of potential bad effects from blindness to death to... Huge waste of time. And it turns out that those potential side effects, if patients are alerted to them, will show up in exactly the same sort of way. So in the study that was reported on in the recent journal, recent issue of science... Science is a very important magazine. It's a journal. It's famous. If you get published in science, your career is assured. Everybody in the scientific world knows about science. And Ethan Reid said... So these experimenters wanted to look at this impact. So they took patients who were suffering from a little bit of rash, and they gave them one of two creams. Now, both creams were actually totally inert. They had no active ingredients at all. They packaged one of them in a very fancy, high-tone expensive-looking box, basically. The kind you'd see in a television ad. Right. And packaged one of them in another plain generic box. And presented these to the patients as a generic cream versus the brand name, the new hot brand name cream. And they told the patients in the exact same language, there was a potential side effect. Well, this was going to cure their rash, they thought. The patients might experience a hypersensitivity, a hyperalgesia. So a pain, potential light stimuli become painful. And interestingly enough, the patients who got the high-priced medicine, the expensive medicine, experienced much more pain, much more strongly than did the patients who got the cheap medicine. Yeah. So you have 10 people, you give them all the high-priced container labelling, and another 10 people would give them all the low-priced. And this is a result you get. What was fascinating about this was it shows up in their brain activation. They actually looked at the pain centers and the centers of the brain that are activated during painful stimuli. And they found that indeed these people were, they were feeling this pain. It wasn't just they thought they were feeling the pain. They were feeling the pain. It was in their spinal cords, it was in their frontal parts of the brains. It was very striking because they placed a greater value on that medicine. They understood it was more valuable. They had higher expectations for it. And therefore, What I get lost is yes, they have higher expectations, but the expectations are of pain. It's a pain for it. The expectations carried over to the side effects. The doctor gave them exactly the same speed about each medication. Was there any examination of where the medication worked? No, these were just the side effects. The patient was totally there was no expectation that it would work. Oh yes, the patients believed it would work. It was working, but they had side effects. The expectations of working and of having side effects were elevated. It was a fancy brand. Exactly. It was very intriguing. And I mean people found in larger studies the same kind of effect where a group of people are going through a treatment and if you tell the people that you are stopping their treatment even while you continue to give them the drugs but you tell them that you've stopped giving them the drugs, they'll begin to experience more pain or symptoms. The recurrence of the old symptoms. Exactly. And for that matter, recurrence of the old disease I suppose. Right. And vice versa of course. I mean, the classic placebo effect if you tell them they're getting treated and they believe you. So where does this take us? Before the show. It sounds like it takes us to the psychology of doctors dealing with patients and what they say to a patient while they're administering a drug. That's what the lesson is. Can you explain? Well, I think it goes actually deeper than that. It really goes to the power of our belief systems, our expectations and if you believe that you have that you can essentially control things in your body you are able to. So you can reduce your own pain level by having an appropriate sort of expectation that you can do this. And it really speaks to the power of the mind in terms of producing or alleviating symptoms in the body. I told you this was going to be a show about mental. And it calls back to me something that was popular in the 70s maybe called biofeedback. And there were doctors here in this community that would wire you up and they would let you see your own biological vital signs and this was supposed to help you sort of deal with yourself and know exactly where you are. You would be in touch with your physiology and that would help you in some way. And I think there's a lot flows out of that because I think there was some real truth in that. Absolutely. And I think most of us are sort of not self-aware of how our body is doing. Very much. In a nuclear society everything is detached. The brain is detached from the body you don't think much about your body you don't think of what terrible things food is going to do for your body. You're not integrated. Right. I mean even my recent guest, R.B. Kelly has come on and we talked about this with just how you present yourself and how you foster yourself these things you're not very aware of but that are sending signals back and forth all the time. I don't know if they do it anymore but it's a worthy adventure to do biofeedback on yourself and develop that kind of awareness you don't actually need machinery to do biofeedback you can just get up in the morning and say I think I'll be in touch with myself it's like weighing yourself on a scale because then you know the sea changes you know how your body is doing so can you step on an imaginary scale and weigh yourself? How do I feel? That's what my body is really doing and that conceivably deals with disease and with pain the other thing just before we get into the meat of that this strikes me that we now have technology that measures pain at the brain level that's very interesting it reminds me of Linda Wan she has right now today in a big laboratory in the basement of Queens Hospital with these MRI machines very advanced MRI machines where she can analyze the brain and what's going on in the brain how the brain is developing and I don't know if she's gone this far but how the brain is reacting to disease but also how the brain is feeling how you're feeling your emotional state of mind and you can see that objectively with some of these machines as I was making the point earlier these patients who had this expensive cream and were feeling the side effect their brains were showing exactly the same patterns as people who really experienced that hyperalgesia the excessive pain to late stimuli in some ways there's no difference between the reality and the perception to your point biofeedback is great if you become more aware of your rhythms whether it's brain waves or stomach growling or whatever it may be that's useful stuff to begin to know but how far can that go and years ago Louis Thomas he was an MD who wrote a wonderful book called Lives of a Cell talked about this exact topic and about people wanting to sort of get in touch with themselves and he sort of took a logical extreme and said but if I were told tomorrow that I was in charge of my liver I'd be horrified I don't have the first clue about how to make a hepatic decision my liver works fine it does what it needs to do it filters up toxins it does all that great stuff I don't tell it what to do I'm not in charge of it so where is this I don't know from the biofeedback you actually found that you could control some things by simply knowing what the metrics were if you listened to yourself but you know the big part of this and we're going to hear about it after the break is what has all of this got to do with Donald J. Trump okay now that's a clear thing it does, there's a lot to do I'm going to come right back when I tell you the answer to that question here on likeable science with Ethan Allen and me you'll see just stick around what on the list is who's going to drive it's nice to know you're going to get home alive plan for fun and responsibility choose the D.D. captain of our team it's the D.D. for every game day a sign a designated driver son all the better to see you with my gear that's the flow what are you doing research says reading from birth accelerates the baby's brain development now this is the starting line read aloud 15 minutes every child every parent every day okay likeable science, Ethan Allen and me he's the host guest so we're talking about the dichotomy between placebos and nocebos and we've found that you can do amazing things by suggesting things and developing expectations or person and this is like a little window on the fantastic magic of the mind remember and you write this down too we're all mammals we're biochemical mammals so our minds are not like AI computers our minds are mammalian minds they can be manipulated they can be engineered and we run in so many ways on expectations it's likeable science sometimes it's not likeable it's something else so the question and we have not discussed this this is a brand new cliffhanger for Ethan what has this all got to do with Donald J Trump well there is Trump and for that matter almost any politician is managing expectations on a large scale but it's the same kind of thing do the people at large expect that the country is going in the right direction or getting better or whatever it may be and if they do you've managed expectations well whether you actually improve the economy or just giving people the impression that the economy is improving whether their lives are actually measurable and materially getting better or whether they just think their lives are getting better does it really matter is it really the same thing and the mammalian biochemical people that we are but I wanted to tell you my own experience my own experience is back when I thought psychology was important and I believe that early on people are mammals that was my theory a long time that's true theory and I studied for example social engineering in a hacking context a lot of shows back in HPR Day on the radio with these hacker people, you know, who would manage to get inside your company or inside your house or inside your machine by social engineering. It wasn't even technological. It was just so it fooled you, they would deceive you, they would play on your emotions and expectations and they would get into your computer and they would hack it and you and everything. And so I okay, I studied that I was sort of a student of social engineering thinking that took things further than psychology, it was like applied psychology. It was a way to manipulate somebody and it was, you know, it was a euphemism, social engineering, what are you talking about engineering, not engineering, it's psychology. And that's what people do and I thought, gee, you know, actually, we all do that. We do that in the course of our lives, you know, you're a lawyer, go to court, you're engineering the judge to think your way or the jury. So it's, you know, it's all about psychology. But then I learned something else, Ethan, and this is only recently and it sort of throws out of you long in Louisiana about being a demagogue or Hitler in Germany being a demagogue and trying to feed through not just a guy with a computer. You know, you want to hack his computer. No, you don't have to throw the whole country, you don't have to throw everybody. You want to do social engineering on a grandest possible scale. Well, look at Madison Avenue, what do you think they do, okay? And we've taken that to a science and then politics, look at politics. And we've taken that to, they pay a lot of money to all these consultants who work for political campaigns to do social engineering, a large population of hundreds of millions of people. It's what it is, it's social engineering. The mind, the human mind is the most incredible thing. We have only begun, you know, to understand it. And I mean, just a little, and it's so much more to understand. So this silly dichotomy that you've stumbled on in the science magazine, the seaballs versus no seaballs is like a window into social engineering is to managing expectations, creating false reactions which people are convinced are true. They believe it's so true they believe their body is actually different, acting differently, experiencing different sensations, diseases even. I mean, you might even solve epidemics. Not just one person, but you know, you can change history by social engineering, large numbers of people to manage their expectations using psychology on a mass scale. How different is that from an anthill? Well, the anthill is more communal. I mean, that's a more friendly one. The anths in general are, you know, in tune with one another on a much better level. So what are you getting here from Trump and expectations and social engineering and managing and having people believe what isn't true? Yeah, that to me is one of the really sort of amazing and sort of disturbing aspects to our current political situation is that there appear to be a large number of people who are perfectly willing to ignore facts that are staring them in the face and situations that are just blatantly obvious and to believe something different. Just because somebody is telling them, you should believe something different. That is, while I said that I thought that Trump's election was a huge statement about the failure of our education system, we have not taught our students our population to think in an evidence-based way. You know, people just, you know, if you repeat something often enough, people will start to believe it, whether there's any evidence for it or not. And this is what, yeah, he apparently hit on a few good themes that resonated well enough with people and hammered them home hard enough. People believe these and, you know, pretty soon everyone's singing that same song. Here we are. Well, you know, I think it's science. What he's, you know, you can say he's mad, but there's a method about that. And I think he understands what this discussion is all about. He understands no seabills. He understands how to make people feel that a subjective thing is the reality and to create the subjective thing in somebody based on maybe base impulses and, you know, all the wrong things. But nevertheless, it's not just one person. He's not just convincing a judge or a jury. He's convincing hundreds of millions of people. It's quite amazing. But it opens the door to a huge new area of science. What, you know, this is, it's not the first time it's happened, but it's never happened on this scale, in my opinion. We need to study this. We need to study exactly what this article is about. We need to study what no seabills are and expectations and psychology and the whole confluence of all these things that are purely human, which we don't really fully understand. Because, you know, it's one thing, if you check me out in a clinical way, put me there with the biofeed machine and all that. It's another thing, if you give me the whole country to play with. It's a laboratory that we have not dropped our arms around yet. Right. And we have to look at that. Yeah, I mean, this is, this takes us all to a different level. It's sort of what we're doing on a planetary level. We are starting to do the same kind of experimentation on our planet in terms of we're dumping carbon and smoke into the atmosphere and micro-plastic particles into the ocean. And we're doing this on a grand scale. And we're telling people that it's good for that. Yeah, yeah, yeah. Talking about deceptions and switching the reality. Right. And Trump just, his EPA just walked back a number of regulations claiming that this is sort of, this is going to be good for the country. You know, it will make businesses proceed faster and smoother. And the fact that, you know, it's going to degrade our water systems you know, all that. Yeah, yeah. Well, we're really in trouble here because I think that it's like, it's like the net. It's like the internet. When the internet, it was about the year 2000 and so when the internet came about, there were people who used it for political purposes and they were ahead of the people who didn't use it for political purposes. And that yin yang has continued till now, where if you were ahead of the other guy in terms of using the science, you could affect more thinking in more people than the other guy and we're in that way. This is not necessarily making the right decision. It's jeopardizes democracy. Right. Democracy assumes that we are maybe less mammalian and more rational. And now I think it's clear that democracy is at risk because of, you know, the internet, because of this kind of new social psychology that we see in evidence now more and more. And so how can we return to the place we were before where we are not so affected, where our expectations were more influenced by critical thinking and evidence-based thinking, as you said? How can we return to that old place? I suppose the better question is, can we return to that old place? Yeah, I don't know. Will we be able to get there before we rip ourselves apart? Yeah. One way, I suppose, is to study this. Yeah, absolutely. You've got to look at the eye and say, hey, this is the situation. Let's study it. Let's deal with it. Let's learn about it. So what would you do if you knew more about it? If you knew how it worked, what would you do? Would you do a drug? Would you do a medicine? Would you do an education campaign? I think education, I think we have to ultimately come to understand that really every freaking one of us, all seven plus a billion of us, live on one tiny little blip in the universe. And it's tiny little blip. It has just limited resources, it's got its own little supply of air, it's got its own little supply of water, neither of those is infinite. You know, what I do to the water around me, pretty soon it's going to drift over to you. What the guy on the other side of the world does to the air, pretty soon it swirls over to me. You know, we can't all pretend that we live our own world and it's just us. I mean, again, this is sort of the Trump nationalism. You know, we're the only one who counts. What's good for the USA is good for all of us. End of discussion. It's no, it isn't. I mean, we're all part of this global community and we need to appreciate our humanness, on our oneness, our relation to everyone else and the the plant that we live on and all the rest of life that supports us and the environments. Well, let me offer another thought about science that has appeared also in the MIT, you know, science. Download, yeah. Yeah, bulletin that comes out every day. It's really, really terrific. You want to learn about what's going on in the world of science. But it's called the MIT. Download. Download, yeah, it's fabulous. It's great. And one of the threads that's come out recently and continuingly is about artificial intelligence, about AI, about how the big computer companies are scrambling to get a corner on artificial intelligence. They're going to build it into our phones, our computers, our world. And, you know, it's part of this is the autonomous vehicle and the self-driving cars. But it's much bigger than that. Oh, absolutely, yeah. Because it can think better than, may I say, better than human beings can think. Oh, yeah. And we live in a time, you know, I hope it works out where artificial intelligence will be increasingly important to our quality of life and our governments. And I've always felt, and I feel more strongly now, that ultimately the human mammalian mind, with all its foibles, remember the lock-hobbs dichotomy, is mankind, if humankind, perfectible or imperfectible? Well, you know, in some ways it's not perfectible. Sorry, we're still mammals. So how do you solve this? I'll give you one element, one thread, you can respond to me. Because what about putting the AI machines in charge? They're rational. And, you know, they don't have problems being deceived and defrauded, I don't think. They've got to be well-programmed, of course. But maybe just maybe they would do a better job and a kinder, nicer, gentler job. What do you think? They might. I mean, again, it depends. Because if the data is fed into them has biases within it, they will sort of incorporate, embody those same biases and feed them right back out. So, yes, as long as they are appropriately programmed and sort of understand the equality, unity of all people, I'm all for it, you know? Remember, they teach themselves, and you can teach them to be ethical, too, I believe. So we live in a time when maybe we can clear this up before we find out what's on the dark side, what's under the rock here, with all this, you know, demagoguery. Yeah, let's talk. It's so nice to talk to you, Ethan. It's great fun. We're discovering the universe together. Thank you so much. Great fun. Have a lot of fun. Have a lot of fun.