Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#28: Is it the Remedy, a Placebo, or just Time? And, How Can You Tell the Difference?
Take the Health Type Quiz
Fascinating interplay between placebos and nocebos: what they are, why they matter, and how they shape your health decisions. Understanding these effects can help you save money, avoid disappointment, and make better-informed choices.
Key Points:
- Placebos and Nocebos Defined:
- A placebo is an inert treatment leading to perceived improvement.
- A nocebo occurs when negative expectations cause symptoms, even without an active trigger.
- Personal Stories:
- My N-of-1 trial with creatine showed measurable improvements in muscle mass, confirming results beyond placebo effects.
- A friend’s experience with plantar fasciitis improvement through chiropractic care raised questions about the placebo effect.
- Taking a "statin holiday" revealed potential nocebo-related muscle soreness, which I’m further testing.
- Historical Context:
- Early mentions of placebos include 16th-century sham exorcisms, where false holy relics exposed imagined reactions.
- The first placebo-controlled trial in 1863 tested rheumatism treatments, showing equal results between opium creams and inert plant-based ointments.
- Scientific Insights:
- Pain Relief: A study using laser pain tests demonstrated reduced pain with a placebo cream compared to control groups (study link).
- Depression: Research on placebo antidepressants revealed that labeled placebos activated opioid receptors in the brain, mimicking real treatments (study link).
- Sham Surgeries: A study on knee arthroscopy found no difference between real and placebo procedures over two years, reshaping how such surgeries are viewed (study link).
- Sports Performance: Athletes showed enhanced cycling performance when they believed they received enriched oxygen, demonstrating the power of belief in physical exertion (study link).
- Everyday Medicine:
- A UK survey found that 77% of doctors regularly use “impure placebos” such as unnecessary supplements or low-dose prescriptions to reassure patients (study link).
Takeaways:
- Question Health Claims: Evaluate whether improvements from treatments or products might stem from placebo effects, not actual efficacy.
- Test for Yourself: Apply N-of-1 experiments to discern the true impact of treatments, incorporating blind tests where possible.
- Stay Skeptical: Avoid falling for placebo-driven marketing claims and expensive remedies that may lack scientific backing.
Let me know your thoughts or questions by visiting drbobbylivelongandwell.com. Let’s keep exploring how to live long and well!
18th century French philosopher, voltaire said the art of medicine consists in amusing the patient while nature cures the disease. This was one of the first discussions of the placebo effect, a very common and important phenomenon where we believe a treatment will work and, lo and behold, it does, even if that treatment has nothing active in it. This concept is critical to not being led in a false direction of what does or does not work for you. Hi, I'm Dr Bobby Du Bois and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome my listeners to episode 28.
Speaker 1:Is it the remedy, a placebo, or just time? And how can you tell the difference? So a placebo is giving a harmless or inert compound and sometimes the patient feels better. It's also used in clinical trials as a comparison between the active agent and, in this case, the placebo. Now related to the placebo effect is something very similar, but you may not have heard about it, and that's the nocebo effect. When you take something, a medication or something like that, and you think it might cause a side effect, well, it's a self-fulfilling prophecy and in many cases you do, and it's not an active agent causing it, it's your mind that's perceiving it. Statins have had a lot of attention on this, with muscle soreness and muscle weakness, and we'll talk a little bit in a few minutes about my scenario with this.
Speaker 1:I believe talking about placebos is a logical follow-on. So last episode we talked about the N of 1 trial, where you figure out what does or doesn't work for you. And of course, when you try something to improve your sleep, to reduce your blood pressure, whatever it might be, there could be a placebo effect built into it. So with the end of one trial, we start it, then we stop it, then we try it again, then we stop it and eventually we get a sense of whether it works or not and that sort of minimizes the placebo problem. But you know, we'll talk about this in more detail in just a few minutes. So my plan for today is part one explain how powerful are placebos and the nocebos? Part two why does the placebo effect happen? What are the things that make it a very, very real phenomenon? And part three what are you supposed to do with this information? Moving forward and hopefully we'll have some very tangible practical steps for you.
Speaker 1:This is surprisingly an important topic. It isn't just an esoteric. Well, isn't this interesting? Dr Bobby, of course, is a nerd and he loves this stuff, which is all true, but it's something that affects you on a day-to-day basis and it's how you react to what you might hear from a friend or read in a newspaper and how you experience your life. So I hope by the end of this, you realize it is something very, very important. Now, the way you incorporate the concepts of a placebo may well relate to your health type. Again, our health types tell us how we acquire information, what we do with that information, how we make decisions, how we react to things that arise that may be problematic in our health. If you haven't taken the health type quiz, please go to my website. You can also sign up for my newsletter if you wish to do that, and again, my website is drbobblivelongandwellcom.
Speaker 1:Well, it's that time for each episode where I have to tell you my personal story and why do I want to talk about this? As you, my listeners, might wonder why do I pick certain topics? Well, of course I pick certain topics because I think they're intrinsically important and that you might want to hear about them and I might have a take. That's quite a bit different, like alcohol or how many glasses of water a day to drink, or whether your coffee in the morning is a good idea or a bad idea, but I also get fascinated by topics because they're relevant to me. I shared in the end of one episode my desire to build muscle strength as I'm getting older and build muscle, and I wondered about creatine. And as I was doing it, I was thinking well, you know, if I'm feeling stronger after I have tried creatine for a period of time, maybe it's just a placebo and that's what's going on. So when I was testing out the creatine, I put in a pretty rigorous N of 1 trial and I measured my actual muscle mass, the number of pounds of muscle I have, using a DEXA scan and I did show that in fact, for me anyways, it worked. So there's some ways around just thinking. Maybe it's a scan and I did show that in fact for me anyways, it worked. So there's some ways around just thinking maybe it's a placebo.
Speaker 1:I was having coffee the other day with my buddy, tim, and he told me a placebo effect and in fact he used the word maybe this is a placebo. So he's had a plantar fasciitis, which is a pretty painful condition when you walk or run or whatever on your feet, and he had tried some ice and various other things and he decided he would go to his chiropractor. This chiropractor said well, look, the heel of your foot is a bunch of bones and I think maybe I can realign those bones and you will feel better. Maybe I can realign those bones and you will feel better. So he went to the chiropractor. The chiropractor did the manipulation of his foot and he got better, or he felt he was somewhat improved. And he said to me Bobby, I don't know whether this is just a placebo, should I go to my chiropractor more often? And I said that's a really great question.
Speaker 1:Now he also said another vignette which wasn't a placebo story but it was a nocebo study. So here's what he told me. He says you know, I'm thinking of going to visit my grandchildren and normally, you know I would take an airplane airplane. But invariably when I get back from my trip I end up with a cold, and I know those airplanes are supposed to do well with circulating through filters, but I think I'm catching a cold on the airplane and next time I'm going to drive. So in essence, he goes in an airplane, he thinks he's going to get sick and he does get sick. And I pointed out to him. I said, tim, you know it's possible, it's the airplane. I doubt it, but it's possible. But when you go to visit your grandchildren you're visiting a bunch of germ factories. You know the kids that you're with your grandkids, of course, go to school and they bring home every virus known to man and you may well just be picking that up from your grandkids. It has nothing to do with whether you drove a car there or you flew on an airplane. He says, well, that's a really good point. So maybe we'll do some testing in his future to figure out what's really going on. To figure out what's really going on.
Speaker 1:And finally, on a personal note as well for me, I have noticed for a fair bit of time that my muscles have been quite sore and maybe a little more fatigued than I would think they should be Now. I work out regularly and so I figured well, it's just because I work out a lot. But I'm also on a statin, on a Lipitor, a generic version of Lipitor to bring my cholesterol down to a nice low level. And I started wondering maybe my muscle soreness and also my pace running and my amount of power on the bike has been falling. It's like, well, you know, I could be just getting older, or maybe it's related to the statin and maybe it's really causing some muscle discomfort and muscle weakness.
Speaker 1:So in chatting with my physician, we decided I would go on a statin holiday, meaning I would stop the statin for a number of weeks and see if I feel better, and then we will re-challenge with perhaps a different statin and see how I do. Well, it's been about five, six days and I ran on the treadmill and I felt a whole lot better and I went on the peloton bike and I felt like, wow, I'm doing stronger than I previously did. So maybe it really was due to the statins causing weakness. But then of course I said to myself, you know, maybe it's just the nocebo effect, in this case, now the reversing of it, the placebo effect. I stopped a drug that I thought might cause the discomfort and the weakness and, lo and behold, I'm feeling better. So at the moment I don't know. I will keep you posted. I will ultimately re-challenge with a statin and see if the symptoms come back. And so I too are facing nocebo and placebo effects in my life.
Speaker 1:And I suspect, if you think about your life, what you experience and what you read and hear from people, there's a bunch of placebo, nocebo things happening for you, perhaps in your life. Well, it is an interesting nerd topic, but why should you care? And there are really four reasons why this plays out in a very important way in your life. The first is I'd like to save you money. There's a lot of marketing campaigns out there and they make claims of really strong benefits. Maybe it's whole body cryotherapy booths or special supplements that you should take, or this new thing, this water bottle that you can carry with you that has hydrogen gas bubbling through it. All of these things cost a fair bit of money. So, by understanding that a lot of the marketing hype is built around placebo, somebody tries these wonderful things, they have a testimonial, it goes on social media and all of a sudden, people think there's actually rigorous science supporting them when in fact there really isn't. So that's the first reason why you should care.
Speaker 1:Reason number two I want to help you avoid disappointment. What do I mean by that? Well, if you get a false belief that something's helping you, like I've stopped the statins and my muscle strength is going to get better and I'm going to run faster I might be disappointed in a month when I realized. You know, it was just a placebo effect. It was just how I was approaching it. It wasn't actually that the drug was causing me to get better or worse. So I want to help you avoid that disappointment.
Speaker 1:Third, I want you to be able to read headlines better, so that when you hear about something that sounds just too good to be true, that you can ask yourself lots of questions, one of which would be is this really a placebo effect? I'm hearing about and I want to help you reduce the fear of a potential nocebo effect. So I hear from family members. You know, every time the pollen count is high, I get a headache, or when I have gluten-containing foods, I feel bad. Now, this could be a real effect of the gluten and the pollen, but it's also possible that it's a placebo or a nocebo effect, where you think that when pollens are high that it causes you discomfort, and, lo and behold, it does. So keep listening. Hopefully I'll give you some tips about how to explore this and figure out what's real and perhaps what's not. Well, I love to delve into the history of every topic because I think it gives us some perspective on kind of how to think about things of every topic, because I think it gives us some perspective on kind of how to think about things.
Speaker 1:Now, this is a bit tongue-in-cheek, but I believe the first report on the placebo effect was in the Bible, in the book of Judges. Now you may be wondering, dr Bobby, we know you're nota reverend or a rabbi, so what's your knowledge of the Bible? Well, I don't have too much knowledge of the Bible, but there is this story of Samson and Delilah, and remember, samson had long hair and he attributed his superhuman strength to his long hair. Now, was this a placebo? Was it not a placebo? Who knows, depends upon how you interpret the Bible. Now, delilah decided for whatever reason and I don't know all the details that she was mad at him and she, one night, when he was asleep, cut off his hair and, lo and behold, his superhuman strength went away. Now, was that a placebo effect? He thought the hair caused him this great strength. He lost the hair. He lost that. Well, later in the story, god gives him back his strength. Was that another placebo effect that God says your strength is back now, and lo and behold, it was, or was it a placebo effect? Anyhow, that's an interesting kind of story, and maybe it's a placebo, maybe it's not.
Speaker 1:Well, the awareness of the concept of a placebo has been around for 500 years or more. There was someone writing in the 1500s, ambroise Perret, and he said something which really encapsulates a lot of how we think about the placebo effect and how we care for our patients. So what did he say? He said the physician's duty was to cure occasionally, relieve often and console always. Similarly, in the 18th century, the French philosopher Voltaire said the art of medicine consists in amusing the patient, while nature cures the disease. So there's this sense that ailments will get better on their own, and our job as a doctor is really just to nurture you along that path, whether or not we have a treatment that really works or not. I think it really does speak to the placebo effect. Now, in the 18th century the placebo word actually became part of medical jargon and it was defined as any medicine adapted more to please than to benefit the patient. So the characteristics were to please the patient and accede to their demands and requests.
Speaker 1:Well, these were just mentions of the concept, but there actually goes back hundreds of years where people tested the concept. Again, I'm not an expert on Catholic history, but apparently in the 16th century the Catholic church was concerned about reports of exorcisms where I guess the devil or demons would be released from the body, and apparently the way this was done back then was to give a holy relic to this possessed person. And if they violently reacted with contortions and seizures, they thought, oh wow, this is really the devil or whatever leaving. So in the 16th century they came up with false relics, just simple wood objects that really weren't relics. And if in fact the patient had this violent contortions, they thought it was a false and purely imagination of what was going on. And then in 1799, a scientist named a physician, named John Haygarth, tried a sham approach. So back in that day people had rubantism, what we might call arthritis today and they thought well, we have this thing called a Perkins tractor. Now it's not a tractor like I drive on the ranch, it's what looks like a Harry Potter wand and it was made out of very rare metals and you would touch it to the painful swollen spot and it would draw out the bad energy. So John Hagar said I'm not sure this thing is real. So he made a wooden tractor like a wand and painted it to look like it was with that rare metal and he would touch it to the patient and draw out the things. And what he found is that the dummy one worked as well as the real one. So that was kind of the first kind of sham approach to what really was a placebo effect.
Speaker 1:The true first placebo-controlled trial happened in 1863 at Dr Austin Flint, and he was again trying to deal with rheumatism, arthritis, painful joints, and he attempted to give people either creams that had opium in it, which might actually relieve discomfort, or a similar ointment with some inert plant that wasn't herbal, that wasn't going to change anything, and what he found was, lo and behold, the placebo ointment did just as well. Well, let's turn from history to some science and walk you through some examples, first of the placebo effect and then of the nocebo effect and how powerful it can be and preview of coming attractions in a few minutes. Doctors use this concept in our practices and I'll explain to you what I mean by that. So four different examples. The first is pain relief. So there's a certain type of experiment where you shine a laser on somebody's hand, causes it to heat up, it causes discomfort in the hand. So what they did was they basically came up with a cream that they put on the patient's skin and they said this cream for the placebo group. They said, well, this cream may provide some anesthetic relief. And then in the control group, they just told them it was an inert cream, they were just putting it on, it wasn't really going to affect their discomfort. But lo and behold, the group that had the cream, thinking it was actually a topical anesthetic, felt much better with the pain, meaning the pain wasn't as difficult for them or as strong for them as it was. For the control group, again, the placebo was just that there was really nothing in the cream.
Speaker 1:Secondly and this is a fascinating study, not only just for the symptom changes but what they found on PET scans so depression. They took 35 people with known depression and they had two different placebo groups. In fact, all of them were in fact placebo groups and they said for one of them, this is going to be a fast-acting antidepressant. And the other group? They said, well, this is just a placebo and there's nothing active in it. Well, the ones that were told this is a fast-acting antidepressant felt better compared to the ones that were told no, no, it's just a pill and there's really not going to do much for you. Now where this gets really intriguing is they did PET scans and they found that in the placebo group where they told them this was an antidepressant, they found that a certain type of opioid receptor was more active in the brain. So something was going on in the brain. In the people who thought they were getting an active antidepressant, certain areas lit up compared to the people who didn't. Now what made it even more exciting was that when they really gave them antidepressants, the people who started to feel better, it was the same part of the brain that lit up with the placebo. So the placebo effect isn't just hocus pocus, it's really doing something potentially in our brains.
Speaker 1:Now the third study is a classic study that goes back about 20 years and it was a sham procedure. Now, what do I mean by that? So at the time, people who had some arthritic complaints in their knee might undergo knee arthroscopy and when they would go in there they would lavage the joint. They would take out the broken pieces of cartilage and they would wash the joint and then the patient might feel better. So they did a study, which is remarkable. So half the people got the real debridement and lavage, the cleaning of the joint, and the other group had anesthesia. But all they did was they had a little cut on the knee to make it look like they had the actual procedure, but they didn't. And they followed these people for two years and, lo and behold, there was no difference between either group. They both had improvements, both the ones that had the actual lavage and the placebo group. And nowadays you don't see a lot of this procedure because this study pretty much showed it was a placebo effect.
Speaker 1:Well, in sports this happens too. They've done studies of cycling performance. Get people on a bike, see how hard they can go, see how long they can go before they get completely exhausted. So in one interesting study. And all of these studies all have links in the show notes. So by all means, go and read them for yourself. So one group is told we're giving you enriched oxygen or a placebo. You're not getting enriched oxygen, and in each case, nothing was different. But the people thought, oh, I'm getting more oxygen, I'm going to feel better, I'm going to do better on the bike. Lo and behold, they did Similarly when you were giving people certain capsules red versus white with certain touted benefits cycling performance improved. Well, those are four examples.
Speaker 1:But this isn't just scientific experiments. In fact, this happens regularly in medical practice. Now, this was a study in the UK and they asked doctors how often do you use placebos? And what they found was they interviewed about 800 physicians. There is that 12% of them used a pure placebo, a sugar pill. They gave it to the patient and hoped that the patient might feel better. Now, there's some ethical questions about this, but that's what we learned from the survey. But then when they asked him well, do you every year use not a sugar pill, what's called a pure placebo, but an impure placebo? Now, that's a supplement that's known not to work. So I might give you a peppermint pill for your sore throat, or I might give you a tiny, tiny dose of something that isn't really going to affect you medically. Or I might say well, I know you have a virus causing your cold, but I'm going to give you antibiotics anyways. Or you might have tried ibuprofen at home, but I'm going to give you a prescription version and see if you get better. And this happened a lot. 77% of the doctors who responded said they use it on a weekly basis. So probably not when you go to your doctor do you get a sugar pill, because generally you go to the drugstore and they're not giving you sugar pills. But you may well be given something that the doctor is like eh, it's not going to hurt. I don't think it's going to help, but it might make you feel better. So placebo effect does happen.
Speaker 1:Now I have been mentioning the nocebo effect, so let me show you, share with you information, that this is equally powerful. So there was an important study called the Samson study, where they took people who were having problems with muscle soreness and weakness from their statins, their Lipitor or Torvastatin or something like that, just like the story I've been telling you. So they did an interesting study where they gave these people 12 pill bottles. Four of them had a statin, four of them had a placebo, but they thought it was a statin, and four were empty. So the patient knew that they weren't on that statin and they used a symptom score and they basically the more symptoms, meaning the more muscle weakness and soreness, the higher the score on this visual analog scale. What did they find? So when people were actually on the statin? So the four bottles that actually had statins in it, they had a score of 16, meaning they had some symptoms, or some people had some symptoms. But when they looked at the placebo month, the ones where they took pills, where the patients thought it was a statin, lo and behold, there was no difference in between the real statin. Lo and behold, there was no difference between the real statin and the fake statin. The fake statin people had symptoms too. So also, sometimes people stop taking their medicines because they say, oh, these side effects are really bad. Well, there was no difference in the rate of discontinuation between the people who got the placebo and people who got the statins. Continuation, between the people who got the placebo and people who got the statins.
Speaker 1:Well, the final nocebo one is a really fun one. There is a phenomenon when you occlude a blood vessel, so let's say you're getting your blood pressure measured, so it cuts off the blood in your arm temporarily, then they release it and then they measure your blood pressure. But if you did that for a little bit longer and released it, the blood rushes into your arm or rushes in into your leg. This is called flow-mediated dilation. It's actually a measure of how good your arteries are and how flexible they are, and you want to see a lot of blood flow going into your arm or leg after you've occluded it for a little while. So this is a measure of goodness of your blood vessels or how happy they are in response to this.
Speaker 1:So they gave a series of people a milkshake and they had everybody got the milkshake but one half of the people. They were told this is a milkshake. It they had. Everybody got the milkshake but one half of the people. They were told this is a milkshake. It has high calories, has a lot of fat in it. The second group was the same milkshake, but they said no, no, no, this is healthy, it doesn't have a lot of calories and we want to give this to you as part of this study. And lo and behold that when they told people that it was an unhealthy milkshake, that flow was reduced, the flexibility was reduced, but when they told people, no, no, it's all very healthy, it wasn't. So it was fascinating that people who thought it was bad for them had a response that suggested it was bad for them. The people who thought it was totally fine and healthy did not have that. Similarly, a lot of people think they have gluten sensitivity and that they really shouldn't have foods with gluten.
Speaker 1:Here's a fascinating study. You might want to look at it if it's something that concerns you. They took 165 people and it was a randomized trial with double blind, so they basically had four different groups and they gave them a meal or a series of meals. In one case they said, okay, this has gluten in it. And here you go, here's your meal, tell us how you feel. The next group they said no, no, it doesn't have any gluten in it, when in fact it actually did. And what low and polled happened was that when people thought it was gluten, they felt worse Right from the gluten. Then they did the reverse, where they didn't give them gluten, it was a meal without gluten, but half the people they said there's gluten in here, and half the people they said no, no, no, there's no gluten. Lo and behold again, the ones that were told there was gluten in the meal felt worse Again. This is something that might be very important and something to test for you. Clearly, celiac disease is a real deal and people have changes in their intestines, but for many other people perhaps it could be a nocebo effect.
Speaker 1:There's also something called an open placebo. People might think, oh, how unethical to give somebody a placebo. Well, there are examples, lots of examples, where people got better and they told them it was a placebo and what they found was substantial improvements. Now how they explained it is. They said yeah, it's a sugar pill, it doesn't have any active ingredient. But in other patients we found it to be very powerful and it helped them. And if you have a positive attitude about taking the placebo, it can be helpful and you really need to take this pill every day faithfully. Lo and behold, people knew it was placebo and they felt better. Lo and behold, people knew it was placebo and they felt better.
Speaker 1:Now let's shift gears to the next part and ask the question why does the placebo or nocebo effect occur? Well, part of it is the power of positive thinking. In the 1950s, there was a book by Norman Vincent Peale of that name. We all want to feel we have agency, that we're not feeling well, we do something and we're going to feel better. It's very powerful, the role of the mind. So that's one aspect.
Speaker 1:But there's some important statistics that are also part of this equation. One is called regression to the mean. That means if something is really bad or really good, if you just wait, you don't do anything, you just wait, it's likely to go back to normal. Somebody who hits five, six, seven basketball shots from a long distance, inevitably we know it's going to go back to normal. If they normally get one for three and now they've hit six in a row, we know that that is likely to go away. And again, if they tried something like now I'm wearing different socks and all of a sudden my jump shots aren't going very well, I blame it on the socks. Well, that's called a regression to the mean. Stock market very high likely to come back down. Stock market very low likely to come up.
Speaker 1:Secondly, you may have a chronic issue that undulates, that comes and goes, it gets better or worse, your pain from arthritis, asthma, low back pain, and if you do something and miraculously, you feel better. It could also have been that the illness was going to kind of run its course, or at least that timing or good timing. So you get a flu shot and inevitably you get a cold the day or two later and you blame it on the flu shot. Well, it could have just been a cold that you got by seeing your grandkids as an example, or, as we talked about with my friend Tim, the airplane ride and blaming the cold on the airplane. Again might have been due to the airplane, but it could have just been bad timing.
Speaker 1:And then the last kind of scientific element is called the Hawthorne effect. Now, hawthorne was an electric company in, of all places, hawthorne, illinois and this was done quite a long time ago. And what they found was they did an experiment where they wanted to see if productivity would get better if they raised the lights. The lighting increased the intensity of the lights in the workroom. Lo and behold, productivity improved. Then they tested the opposite they reduced the intensity of the light. Lo and behold, productivity improved. And what this means is that one of the phenomenon that can happen is when you know someone's watching or measuring, it changes your behavior. So that's another piece of the puzzle that may cause this very real effect of nocebo or placebo.
Speaker 1:Well, it's time to wrap up. Another episode is coming to a close. So what do we do with this information? It is around us all day. Every day, we will run across concepts like the placebo and the nocebo. It isn't just ancient history, like Samson and Delilah, or the things they said about the doctor's role in the 1500s. Yes, hundreds of years ago people were selling snake oil and people were using leeches, and people thought that was wonderful and they got better. But today it's just the same. It's just a different product, whether it's special greens from the garden in packets and capsules, whether it's red light therapy will get rid of your fatigue and have you live longer or vitality vitamins or a lot of interest in fasting. Well, if you fast or if you do a detox, we're going to get this bad stuff out of you. People feel better and they were like, oh, it worked, but again, maybe it was the placebo effect.
Speaker 1:Also, in your life, day to day, you may read about maybe a new surgery or a new treatment that's really helping people. Well, take a close look. A lot of these studies, or at least some of them have what's called a pre-post design. They measure somebody's symptoms, they do something and they measure their symptoms again, without a placebo comparison and, lo and behold, maybe the surgery seems to help people. Ask yourself the question did they do a placebo, and could that have been what's going on In your own life?
Speaker 1:If you're not sure if it's a placebo, just like I'm doing do your own N of 1 assessment, try it, stop it, try it, stop it. And, as we talked about in the N of 1 episode, maybe you can even have your own real placebo by having your partner buy magnesium. If you're testing magnesium, and then a pill that wouldn't help muscle cramps or sleep, like vitamin E, and that person will give you the pills and you really won't know what's what. And then a pill that wouldn't help muscle cramps or sleep, like vitamin E, and that person will give you the pills and you really won't know what's what. So, to finalize, keep your eyes open for the phenomenon.
Speaker 1:Ask yourself might this great improvement I'm hearing about or experiencing be a placebo? And, most importantly, let me know what you think. Does this make sense? Is it too nerdy? Please send me a note through my website, drbobbylivelongandwellcom, or reply within the podcast episode itself. I love to hear from you and, to the extent I can, I will absolutely respond. So until next time, placebo or not, nocebo or not, I hope you can live long and well. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobbilivelongandwellcom. That's doctor, as in D-R Bobby, live long and wellcom.