The Drugs Inside Your Head
Science writer and reporter Erik Vance says today’s brain scientists are like astronomers of old: They’ve unsettled humanity’s sense of itself by redrawing our picture of the cosmos within our own heads. Vance has investigated the healing power of stories and the “theater of medicine” (white coats included). It turns out that the things that make us feel better are often more closely connected to what we believe and fear than to the efficacy of some treatments. In fact, most drugs that go to trial can’t beat what we’ve dismissively called the “placebo effect,” which is actually nothing less than an unleashing of the brain’s superpowers.
Erik Vance is a Pulitzer Center grantee and the author of Suggestible You: The Curious Science of Your Brain's Ability to Deceive, Transform, and Heal. His work has appeared in several publications, including the New York Times, Harper’s Magazine, Scientific American, and National Geographic.
Krista Tippett, host: The science writer and reporter Erik Vance thinks that present-day brain scientists are like astronomers of old. They unsettled humanity’s sense of itself by redrawing our picture of the cosmos out there. We’re now learning a huge, new, reality-shifting story about the universe within us. Erik Vance has investigated what he calls “the theater of medicine,” which, it turns out, is often more closely connected to what we believe and what we fear than to the efficacy of this treatment or that. In fact, most drugs that go to trial can’t beat what we’ve dismissively called the “placebo effect.” But the placebo effect is nothing less than an unleashing of the superpowers of the brain.
[music: “Seven League Boots” by Zoë Keating]
Erik Vance: There’s a whole theory around pain that says that chronic pain isn’t really something wrong with you; it’s just, the chemicals in your brain haven’t been set to the right levels. So we’re all in pain right now, from whatever injuries we’ve ever had; it’s just that your brain has set the levels of its own endogenous opioids to a point where you don’t feel it anymore — which will mess with your head, I promise you, if you think about it long enough. That will mess with your head.
But it is this sort of this sense that you’re not trying to get rid of something, you’re just trying to reset the levels. And that’s within us all.
Ms. Tippett: I’m Krista Tippett, and this is On Being.
Erik Vance is the author of Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal. We spoke together with a live audience at the 2019 Beyond Religion Conference of the Pulitzer Center in Washington D.C.
Ms. Tippett: The question I often ask, whoever I’m interviewing, is about the religious background of someone’s childhood, how you would describe that. And the religious background of your childhood is very intricately interwoven with a lot of the science writing you’ve done, and certainly, the research behind your book Suggestible You.
So if I just ask you to start talking about the religious background of your childhood, how you describe that now?
Mr. Vance: Sure. I was raised in Christian Science, and Christian Scientists don’t go to doctors. That’s sort of what they’re known for. And when I describe Christian Science, I know I’ll probably offend Christian Scientists by doing this, but this is always the way I’ve always considered it, is, it’s kind of like the movie The Matrix, if you ever saw The Matrix, where basically, everything you see, it doesn’t really exist. The world is a mental construct.
And that’s not a terribly new idea. You look at the Gnostics, the ancient Gnostics, or the Sufis — there’s a lot of people over the course of human history who have — a lot of mystics have had this idea that the world doesn’t really exist; it’s a construct in your mind.
Ms. Tippett: A lot of physicists talk that way these days, too. [laughs]
Mr. Vance: Yeah, it’s interesting how that works. It’s just, if you take it to its logical conclusion, then why bother going to a doctor when you can just fix it with your mind?
Ms. Tippett: And it isn’t — there is very much — and I really got this from your writing — a culture of healing, a practice of healing. And the way I understood it — and tell me if this is correct — is that what you’re talking about is that there is health, and there is wholeness, and that this is about living into that truer reality.
Mr. Vance: It’s very true. This actually does work. Now, there are limits to it. And this is a theme I saw throughout working on this book and in my career, is, people are not crazy. And stepping on the outside, it might look odd or crazy, but if you get inside and really get to know the people involved, Christian Scientists aren’t crazy. They are acting in a way that is, they believe, in the best interests of their children and themselves. It is the best pathway to health. And what I saw, growing up, is that these things did work. I mean, obviously I believed it; I was in, very passionate, for a number of years, and it did work. I saw healings happen. So after I got out of the religion —
Ms. Tippett: Well, so you went to doctor for the first time when you were 18. Is that right?
Mr. Vance: [laughs] Yeah, I was 18.
Ms. Tippett: Tell me about that. What was that like?
Mr. Vance: Well, I was not a good patient. Some of you guys probably know that your experience with a doctor is only as good as the patient is willing to be at working with them. I had these horrible stomach pains, and I went to the doctor, and he felt around on my stomach like some sort of witch doctor, which I now know he was checking my appendix; he was looking for gallstones.
But he just sort of felt my stomach, and then he said, “Oh, it’s growing pains,” and “Go on your way.”
And I was like, “I have not been missing anything. That’s it? They feel your stomach and tell you it’s growing pains?” I didn’t tell them that I had been in Mexico the year before. Clearly, I had some sort of parasite that hung around for another couple of years until I, for another reason, took a bunch of antibiotics, and it went away. But I just remember walking out and being like, “Wow, these guys are all quacks. I’m glad I’ve not been going to these guys for 20 years.”
Ms. Tippett: [laughs] Oh, that’s funny. So you studied biology. You got into your rock climbing; you became a rock climbing guide, an environmental consultant, an environmental educator, and a science journalist. And then it seems like you — I wonder if this is true — you didn’t come out of this thinking people are lying or they’re fooling themselves, but there’s something happening, something else happening, and you wanted to know what that something else is.
Mr. Vance: Yeah, it actually came about I was at a brain mapping conference, and one of the keynote speakers was — his name is Tor Wager. That is an unusual name.
Ms. Tippett: Also turned out to be a Christian Scientist. [laughs]
Mr. Vance: Former Christian Scientist who I actually recognized; I actually recognized him from —
Ms. Tippett: Did you go to the same college?
Mr. Vance: I went to the same college. And I was like, “Wow, that’s weird.” And he’s giving a talk on placebos. And there was a little light went off, and I was like, “Whoa, that —” and I always say, it’s a little like a former Catholic studying the brain circuitry around guilt.
It’s hard to ignore, once you get this question and you’ve grown up with this, it’s very hard not to be wondering what the mechanisms might be in what you’ve seen. And so, I was hooked. I did a story about him, and then I just kept trying to do more stories about this phenomenon.
Ms. Tippett: So you have likened brain scientists to modern-day analogs of what Copernicus did, in terms of pulling back the veil, of pulling back the curtain on a fuller reality. And a big piece of this that you focus on are the mechanisms and intricacy of what we call the placebo effect. And how many times have any of us heard the phrase, “It’s ‘just’ the placebo effect”? And in fact, it’s a cornerstone of the modern pharmaceutical industry. Even the medications that work, there’s some kind of placebo effect going on in terms of how quickly we feel they work. And this is this huge — it masks — the way we’ve talked about placebo and treated it masks this huge story we haven’t told about ourselves and about reality.
Mr. Vance: You’re absolutely right. When you think about modern medicine — what is “modern medicine”? Modern medicine is something that can outperform a placebo. And it’s not that old; 1962, I think, is when the U.S. made —
Ms. Tippett: That’s the definition of a drug that works.
Mr. Vance: Exactly. And before that, we don’t really consider that evidence-based medicine. So the fundamental — the foundation of what we consider medicine is, is it better than your own mind? — which is kind of nuts.
Ms. Tippett: Which it often isn’t.
Mr. Vance: Which is often isn’t, and especially — and what I’ve learned, and what’s interesting about placebo is that it does not affect everything equally. Things like pain, irritable bowel syndrome, Parkinson’s disease, anxiety, depression, some autoimmune diseases, and maybe addiction — depending on how you work on that; it’s a little harder to study — these things have these very high placebo rates. But you look at something like autism or OCD, they have very low placebo response.
Ms. Tippett: I also read Alzheimer’s has a low — and is there some suggestion that whatever — and there’s so much we still don’t understand about placebo, but whatever the trigger is, that those conditions might also be affecting whatever that trigger is in the brain?
Mr. Vance: Right, yeah, Alzheimer’s is another one, and — it’s not clear why, but placebos, one of the things they do is, they tap into the drugs you already have inside your head. Cancer’s another one. You can’t just think away a tumor. The unfortunate thing is, you can be very effective against the symptoms of cancer, so it feels like the cancer’s going away. But we don’t have the tools — your brain can’t pull away the tumor, but it can have dramatic effects on things like pain and Parkinson’s. So when they first started doing placebo controlled trials, they got rid of 1,000 drugs they were using, which back then was a lot, that they thought worked and could not outperform the placebo effects.
Ms. Tippett: So let’s talk about what you’ve learned about what the placebo effect is. There is this language of “it’s the brain’s pharmacy.” Somewhere, you said, “Endorphins are little opium dens tucked away in our brains.” [laughs] But it’s actually — you’ve gone into much greater detail about what that means. And something you talk about that is core to understanding this is that the brain is, at its core, a prediction machine. So explain what that has to do with this reaction of ours or this capacity.
Mr. Vance: This a great segue, and this is a really important point. If you boil down what your brain does to a single idea — this is fundamentally what a brain is, based on artificial intelligence going back 50 years: It is a prediction machine. Everything your brain does, it takes the past, it applies it to the present to predict the future. And it does it in small ways — it’s basically creating a map of how the world works, based on the experiences that happen to it. And if you watch a little baby crawling around, they’re figuring this stuff out. They’re like, “Oh, wow — gravity. That’s painful if you’re not careful.” [laughs] Your brain learns from that, and then it learns where it can step and where it can’t step. And everywhere along the line, your brain is taking these observations and turning them into predictions that it uses to map the world.
So, when you give someone a sugar pill, and you say, “This is gonna take away your pain,” it’s not a circus trick. This is getting down to the very fundamental role that your brain has. And when you take that pill — this doesn’t happen to everyone, but if your pain goes away, it’s partly because your brain has an expectation, that when you take a pill, your pain goes away. And sometimes it’s easier for your brain to change reality than it is to change an expectation. Think of your brain as a bureaucrat; like, “I punch this paper, and I get the paper — that’s what I do. And you give me the pill, and the pain goes away. And if it doesn’t happen, I’m just gonna make the pain go away…”
Ms. Tippett: Myself. [laughs]
Mr. Vance: “…rather than question why it didn’t work. I have one job, and that’s what I do.” [laughs]
And that’s kind of how it is. It’s very hard to break these expectations. And so, placebo effect is basically taking advantage of this fact that your brain doesn’t want to divert from what it expects.
Ms. Tippett: There’s also some interesting story about the fact that if people see a physician administer pain medication, they will respond better — that medication will work, whereas if you just load the medication into the IV and they don’t see it administered, it may not work at all.
Mr. Vance: And that touches on something that actually is a new field of study for placebo, which is the social component of placebo.
Ms. Tippett: And the storytelling, also.
Mr. Vance: And the storytelling.
Ms. Tippett: Talk about that, because that’s also about the complexity of what it is to be human; that this is about biology, and it’s about chemistry, and it’s about storytelling.
Mr. Vance: Well, think about going into a doctor’s office in some old warehouse, and he’s wearing cutoff jeans and an undershirt, and he comes in and he’s smoking a cigarette, and he tosses you some pills. How well are those pills gonna work on you? We need to have the theater around medicine. The white lab coat, for example. Why do you need that? People aren’t splattering blood on themselves anymore, they need to see — [laughs] I certainly hope not. But that’s why we have it, and that’s something we identify with getting better. And all the placebo scientists I work with, they always stress the importance of the lab coat.
And all that theater is really important. And it’s a huge part — it’s the stories we tell ourselves.
Ms. Tippett: It’s about us. It’s about us.
Mr. Vance: Yeah.
[music: “A Little Powder” by Blue Dot Sessions]
Ms. Tippett: I’m Krista Tippett, and this is On Being. Today with science writer and reporter, Erik Vance.
Ms. Tippett: The scope — the magnitude of how it can work is also still very mysterious. You said you can’t cure cancer, but certainly, there are stories of — there are people walking around who had cancer and then didn’t, and then there’s this guy who feels like he’s this iconic figure in this field, Mike Pauletich, who had Parkinson’s. This is a fascinating story: They were doing a study of a drug to work on Parkinson’s. And it failed miserably; basically, the results didn’t look like the drug worked. But there was this one guy, Mike.
Mr. Vance: So Mike — this was called Neurontin, and it was actually the second trial that they were doing. And the first trial had failed, and then the second trial — basically, they’re drilling into your skull, Parkinson’s disease is a chronic deficiency in dopamine. And so they’re trying to jumpstart your dopamine processes. And it’s kind of a perfect placebo chemical, because it’s rewards. And so the placebo effects are all over the place. It’s very, very hard to do Parkinson’s research, because of the high placebo rates.
So they always do a sham surgery around a —
Ms. Tippett: Right; that was astonishing to me, too. This isn’t just about giving pills. People think they’ve been operated on.
Mr. Vance: Yeah, so this is — basically, you go in, the doctor doesn’t know what he’s giving you; no one knows. And you go in, the doctor gets a card, and it says, “OK, we’re doing the real surgery.” They do the surgery, which is two holes drilled into your skull. And the other one is, “OK, we’re not doing it,” and then they basically just do two divots, so it feels like you had surgery in your skull, but you didn’t. And this guy went in, and he basically — this changed his life. He went from having trouble walking and talking to — I kid you not, he was heli-skiing. He did a half-marathon. He climbed the backside of Half Dome.
Ms. Tippett: And years later, he’s…
Mr. Vance: Well, two years later — his doctor, Kathleen, was like, “We’ve cured Parkinson’s. This is it. This is amazing.” And two years later, they un-blind the trial, and the trial failed. Basically, that chemical’s not really being used anymore, the company went out of business. And she was absolutely flabbergasted. And then she went through and looked at the un-blinding, and he had gotten the placebo. He had gotten the sham surgery.
My question for you guys, and everyone, is, would you have told him?
Audience member: No.
Mr. Vance: [laughs] You’re required by law to tell.
Ms. Tippett: We don’t want him to read your book. [laughs]
Mr. Vance: These are — when you have a process that is susceptible to placebo, it’s shocking. It’s shocking what it does, because when your brain has access to pain and a lot of other conditions — anxiety, depression — it can be stunning. And this is why you don’t see very many Parkinson’s drugs. This is why it’s so hard to get pain drugs on the market. This is not a problem that is new to pharmaceutical companies; they know about this. This is a huge issue with big pharma.
Ms. Tippett: So one thing you say is that, bottom line, this is about the power of belief in our brains, in our bodies.
Mr. Vance: It is; and it’s interesting, because it’s not unlimited. I think Alia Crum, one of the researchers, she said it best. She said, I think, the placebo effect is not unlimited; we just don’t know where the limits are yet. We haven’t figured out where it’s appropriate and where it’s not appropriate. And there’s some real lessons there, because there are people who are trying to sell placebo cures to cancer patients, and I can tell you right now, those people, they’re dying. I’ve gone and done the reporting, and it’s criminal. So there are times when it’s appropriate, and there’s times when it’s not. If you have lower back pain, placebos are a really interesting area to think about and to work in, and I talk to a lot of pain doctors who, frankly, are desperate.
Ms. Tippett: Again, I feel like the language is so off, because really, it’s not that we want doctors to be using placebo. It’s that we want doctors to get sophisticated about unlocking the power of our brains.
Mr. Vance: Yeah — doctors complain a lot about alternative medicine and homeopathy and things like that. And it’s like, “You shouldn’t be complaining about it. You should be learning from it, because these people are healing with nothing.” Be real. [laughs] Homeopathy is not …
Ms. Tippett: Nothing external, right? They’re healing with something internal.
Mr. Vance: But if you ever sit down with a homeopath, they spend so much time with you. And the time and the effort and the theater that they put in is really effective, and it’s very powerful.
Ms. Tippett: I feel like you also were describing that, in a way, in Christian Science, where you said there is a lot of healing going on all the time. And there’s this place where you said, Christian Science practitioners are always available on the other end of the phone, and — this is some lines from your book — “I can still hear her perfectly graveled alto on the other end of the phone, maternal, weathered, and as tough as nails” — that doctor you trust — “telling me that everything was gonna be OK and that God loved me. To this day, it’s the most comforting voice I can imagine.”
That’s also tapping into that power. There’s sophisticated intelligence there.
Mr. Vance: That was my practitioner, my childhood practitioner, named LaMeice Schierholz — she’s since passed. But she was this amazing, amazing woman who just — she could heal you with her voice. And that is not something to shirk off. It’s something to be studied, no question; but it’s also something to be respected. And I think she — I don’t know if she worked on it, if she practiced, [laughs] because it was just such a powerful thing. And a good doctor can be like that. But I don’t think it’s part of their training. You’re lucky if you get one. But it’s not something that’s necessarily encouraged.
Ms. Tippett: I really love this invoking the theater. I actually just did an interview this week with Esther Perel. And she also talks about the theater of romance and relationship and the erotic and how that, actually, is so much more important than technique or performance.
Mr. Vance: Well — [laughs]
Ms. Tippett: And this is another realm of technique and performance.
Mr. Vance: I won’t argue with you on that one.
Ms. Tippett: OK, fine. [laughs]
Mr. Vance: [laughs] If we want to go to that, I got a whole other thing on Viagra I can talk about, the last chapter in the book.
Ms. Tippett: It really is. He’s not kidding.
Mr. Vance: [laughs] Yeah, no, I think we are storytellers. And of course, I say this because I’m a storyteller, so I’m a little biased. But your brain is trying to make sense of the world. That is fundamentally what it’s doing. It’s trying to make sense of the world, so it doesn’t get eaten by a lion. And part of that are these stories. And pharmaceutical companies do the same thing. The placebo effect is the worst enemy of the pharmaceutical company, right up until the point when it gets FDA approval; then, it becomes their best friend. And you see these advertisements for —
Ms. Tippett: The ads on television for how wonderful your life will be, once you take this pill.
Mr. Vance: Or the cartoon where you’re all red down here, and you take this pill and it turns blue, and it’s like, “Oh, the magical soothing blue pellets that are somehow released by the thing.” And it’s like, “Oh, it’s the blue soothing.”
Ms. Tippett: So you know what I thought of, though —
Mr. Vance: Like, how does that work? [laughs]
Ms. Tippett: There’s so much going on there that has so much resonance and relevance for other areas of our life together. What you said a minute ago about there is this idea that we are already healed, but we have to live into that; we have to believe in it and make it more true. And I was actually thinking about social changemakers. I was thinking about John Lewis talking about — [laughs] OK, here we go — about during the Civil Rights Movement, that what they had to do mentally was to live as if …
Mr. Vance: As if, yeah.
Ms. Tippett: … that the beloved community was there; it was the true reality and the true wholeness, and you had to act accordingly, even if what was in front of you didn’t correspond to that reality. That’s a dynamic in human society.
Mr. Vance: That’s fundamentally what I was raised with, which is cool to talk about when you’re in your 20s, but try explaining that to your classroom when you’re in the second grade, show and tell; like, “Oh, yeah, none of this is real, but we assume it’s real.” [laughs]
But yeah, no, you’re absolutely right. That’s exactly the way to hack the brain, is to live — I see this a lot; in fact, I talked to one pain doctor — the place to really understand this, I think, the best is with chronic pain, which is a huge problem in our country, by itself, but it also is the foundation of the opioid crisis and understanding that most of this opioid addiction — a lot of it comes from prescription drugs related to chronic pain. And pain doctors are really struggling with how to treat pain that doesn’t involve filling people up with opioids. And one of the doctors, world-renowned researcher who, I think, is established enough in his position to be honest with me, said, “Look. I’m lucky if I can help 40 percent of my patients. If I’m a baseball player, I’d be making millions, but as a doctor, that’s not a great number.” And he’s the one who actually says — he recommends to patients, “If you’re a lapsed Catholic, go back to church. Try it,” because, first of all, he’s looking for anything. But second of all, he wants to create a sense — even if they’re continuing treatment with him — that good things are coming, that there is an order —
Ms. Tippett: There’s that prediction expectation again?
Mr. Vance: And just going back to church and feeling like they’re getting some sort of sense that this will go away, good things are coming, is the first step for him. And he’s willing to try anything because it’s very, very tough. And there’s a whole theory around pain that says that chronic pain isn’t really something wrong with you; it’s just, the chemicals in your brain haven’t been set to the right levels. And then it’s a matter of — so we’re all in pain right now from whatever injuries we’ve ever had; it’s just that your brain has set the levels of its own endogenous opioids to a point where you don’t feel it anymore — which will mess with your head, I promise you, if you think about it long enough. That will mess with your head.
But it is this sense that you’re not trying to get rid of something, you’re just trying to reset the levels. And that’s within us all. And so, trying to fix the knee or do something, inject something that will make the pain go away — well, we have it in us, in theory, to be free of it right away. You just have to figure out how to convince your brain to do it.
[music: “Brass Buttons” by Blue Dot Sessions]
Ms. Tippett: After a short break, more with Erik Vance. And you can find this show again in three of the libraries at onbeing.org: Body, Healing & Trauma, Brain & Neuroscience, and Science & Being. We created libraries from our 15-year archive for browsing or deep diving by theme — for teaching and reflection and conversation. Find this and an abundance of more at onbeing.org.
I’m Krista Tippett, and this is On Being. Today we’re exploring the brain’s theater of healing — also known as the placebo effect — with science writer and reporter Erik Vance.
Ms. Tippett: Something I noticed, because I was reading articles that have been written about your work and interviews you’ve given, and [laughs] I noticed that there was still this kind of dismissiveness and defensiveness in the science journals.
What they picked up on was — and we haven’t talked about this, and we probably should — the “nocebo,” which is actually the same — it’s that same power of belief; it’s the dark side of that, which is the power of fear. That, also — talk about something that has relevance in all kinds of things about our life together, these days and in the world.
So they picked up on that mass hysteria caused by our brains. And the Scientific American podcast interviewed you, and the title was, “Your brain is so easily fooled.” [laughs] And National Geographic: “Here’s what placebos can heal — and what they can’t.”
Mr. Vance: He was very hung up on that, because it’s — there is this desire to put limits on it, and I think it’s important to put limits on it. But it’s worth mentioning, nocebos are probably more powerful than placebos. All the evidence we have is that they’re easier to create, and they last longer.
Ms. Tippett: Well, say a little bit about nocebos.
Mr. Vance: So a nocebo is a — think of it as, if a placebo is “This will make your pain go away,” [laughs] think of nocebo as “This is really gonna hurt. I’m gonna do this thing — it’s really gonna hurt. You ready? It’s really, really gonna hurt.” You can feel, even my saying that, there’s this —
Ms. Tippett: It will hurt.
Mr. Vance: It will hurt.
Ms. Tippett: It will really hurt.
Mr. Vance: These studies they do, basically a lot of them are: give someone pain; and then, depending on the story you tell them, rate that pain as higher or lower than what someone would have if they didn’t have any story. That’s a lot of the placebo research, the way it goes. And the higher pain is the nocebo. And that applies to a lot of other different things in the world. Now, they’re hard to study, because you can’t go to a Parkinson’s patient and give them a pill and say, “This is gonna make your Parkinson’s worse.” No one should ever do that.
Ms. Tippett: So this is where you take that desire our brains have to be predicting and preparing, and you channel it into fear. And you say there is nothing more powerful that happens in our brains and bodies than fear. You tell this interesting story about how you ran up against this in yourself when you had to vaccinate your baby.
Mr. Vance: Yeah. I am a science writer; I’ve seen the data; I’ve written about autism, and I’ve written about vaccinations. There is no connection. I’ve seen it. But when that guy pulls out that big old needle and comes after your kid, you don’t — rational thought is not what’s happening. And I was worried about autism with my kid. And the science writer part of my brain was so embarrassed about the rest of my brain; like, “I don’t know this guy. I’m not here. I don’t know where this guy came from.” [laughs]
And so, rather than not tell anyone, I decided to write a story for NPR about it, [laughs] which may or may not have been a good idea.
But the point is not, is autism a thing? The point is the power of fear. And that’s for a science writer. I understand fully why anything with your kids is — why there’s so much fear around not just vaccinations, but a lot of things with your kids, because it’s powerful. It’s powerful. And if you think about it, from an evolutionary perspective, it makes sense. Which is a more important feeling to have, as we’re surviving in the forest, fear, or hope and optimism? [laughs] Probably the fear, because it’ll keep you from getting eaten by the lion. So it makes sense why it’s more powerful.
But it’s definitely — and acknowledging this is the most important thing; understanding that these things exist and that none of us are immune to them. I can’t stand when people say, “Oh, look. I’m not a sucker, but echinacea really works.” It’s like, well, no, you are a sucker, but so am I; we’re all suckers, every one of us. And echinacea, if it works for you, I’m not gonna say anything. [laughs]
Ms. Tippett: Well, and I also think taking seriously the power of fear is really important. I was at Stanford earlier this year and had a conversation with some physicians in the medical school. And they’re working with young residents who sometimes end up counseling parents who don’t want to vaccinate their child. And the conversation we were having was very pragmatic; it was about how can that be a fruitful, productive conversation? And the fact is that the young residents, as I was hearing, often went into that really dismissive of the fear, annoyed with it, kind of like you were annoyed, embarrassed by it, annoyed like — it sounds like when you were in the doctor’s office, these warring parts of your brain were having this fight.
Mr. Vance: Absolutely.
Ms. Tippett: And yet, we would be applying our more complex intelligence from what we’re learning through science about ourselves and our fellow humans, to — not to honor the irrationality, but to honor the fear, because the only way —
Mr. Vance: I like that.
Ms. Tippett: Because what actually happened in that room —
Mr. Vance: I like that.
Ms. Tippett: Wasn’t that true, that the doctor — I’m remembering it now — that he said, at some point — I think I wrote this down — “Maybe you need a lollipop, dad.”
Mr. Vance: [laughs] Well, the doctor couldn’t figure out why I was so upset, so he was like, “Does daddy need a lollipop?” [laughs]
Ms. Tippett: But honestly, that’s actually what’s needed when we’re dealing with something that is about our humanity, like it or not, attractive or not, that we deal at a human level with each other.
Mr. Vance: I think, in all of this, what is needed is empathy. We can all start at least finding some bridges to bridge the gap.
And if you guys haven’t been on Twitter and seen the wars between “rationalists” and people who are alternative medicine people — they’re not nice. And if we can use the same language and understand that people’s experiences, they are real, and that we’re having these experiences, and frankly, if you can rub a crystal on your arm and have pain go away, you are the lucky one. Your rational friend who doesn’t have any use for them —
Ms. Tippett: Your better at unlocking your brain’s pharmacy.
Mr. Vance: And you have a tool that they don’t. You have that capability to unlock the drugs that are already in your brain, and you can do something that other people can’t. That is — if you gave me the choice, I would much rather be that person.
Ms. Tippett: Than just stay in pain…
Mr. Vance: Than just stay in pain and be right; that doesn’t help.
[music: “Trying Not to Work in Beautiful Barcelona” by Lullatone]
Ms. Tippett: I’m Krista Tippett, and this is On Being. Today we’re exploring the brain’s theater of healing — also known as the placebo effect — with science writer and reporter Erik Vance.
Ms. Tippett: Liliana Maria Percy Ruíz, the executive producer of On Being, is going to facilitate the …
Liliana Maria Percy Ruíz: Yes, just read some questions from all of you. And the first question is for Erik: “Can you talk a little bit about why the placebo effect wears off? What’s actually happening in the brain?” This person says that they once had acupuncture for pain, with amazing results. But the effects wore off after a few weeks, and subsequent acupuncture treatments had zero effect on the pain.
Mr. Vance: That is a great question. In the case of acupuncture — let’s assume it’s pain; again, the thing that’s most often studied is pain — you have to reset the way the brain actually perceives pain, and simply having a placebo rush of endorphins — which is what we’re talking about; these are endogenous opioids, but the other word for them is endorphins — is not resetting the brain, it’s giving a rush of endorphins. And so resetting the brain is not easy. That’s what we’re talking about, if it’s chronic pain. Let’s say it’s a stomach pain, and there’s something going on in your stomach — that will surface out again. That mechanism will come out again. And even if it’s just a mental pain, like fibromyalgia or something like that, that will reassert itself. And to actually reset and make that pain go away, it seems to be a much longer process. And we don’t really understand that, and we also don’t understand different people, how they respond to that.
Ms. Percy Ruíz: This next question is tied to that a little bit, which is, “Do you have a hack or an easy way for people to teach themselves to tap into their brain?”
Ms. Tippett: This is where we get to talk about hypnosis?
Mr. Vance: Oh, my God. Hypnosis is amazing.
Ms. Tippett: So this is the most fascinating thing, that you are so into — that hypnosis, to you, is a way to channel this stuff.
Mr. Vance: Well, hypnosis — what’s interesting about hypnosis, it’s actually not placebo, because you can give people this drug that makes placebo effects go away, and the hypnosis still works. So, it’s definitely other mechanisms that are involved. Why it hasn’t been studied more — doctors have been doing it since the mid-1800s, and it got a bad rap for a bunch of different interesting reasons, which you can read about. But I always point to Bram Stoker’s Dracula. If you look at the difference between when the book was written and when the first movie came out — when the book was written, the good guys did hypnosis, and that’s how they found Dracula. By the time the movie came out, it was the bad guy who was doing hypnosis. So it got a bad rap.
But it is an incredibly — but the problem is, it doesn’t work on everyone. You have to be hypnotizable. And there are certain people who are not very hypnotizable.
Ms. Tippett: You said it’s a talent, to be hypnotizable.
Mr. Vance: It’s a talent, and I don’t have it, because I tried to get hypnotized a few times, and I was like, “Am I hypnotized? I think I’m hypnotized. Ooh, I’m hypnotized. No, I’m not hypnotized. Oh, wait. Yeah, now I am — nope.”
And it’s like, that doesn’t work. [laughs] So I’m low on the scale, so I don’t really have that tool available to me. So that’s a great — I don’t know if it’s a hack.
All of the hacks that there are vary from one person to the next. And I always say, throw yourself all the way — alternative medicine, throw yourself all the way in, but leave one foot out. Try a bunch of different — because the storytelling is important. So, maybe homeopathy story doesn’t resonate like acupuncture story. But don’t let someone tell you not to go to a doctor, especially if it’s a serious disease, because there are people who will do that.
Ms. Tippett: So that’s what you mean by “keep one foot out.”
Mr. Vance: Keep one foot out, and don’t put your life in jeopardy. But yeah, the hack would be, look for stories that resonate for you. And if you kind of think it might be a placebo, that doesn’t mean it won’t work. You can give people placebo pills and say, “These are placebo pills,” and they will still work, because a lot of this is unconscious, and you can’t help it.
I will say, reading my book will not hurt you from getting a placebo effect …
… buying my book won’t affect that. Writing my book might. [laughs] That might.
But you guys, hypnosis, it’s not a placebo. It’s just — we just don’t know, enough, what it is. And that’s — if you guys haven’t tried that, find out if you’re hypnotizable. If you are, you got a whole bunch of tools to play with.
Ms. Percy Ruíz: This next question came up a couple of times in a few different ways. “Are there any studies comparing healing rates between religious believers versus atheists?” And then a similar question around positive people versus cynical people.
Mr. Vance: Unfortunately, there have been many efforts to figure out who the placebo people are. And these efforts have varied from personality type to age to gender to race to anything you can think of, and they’ve never found a correlation that sticks. They’ve claimed they’ve found them, and then they disappear. There are no — we all kind of know people who you’d think would fit — “I bet that’s someone who responds.” But it doesn’t — when you get a bunch of people together, and you do scientific work, it doesn’t seem to work. The one thing that seems to be the exception to that is genetics. There’s a few genes that may be related to — certainly, with pain, because again, easy to study — and it would make sense that there are a few other conditions where the placebo rate — there are some researchers who are trying to compile all the genes related to placebos right now, at Harvard, and it —
Ms. Tippett: And that would start to be a map of who is susceptible?
Mr. Vance: Right, well, the idea would be, if you put them all together — because some of them cancel each other out, and so if you have one that’s aiding the placebo and one that’s hurting the placebo, and you have both of them — but it would depend on where it acted, because one would be the surface of the receptor, and the other one would be further down the line. So these things get real complicated, real fast. But if you just look at personality, it doesn’t work, and if you just look at gender, it doesn’t work.
Ms. Tippett: So to the theme of this Pulitzer conference, you’ve ended up as — you’re kind of straddling, at least with this work, not with all your reporting but some of your reporting, both the fields of science and religion. And my observation is that — you actually end your book with a little bit, here, a little bit sad that these two worlds that you’ve been …
Mr. Vance: Oh, that’s right. [laughs]
Ms. Tippett: …that they don’t engage with each other in illuminating each other. And I think you use beautiful language — or that there’s this feeling that you have to choose between the two, which is a false choice. I love the way you open that up. You say, “The human mind is an elaborate, ever changing [human] palace,” and that it has all these secret passageways we have yet to comprehend, and we really don’t know.
Mr. Vance: This is not easy stuff to understand. And — A) it’s not easy stuff; B) anyone in this room could probably come up with a really good study that no one’s done. There just hasn’t been funding for it. And it was hard. I was hoping at the end to bring my — I sat down with a Christian Science practitioner, and I was trying to bring my childhood together with my “rational,” scientific, reporter life. And I don’t know that I did. And I feel like there’s certain leaps that people aren’t willing to make. But I do think that there’s so much opportunity, like you said. And the brain and the mind — however you want to call it — is a fascinating, vastly confusing place, and it’s so big that we’re just scratching the surface.
And with this, particularly, because placebo spent so much time in the doghouse as being this hippy-dippy thing, that we’re only recently starting to be able to have the tools to actually look at these things. We’re gonna see a whole new picture of the brain in the next generation.
Ms. Tippett: The placebo is the natural thing. We could just call it “natural healing.” Or, that sounds like a methodology, but just your body’s ability to heal itself.
Mr. Vance: You could rephrase Hippocrates, the Hippocratic Oath, to basically be: “Let placebo effect happen” …
… because that was his whole thing. He was like, “Look, let’s not cut you into pieces or sacrifice goats to the god of war. Let’s just see if this takes care of itself. He didn’t know what the placebo was, but he certainly understood. And he watched it, and he knew that “Do no harm” was, basically: “Lay down for a while. Let’s see if the placebo effect takes care of things.” [laughs]
Ms. Tippett: Does the language — in your work, the mind/body language appears a lot. And I think the mind/body/spirit is implied in there; you can define spirit in so many ways. I have this theory that 100 years from now, people will look back and see how we used that phrase and think it’s like people talking about four humors in the body. Is there a distinction for you now?
Mr. Vance: No, it’s a false dichotomy. There is no mind/body, unless you want to be, like, mind/body/stomach, because the stomach has almost as many nerve endings as the brain; it’s your second brain. So, let’s not cut the stomach out of this; the stomach’s like — no, it’s your whole body. The body is the body; the mind is a part of that. It’s just the part you really don’t want to shut off. It’s the part of the body that really doesn’t want to get hurt. But other than that, this is — separating the mind from the body is really pointless. The whole thing — you look at dopamine, which affects Parkinson’s, it affects reward. It also affects digestion and movement — a lot of your brain’s functions. It’s doing double duty. This is not like, “Oh, we’re in Braintown now.” This is your whole body working together. And so, trying to break it apart, it’s just something we’ve constructed.
Ms. Tippett: So just to illustrate that, one of the ways you described how placebo happens, which I had trouble visualizing it — but that it goes backwards — because this illustrates this.
Mr. Vance: So just really quickly, if you can imagine burning your hand on a stove, and then you put your hand in ice-cold water. That sensation would go up your arm, up to the back of your brain, go through some of the — I hate to use this, but “lizard part” of your brain — up to the thalamus, into the hippocampus, the anterior cingulate cortex — excuse me — into the front part of your brain, the prefrontal cortex. And you say, “Oh, God, that feels so good. I’m just gonna leave this in here for a while.” A placebo effect does a lot of the same things, but it starts in the prefrontal cortex and goes backwards, and it works its way backwards to those other parts, to the beginning to the fear parts and everything later, and releasing chemicals as it goes.
Ms. Tippett: So you have a belief, or an expectation …
Mr. Vance: And it works its way back …
Ms. Tippett: … and then — and your hand gets better.
Mr. Vance: Right; right. And they’ve also teased apart the unconscious versus the conscious, which aren’t exactly the same pathways; they’re different pathways. So we’re learning a lot of cool stuff.
Ms. Tippett: How do you think you walk through your days differently, or parent differently, because of these things you know?
Mr. Vance: I have a whole different perspective — I have a little three-year-old, and when he falls down and goes boom, and when I kiss it and make it better, that’s a whole different thing now. [laughs]
I’m releasing some serious chemicals. I’m a lot more comfortable lying to my child.
[laughs] Other than that, I try to lie to myself as much as is healthy. [laughs] I know that the fizzy drink that makes my cold go away doesn’t really work, but if it’s fizzy, 100 percent, I’ll buy it. Anything fizzy, you tell me this is fizzy and it’ll turn your hair green, I’ll believe you. Fizzy drinks are magic. I will 100 percent look for my own hacks and try to figure out how this works.
And I also — this has given me a lot more empathy for people who would otherwise, “Oh, you’re such a fool. Whatever your thought is that I don’t agree with makes you worthless” — that idea — at least — it always comes back up, because I’m human, but this helps you get past that and understand that people’s reality is really their reality. It’s just not their imagination. It’s really what’s happening.
Ms. Tippett: So this is a huge question, and you don’t have to answer it, but I just wonder how you would start thinking it through — in front of all of us — the question of what it means to be human, and how you might start to answer that differently after all this research you’ve done and this place you’ve gone in your mind and in your experience.
Mr. Vance: Wow. You’re asking me. I feel like I’m massively unequipped to answer that question, but I do think that there is this unifying thing about belief and belief affecting your body that is universal, and it really is who we are. And there is no getting away from it. This idea that somehow you’re too clever for belief to completely change your reality — as soon as you think that, you are setting yourself up for problems if you think you’re above this somehow or that rationality has gotten you someplace where other people aren’t. This is something we all do. We all look for patterns, and we look for things that make sense. And when we find those things, we are susceptible to changes, certainly in our body and also in our reality.
I think that it gets back to that idea about making predictions. That’s what our brain does, and those predictions, they create this tapestry of reality and expectations and the way we see everything fitting together that is just as flawed and amazing as the person next to you. And so I think that’s what we’re talking about is this tapestry of the map that we’ve created about the world that is not accurate, but it’s kind of awesome. And we all have one. And that’s just being human. That’s just who we are.
Ms. Tippett: Thank you, Erik Vance and Pulitzer Center, and thanks all of you, for coming.
[music: “Besos” by Arliss Parker]
Ms. Tippett: Erik Vance is a Pulitzer Center grantee and the author of Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal. His work has appeared in several publications, including the New York Times, Harper’s Magazine, Scientific American, and National Geographic.
Staff: The On Being Project is Chris Heagle, Lily Percy, Maia Tarrell, Marie Sambilay, Erinn Farrell, Laurén Dørdal, Tony Liu, Erin Colasacco, Kristin Lin, Profit Idowu, Eddie Gonzalez, Lilian Vo, Lucas Johnson, Damon Lee, Suzette Burley, Katie Gordon, Zack Rose, Serri Graslie, Nicole Finn, and Colleen Scheck.
Ms. Tippett: Special thanks this week to Nathalie Applewhite, Peterson Njamunge, Ed Ilgenfritz, and the rest of the Pulitzer Center team.
The On Being Project is located on Dakota Land. Our lovely theme music is provided and composed by Zoë Keating. And the last voice that you hear singing at the end of our show is Cameron Kinghorn.
On Being is an independent production of The On Being Project. It is distributed to public radio stations by PRX. I created this show at American Public Media.
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