The Placebo Effect

Co-hosts Erin Stein and Dr. Gillian Goddard tackle one of the wilder phenomena in science: The Placebo Effect. It’s real, but why and how? What’s happening in our brains and bodies when we take a medication (or a fake one)? How does it relate to things like positive thinking or mindfulness? Join us for a discussion of one of the most basic yet fascinating building blocks of medical science.

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.

This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

TRANSCRIPT

Erin Stein: Hello, everyone. Welcome to The Savvy Patient. You will be listening to this in September, which is Perimenopause Awareness Month. 

Gillian Goddard: It is.

Erin Stein: We thought you should know that. But also, if you are one of our newer listeners, I want to make sure you know that episode number four is called Lady Cycles. And I think maybe I should have titled it something else. But it's all about your lady cycles, your perimenopause, your menopause, and the millions of stages of each one that Gillian helpfully walks us through. I encourage you to go back and listen to that one, along with our perimenopause episode.

Gillian Goddard: It’s also a really great time to pick up The Hormone Loop. 

Erin Stein: It is, isn't it? Such a great time to buy The Hormone Loop written by Dr. Gillian Goddard.

Gillian Goddard: But today we're not talking about any of those things.

Erin Stein: Even though we just did. Today is a fun one, I think.

Gillian Goddard: I do too, it's one of my favorite things in science. The placebo effect.

Erin Stein: The placebo effect and I think it's an example of how wild science is.

Gillian Goddard: Yeah.

Erin Stein: Science is not boring.

Gillian Goddard: No, and it speaks to, and we'll get into the details on this, it really speaks to our brains and how our brains work. Like you certainly don't feel like all this stuff is going on in your brain all the time. But there's a lot happening up there.

Erin Stein: Your brain does an enormous amount that you are not aware of. And I’ve said it before, I'll say it again. We still have so little understanding of how our brain actually works. Which doesn't mean we don't know anything. We do know a lot, and we have studied it a lot and learned a lot, but still, what we know is such a small fraction of what is happening in there and now there's potentially quantum mechanics happening in there. We have no idea what we're truly, truly capable of and how it all interacts. And it's kind of amazing.

Gillian Goddard: It is. But let's get back to the basics here. We talk about the placebo effect a lot.

Erin Stein: Let's explain it.

Gillian Goddard: But what is it? Exactly. Exactly. So, the placebo effect is when you take something believing that it will be helpful, and experience an improvement in your symptoms, even if what you took didn't contain any active medication in it.

Erin Stein: Should we be adding to that definition an improvement in your perception of your symptoms? Or is it an actual improvement in your symptoms?

Gillian Goddard: Well, this is interesting because…So it is more prominent among symptoms that are subjective, right? That are our perception.

Erin Stein: Mm, mm-hmm.

Gillian Goddard: So, things like pain, for example. It is more prominent in those types of situations. But there are also, biochemical things happening in our brain that that the improvement is real, like the same things are happening in our brain is as if we got the real medication in some cases.

Erin Stein: So, it is registering somehow physically in the body, is what you're saying.

Gillian Goddard: Yes, yes. Understanding the placebo effect is really important when we're thinking about science because if we want to see if a treatment is effective, and we give you the treatment and say the treatment is a pain medicine. We give you the treatment and your pain gets better. Did it? Did it get better? Did the medicine really improve your pain? And so, the way we get our answer to that question is by comparing a medication or a treatment to a placebo. And in medications, this is the most obvious. If we're giving you a blood pressure medicine, half the people in the trial will get the active blood pressure medicine and half the people in the trial will get a sugar pill that has no effect whatsoever that we're aware of.

Erin Stein: We should state for the record a placebo is essentially fake medication. It has no active ingredient. It is a placeholder.

Gillian Goddard: It has no active ingredient. There are other ways to have a placebo. So, for example, when we're talking about laser treatments, they will give people sham treatments where the placebo group will still be receiving a treatment, and it will essentially feel just like this experience of having the active laser treatment, but the lights that are in the treatment are not the lasers that are the treatment wavelength. So, a sham procedure is like a placebo in the procedural world.

Erin Stein: Okay. Okay.

Gillian Goddard: And so, it's the ideal situation to be able to compare two groups of people: one group of people who got a medication and a group of people who didn't. But the key to understanding this is a bunch of people have to not know whether you got the treatment or the placebo. And by a bunch of people, I mean all the participants in the trial need to not know whether they got the treatment or the placebo. And it's typically helpful if the researchers who are interacting with the patients also not know. So that's called a double-blinded trial. So, the patients are blinded and the researchers are blinded. Because even the researcher knowing can change the outcome of the trial, right?

Erin Stein: Yes. It's an unfortunate use of the term blind and blinded, but it means no one knows which is which and who's getting which.

Gillian Goddard: It means that you can be more assured that any difference you see between the two groups is because of the medicine and not because of the participants' perception or the researcher’s perception.

Erin Stein: It's important that the researchers don't know because they could unconsciously signal somehow that someone's getting the real quote unquote medication or the placebo and you don't want any leakage of that information like even just a subtle shift in your eyes or a crinkle around your mouth could give something away. So, you want them to genuinely not know so they're not unconsciously passing on some information. And then you want the patients to not know because you don't you want to be able to remove the placebo effect from the results. And not have them think, ‘well, I got the real medication, so it's definitely going to work,’ or ‘I know I didn't get the real medication so I know nothing's going to happen’ because apparently that will affect the outcome.

Gillian Goddard: It will. So, I have a great example of this. I'm going to reach behind me here and if you're listening to this, I'll do my best to describe it. But my favorite, favorite illustration in my book, The Hormone Loop, is the illustration of the placebo effect. And I'm going to, for those watching, you can see it here. [holds up book] The placebo effect that they saw in trials related to testosterone. So, testosterone may do a number of beneficial things for women, both pre- and post-menopausal. But what it's really been studied for is something called hypoactive sexual desire disorder, which is just a really long and fancy way of saying you're either having trouble being interested in having sex or having trouble getting turned on, and that it is causing problems for you. Either it's causing problems for you because you're unhappy with that situation, or it's causing problems in your romantic relationships, but the way that they measure an effect in these trials, the thing they're measuring is how many satisfactory sexual encounters have you had in a given time period? And you can imagine that is the best measurement you can maybe come up with in this case. It's a really hard thing to measure, but it is particularly subjective. 

Erin Stein: Yes.

Gillian Goddard: And so not surprisingly, these trials have huge placebo effects. Huge placebo effects. The women who get the, you know, usually this was a gel or a patch or in one case a spray. You see that the women who got the placebo gel or patch or spray, the one that didn't have any testosterone in it, have many more satisfactory sexual encounters when they're in the study than they did at baseline before starting to use the placebo. And the women who took testosterone had a bigger increase and there was a difference. So, the testosterone was doing something, but there was a big, big placebo effect. But my favorite thing is one of the things that you just talked about. When women take testosterone, depending on where they apply it, some will find that they grow hair on the area of their skin where they're applying the testosterone. So, in one study in particular, they specifically commented on the fact that some of their study participants had become unblinded because they knew they had gotten the testosterone, because they had patches of hair growing on their abdomen where they didn't before.

Erin Stein: Ha! Waa waaaa.

Gillian Goddard: Waaa wah.

Erin Stein: So much for keeping that a secret.

Gillian Goddard: Yeah.

Erin Stein: What's the history of the placebo effect?

Gillian Goddard: Placebo is a Latin word. It means “I shall please.”

Erin Stein: Weird.

Gillian Goddard: I know. Look, I don't speak Latin. I've never spoken Latin. 

Erin Stein: I studied it, but I don't remember very much at all.

Gillian Goddard: I've got a kid around here somewhere who takes Latin. But it didn't come into medicine, right, until the late eighteenth century, so the late seventeen hundreds. It was first mentioned in the medical literature in 1772. Initially, giving people placebos was not because they were doing rigorous clinical trials in the seventeen hundreds, but because when patients would demand medication, the physician or apothecary to make them happy would give them a placebo.

Erin Stein: Mm-hmm, mm-hmm. I think there were a lot of quote unquote practitioners selling things.

Gillian Goddard: Yes. Well, this went on for into the nineteenth century. Think about like patent medications, right?

Erin Stein: And I would say there are still practitioners today selling things. But it's interesting because the placebo effect is real and not just a theory, that it's been proven time and time again to the point that scientific studies are structured around the placebo effect and accounting for it.

Gillian Goddard: That is correct. That is a hundred percent true. And actually, there's evidence that the placebo effect works even if you know it's a placebo.

Erin Stein: See, that's wild to me. I'm fascinated by that because part of my thinking is we’re conditioned from birth, at least most of us nowadays, to take medicine when you are sick. Or even if you don't believe in Western medicine, to take some herbs or to drink a tonic or you know, to treat yourself with something.

Gillian Goddard: Mm-hmm.

Erin Stein: Not treat yourself with a prize, but give yourself some treatment of some kind, a different kind of treat yourself. but that's what we do when we get sick, when we have a pain, we have a ritual, if you will, of taking something for it. And so, we are training our brain that that's what you do and that that will work. You know, parents tell their child, ‘take this and you will feel better.’ Or even ‘I'll put a band-aid on it and kiss your boo-boo and you will feel better.’ You're programming your brain with this reinforcement. And so, not being a scientist, but that's what I would want to study, how much of this is from our conditioning ourselves to have a placebo effect.

Gillian Goddard: Yeah. One of my kids when they were little used to say, “Mommy, give me something to feel me better.”

Erin Stein: Not something to say in public. [laughs]. But that's fascinating.

Gillian Goddard: No, but so yeah, so they have done studies. There was a systemic review and meta-analysis that was published in Scientific Reports in 2021 and basically, they looked at studies of what are called open label placebos. So basically, they are placebos given without deception. So, they're not telling the patient that this is going to fix you. They're telling them that it is a placebo and that the patients know they're receiving the placebo. And they compared that to no treatment, and these are randomized control trials. There were eleven trials that they found and they assessed things like back pain, cancer related fatigue, ADHD, allergic rhinitis, so stuffy nose, depression, irritable bowel syndrome, and menopause symptoms. In fact, hot flushes. Different conditions responded differently, but the placebo was about twenty eight percent better than doing nothing. But that was all those things combined.

Erin Stein: Right.

Gillian Goddard: Things that did particularly well as a result of placebos were things like back pain. And again, pain is one of those things where there's a subjective component to is it better, is it not better?

Erin Stein: Super subjective.

Gillian Goddard: And think about that, what we're asking someone to conceptualize, and they always do it on this ten-scale, right? Like, is my pain, was it an eight and now it's a six? Like that’s hard to think back.

Erin Stein: It's hard to think back and as a person with back pain, it's also a little bit of set it and forget it. Like you can't sit there and focus on your back pain all day long or you won't get anything done.

Gillian Goddard: Yeah. Yeah. Yeah.

Erin Stein: So, you tend to compartmentalize it and not think about it as much as possible.

Gillian Goddard: Yep. Right. 'Cause there's only so much you can do about it.

Erin Stein: Right.

Gillian Goddard: But it was definitely shown to be beneficial in things like back pain, in particular. It did work for allergic rhinitis.

Erin Stein: That's interesting. I'll take a placebo for that.

Gillian Goddard: Alright, a little sugar pill for some allergic rhinitis.

Erin Stein: What about the menopause?

Gillian Goddard: A hundred participants with hot flushes. Fifty got placebo for four weeks and the other group got no treatment. After four weeks, the group was randomized again, and one received the placebo in it. So, they got randomized, got the intervention for four weeks, and then got re-randomized and got the intervention for four weeks compared to nothing. And their outcome was a hot flush composite score; that's like how frequent are they and how intense are they. And it gives you a score that kind of combines those two things.

Erin Stein: Yeah.

Gillian Goddard: After four weeks of placebo hot flushes were significantly reduced compared to the control group.

Erin Stein: Hm. Even though they knew this is, again, they knew this was a placebo. So weird. Okay.

Gillian Goddard: Yes, this is a group of people who knows.

Erin Stein: So not everyone is getting that effect, obviously, right? We're not saying everyone felt it. A significant number of people did.

Gillian Goddard: Right. Right. There's a statistically significant difference between the two groups.

Erin Stein: So, it really just proves the old saying, something's better than nothing. But how far does this go? Like how far will the placebo effect take you?

Gillian Goddard: Mm. This is a good question. I mean it's not going to fix your appendicitis, for example.

Erin Stein: Correct. Right.

Gillian Goddard: Obviously we don't have any clinical trials of that because that would be unethical.

Erin Stein: It really would be and we shouldn't mess around with that. But do any of the studies look at it long term? Like if you keep taking the sugar pill for years, do you continue to get some sort of placebo effect or is it limited to a certain amount of your brain, your mind over matter.

Gillian Goddard: Yeah. That is not so clear because all these studies are short because who's funding a trial of placebo pills because you can't patent a placebo pill and sell it. Yeah, there's no clinical evidence, but my guess would be that there's a limitation to it to the efficacy of it. But it does work.

Erin Stein: Well also, to what extent does it work? Obviously, appendicitis is an extreme example, but you know, what kinds of medications or responses is it most notably or is it everything?

Gillian Goddard: So, I think that this kind of gets to so what's going on? Why does it work? And people have done studies.

Erin Stein: I just assumed you didn't know.

Gillian Goddard: People have done studies looking at what's going on here? What's going on from a neurochemical point of view?

Gillian Goddard: And they have found that giving someone a placebo that they believe will help them increases our endogenous production of opioid, dopamine, and serotonin. So, if you think about what those neuro hormones really do and are it makes sense if you're stimulating the opioid receptor, it makes sense that you are improving pain that's how morphine improves pain, okay that makes sense.

Erin Stein: Right. Right.

Gillian Goddard: The other place where placebos have been shown to be effective is in Parkinson's disease, which is fascinating. But Parkinson's disease is a loss of dopamine production in the brain. And so, if you can wring out the dopamine producing cells in the brain and get them to produce a little bit more dopamine. It makes sense that Parkinson's disease symptoms would get better. One of the things in the review article that I mentioned was a study of ADHD. Well, dopamine helps us direct our attention. So, it makes sense that if the placebo increases our dopamine production that it could improve our attention. And serotonin and dopamine are both important for mood. And so again, it makes sense that a placebo could improve mood if it's increasing dopamine and serotonin production in the brain, right? When you increase dopamine and serotonin, you're changing our perception of the world when we bathe our brain in these positive neuro hormones. It does good things for our perception of our experience. The answer to your question is a little bit the effects that we're seeing have to do with these neurotransmitters that are increased when we believe that something is helping us. And that is that is a key to the placebo effect is, you do have to believe it's working. You gotta buy into it.

Erin Stein: Although you said even if people knew it was a placebo.

Gillian Goddard: Yes, but you still have to think it's going to work.

Erin Stein: That's why I have this theory that we've conditioned ourselves to think that something will happen when you take something.

Gillian Goddard: Well and they say that some of it is the anticipatory changes in our brain that happen because we are taking something.

Erin Stein: Yeah and I think that's very interesting because obviously there's a whole lot of things out there about mind over matter and prayer and healing and all kinds of things. And like so many of the things we talk about, there is something to that, but it's not going to go as far as some people claim it will.

Gillian Goddard: Sure.

Erin Stein: It might improve things, but it's not removing your appendix for you.

Gillian Goddard: No, it's not going to do that. No.

Erin Stein: This placebo effect is not the same as positive thinking, but it's an interesting related topic. You know, there have also been lots of studies about positive thinking and optimism, which is not exactly the same but related. And there is some scientific evidence that if you think more positively and have more positive emotions that you have better health outcomes. And it's not exact and not a hundred percent. You know, they did a big study with nuns. And I'm like, okay, interesting. And it's a huge study, 70,000 women across eight years.

Gillian Goddard: Yep. That's a lot of nuns.

Erin Stein: It's a lot of nuns. And they looked at what they had written as young people in their diaries and to assess, you know, their positivity or lack thereof and the most optimistic women had a 30% lower risk of dying from a bunch of diseases. And that seems compelling, except that I'm like, they're nuns, so…

Gillian Goddard: They're not representative of the general population.

Erin Stein: I would hope they have a somewhat more positive outlook on life than the rest of us if they are believing and faithful and doing good works out in the world and also if you're a nun living amongst other nuns, I think your stress level is a little lower.

Gillian Goddard: I think so. But here's the other thing. Are you positive and optimistic? Do you have a happier outlook on life because you don't live in poverty? 

Erin Stein: Because you are able to. Yes.

Gillian Goddard: Right, because you don't have the stressors that might make a person more prone to a negative outlook.

Erin Stein: Correct.

Gillian Goddard: Also, those stressors are correlated with long term health.

Erin Stein: They're very important confounding factors. 

Gillian Goddard: Very.

Erin Stein: However, another literature review that I found was interesting because it got at the complexity of this a little bit as to what you just said, but also happiness or positive affect generally leads to more social interaction. Better social interaction, which we've already discussed, is better for your health long term.

Gillian Goddard: Yes.

Erin Stein: Also, and perhaps even more important to me, leading to outcomes, is it helps with coping.

Gillian Goddard: Mm-hmm.

Erin Stein: Even if you do experience bereavement or depression, or they studied this following 9-11, actually, the stress everyone was experiencing because of that traumatic experience, if you have more positive affect and happiness, and you know, that was all defined in certain ways, but it gives you a way to cope with such things and move through those processes with more resilience and more bounce back and psychological growth as opposed to just withering away in depression.

Gillian Goddard: Well, think about this. People cope with challenges in all different sorts of ways. And some coping mechanisms for stress, like talking a problem through with a friend or with a professional or exercising as a way of managing your stress. That's my favorite stress management technique. Those things are going to have positive long-term outcomes versus if you have a maladaptive coping strategy, say you drink alcohol or take drugs which are obviously much more likely to lead to bad health outcomes and bad outcomes generally in the long run, right?

Erin Stein: Yes, and I don't want it to be taken as those people who are like, ‘this horrible thing happened, but it was God's plan’ and they just dismiss it. We're not talking about that.

Gillian Goddard: We're not trying to be Pollyanna-ish, if you will.

Erin Stein: This is more like when somebody passes, you are sad, you acknowledge you're sad, but you also remember happy memories of them. Like you are able to find something that's good and something to help you move through the grieving experience that is not all negative, right?

Gillian Goddard: Absolutely. Yes.

Erin Stein: And I've thought about this having lost people in the last couple of years. It's also a time when the whole family comes together and we should all learn to get together before funerals, but at least you can spend some time with your family and have some togetherness and share some happy memories of that person. And that is a good thing too. That's a positive emotional outcome.

Gillian Goddard: Yeah.

Erin Stein: Another related thing is positive affirmations and our manifesting, our vision boards of it all. And there is some evidence for that having an effect. But interestingly enough, it seems more in younger brains and that makes sense to me too, because we're conditioning ourselves.

Gillian Goddard: You're laying down those neural pathways, right?

Erin Stein: Yeah, exactly.

Gillian Goddard: Our brains actually retain a remarkable amount of plasticity, but they're at their most plastic, their most programmable, when we're younger, obviously.

Erin Stein: Yes. And also, there's a lot of scientific research about laughter having really positive outcomes and effects on people.

Gillian Goddard: Mm. I love that.

Erin Stein: And what all of this gets at is circling back to how we started this conversation, our brain works in mysterious ways, but…

Gillian Goddard: Hehehehe

Erin Stein: …part of the mystery is how emotions are a huge factor. 

Gillian Goddard: Absolutely.

Erin Stein: We tend to abstract emotions away from our physical selves as this nebulous thing floating out in the ether, but it's actually a physical process that our body creates emotions. It's all laid out in the textbooks, the pathway to creating this kind of emotion, that kind of emotion. So, it's a critical part of how we function and how our brain functions and how all our systems function. And so, it can't be totally divorced from all of these physical, medical things. Even though we tend to completely separate the two.

Gillian Goddard: We really do. We really do. I mean, think about biofeedback and how people can do things like lower their blood pressure by doing deep breathing, by engaging in mindfulness exercises and meditation. These things are deeply connected.

Erin Stein: You can calm yourself down.

Gillian Goddard: Yes, you can.

Erin Stein: And that affects you physically when you do that.

Gillian Goddard: Yes, it does.

Erin Stein: And so, the interesting thing is you might think, well then prayer should also have some backing in scientific study. That's less convincing in the research. And one of the overviews I looked at said it's really hard to do studies about prayer in general because it's so tied into someone's personal belief system and their affect about the prayer because generally speaking it's tied to an organized religion, and how they feel about that. So, it's pretty difficult to actually study that as an effect. But it has been studied. People have studied, you are praying yourself or people praying for you long distance. And sometimes they see some sort of result, but for the most part they don't really see anything scientifically significant.

Gillian Goddard: I think one of the challenges is that different religions, different attitudes toward things like guilt and punishment and you're bringing a lot of values and judgment in with the prayer that could have a confounding effect.

Erin Stein: But I think if you are a religious person and you find comfort and stress release in prayer; I would think it would have a positive impact for you.

Gillian Goddard: Right. Right. Yeah, I think it would be similar to meditation or mindfulness, right, in its biological effects.

Erin Stein: So going back to how effective the placebo effect is, because we did a whole episode about supplements and multivitamins and all of these things and this is where so much online contention comes from now that everyone's reading studies and looking things up for themselves and then going on TikTok and making grand pronouncements about the effectiveness of this, that, or the other thing. And I think this is where we're always trying to explain, take everything with a grain of salt, because one person might have taken some sawdust once a day for a month and seen a positive result.

Gillian Goddard: Yeah.

Erin Stein: That's entirely possible.

Gillian Goddard: One hundred percent. The placebo effect really does come into the supplement data because so much of it is, ‘well I started taking X, Y, or Z and I had so much more energy.’ I mean, when you think about serotonin and dopamine going up because you believe something's going to help you, that could in fact give you more energy. And so, we do have to be really careful. So many supplements are evaluated in clinical trials, but they're not placebo controlled oftentimes.

Erin Stein: Mm-hmm, and I think this applies beyond supplements too. I think this applies to like cold medicines from the drugstore.

Gillian Goddard: There was one that was taken off the market. It was supposed to be the replacement for pseudoephedrine if you didn't want to take the amphetamine based, like Sudafed is the brand name. They came out with phenylephrine, which you can't make into crystal meth and so you didn't have to go to the pharmacist to get it and show your driver's license and everything. Well, it turns out it didn't do anything either. So, you can't make it into crystal meth, but it also isn't an effective decongestant.

Erin Stein: I really wish my allergy medicine couldn't be turned into meth. It's such a pain to have to go buy it from the pharmacist.

Gillian Goddard: I know. I know, I know.

Erin Stein: Again, psychologically, there's also an element of control, like I can do something about this and to help myself. So, you take something and then you think you perceive that things are better. And the reality is most of us are not thinking about it that much, and we're not tracking our symptoms in a diary, and two weeks later someone asks us a question and they're like, yeah, I feel better. Do you? Or you just think that you do?

Gillian Goddard: Yeah. A hundred percent. A hundred percent. But isn't it kinda cool that our brains do that for us?

Erin Stein: It's very cool. I mean this is why I'm not closing the door on psychic powers. whether it's the way we think of how it works, probably doesn't actually work that way, but I do think we are capable of sensing things much more minutely than we realize.

Gillian Goddard: I think that is true, whether you call that being psychic or something else.

Erin Stein: But I think there's a possibility. I am very skeptical, but I still think there's so much we don't know about what's happening in there.

Gillian Goddard: Fair enough.

Erin Stein: And dreams are fascinating. We gotta get a guest on someday to talk about dreams something we've studied but still don't know very much about. And it's so interesting.

Gillian Goddard: And there is a hormonal connection because women have incredibly vivid dreams when they're pregnant and it has to do with your hormones in your brain and probably the fact that you're not sleeping all that well and the fact that you may have emotional feelings about your impending parenthood.

Erin Stein: You might. So, to bring it back to Perimenopause Awareness Month, you know, when you're experiencing symptoms, how much can a placebo effect help you with your midlife changes or not? 

Gillian Goddard: Apparently at least a little bit, but you have to believe. The key to a placebo is that you have to believe it's you're doing something to help yourself. You have to believe it. You gotta believe or it doesn't work.

Erin Stein: You gotta believe. I'm not sure I finished making this point, but I think this is why people get so worked up online about I did this, I took this, and it did this for me, and it helped me, and maybe it did, but maybe it was just the placebo effect. And so, you can't ever prescribe something for everyone because all of us are unique, but there are generalities. However, just because you took it. And it did something for you. It may or may not have actually done something for you. You may have just believed enough that it did. Which I know sounds insulting, but it's true.

Gillian Goddard: No, it's real. The placebo effect is real.

Erin Stein: Now I'm like, have I ever felt the placebo effect? I don't know.

Gillian Goddard: Probably.

Erin Stein: Probably. I think my allergy pill might be a little bit placebo effect.

Gillian Goddard: That is one of the things that could be helped with a placebo.

Erin Stein: It does do something because if I don't take it enough days in a row, I'm a disaster. So, knowing that it is real and it can have an effect or an impact, how do you assess whether something really works or whether it's just the placebo effect? And is it only if there was a trial that controlled for the placebo effect?

Gillian Goddard: I think that as a person prescribing medication, I want the trial that controlled for the placebo effect. As a human living in the world, if I think that the melatonin is helping me go to sleep faster. it's not harming me, so does it matter whether it really does or not? Probably not, because what it has fixed is the uncomfortable feeling of lying in bed waiting to fall asleep.

Erin Stein: And there you have it, folks. As long as it's not doing any harm. Right? If you want to spray magnesium on your feet, go for it.

Gillian Goddard: But don't think it's doing anything because it can't get in.

Erin Stein: You can know if you want to get placebo effect results from magnesium spray on your feet, go for it.

Gillian Goddard: But if you want real effects, you have to take it orally.

Erin Stein: But it's not scientifically valid. My point was it won't harm you to spray some magnesium on your feet.

Gillian Goddard: No. And I mean, unless you get out of bed to go to the bathroom and slip and fall.

Erin Stein: Right, that would be bad. All right, yeah, we definitely need to end this episode now.

Gillian Goddard: [laughs]

Erin Stein: Thanks for listening, everyone.