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All The World's A Stage—Including The Doctor's Office

In medicine today, placebos serve a specific purpose. In the form of sugar pills or pretend treatments, placebos provide a benchmark against which researchers can compare drugs and other medical interventions.

Ted Kaptchuk is a professor at Harvard Medical School. He says it's often hard to pin down why a medical treatment has worked.

"If people get better, we want to know if it's because [of] the drug we gave them, or is it spontaneous remission, or is it because of the doctor-patient interaction, or is it because of the ritual of taking pills?" he says.

Placebos allow researchers to separate out those factors from the influence of the drug itself. They enable doctors to determine whether a treatment does what it's purported to do.

Outside the setting of a clinical trial, you're unlikely to find physicians dispensing placebos. The reasoning is simple. It's long been assumed that the placebo effect can only take place when patients don't know they're taking a placebo. In other words, when patients have been deceived. For many doctors, deception like this would violate their profession's ethics.

But recently, researchers like Ted Kaptchuk began to question whether our assumptions about placebos were valid.

"Everyone believed that deception or concealment is necessary for people to respond to placebo because the idea was, you fake people, you trick them. I sat with myself for a long time, read the literature and I said, 'You know what. No one's tested that ever in history. What's going on here?'"

This week on Hidden Brain,we consider what it means to be sick and what it means to heal, and the powerful tool that modern medicine has overlooked.

Additional Resources

"A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee" by J. Bruce Moseley, Kimberly O'Malley, et. al. in The New England Journal of Medicine, 2002.

"To What Extent Are Surgery And Invasive Procedures Effective Beyond A Placebo Response? A Systematic Review With Meta-analysis of Randomised, Sham Controlled Trials" by Wayne B. Jonas, Cindy Crawford et. al. in BMJ Open, 2015.

Credulity: A Cultural History of US Mesmerism by Emily Ogden, 2018.

"Components Of Placebo Effect: Randomized Controlled Trial In Patients With Irritable Bowel Syndrome" by Ted J. Kaptchuk, John M Kelly, et. al. in BMJ,2008.

"Placebos Without Deception: A Randomized Controlled Trial In Irritable Bowel Syndrome" by Ted Kaptchuk, Elizabeth Friedlander, et. al. in PLoS One, 2010.

"Open-Label Placebo Treatment for Cancer-Related Fatigue: A Randomized-Controlled Clinical Trial" by Teri W. Hoenemeyer, Ted J. Kaptchuk et. al. in Scientific Reports, 2018.

"Is The Placebo Powerless?" by Asbjørn Hróbjartsson and Peter C. Gøtzsche in The New England Journal of Medicine,2001.

"Placebo Interventions For All Clinical Conditions" by Asbjørn Hróbjartsson and Peter C. Gøtzsche in Cochrane Database of Systematic Reviews, 2010.

Hidden Brain is hosted by Shankar Vedantam and produced by Jennifer Schmidt, Parth Shah, Rhaina Cohen, Laura Kwerel, and Thomas Lu. Our supervising producer is Tara Boyle. You can also follow us on Twitter @hiddenbrain , and listen for Hidden Brain stories on your local public radio station.

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Shankar Vedantam is the host and creator of Hidden Brain. The Hidden Brain podcast receives more than three million downloads per week. The Hidden Brain radio show is distributed by NPR and featured on nearly 400 public radio stations around the United States.
Rhaina Cohen is a producer and editor for NPR's Enterprise Storytelling unit, working across Embedded, Invisibilia, and Rough Translation.
Tara Boyle is the supervising producer of NPR's Hidden Brain. In this role, Boyle oversees the production of both the Hidden Brain radio show and podcast, providing editorial guidance and support to host Shankar Vedantam and the shows' producers. Boyle also coordinates Shankar's Hidden Brain segments on Morning Edition and other NPR shows, and oversees collaborations with partners both internal and external to NPR. Previously, Boyle spent a decade at WAMU, the NPR station in Washington, D.C. She has reported for The Boston Globe, and began her career in public radio at WBUR in Boston.