Translator: Tanya Cushman Reviewer: Silvina Katz
Let me give you a quick headache remedy.
It comes from Aretaeus of Cappadocia.
He was a first century B.C. philosopher, physician,
and kind of a quack.
It went like this:
you make an incision right here along the hairline,
and then you chisel down through the bone
into that spongy layer between the skull and the brain,
and then you let it all heal over,
and once it’s healed, no more headache.
He wasn’t the only one who had some interesting ideas
about pain relief in olden days.
There was, of course, eel innards that are dried in an oven –
you could use those.
Or you could take ox bile,
mix it with some suet and some urine,
rub it all over your body and then sit next to a fire
until you couldn’t handle the pain anymore,
and when you stepped away,
the pain in the other part of the body would be gone.
My favorite is if you have a toothache,
find a donkey and give it a big kiss.
(Laughter)
Now you laugh, except the people back in those times
actually believed these things worked.
Otherwise why would they go through it, right?
Why, indeed?
I would argue that the reason they went through it
is because it actually did work.
And by the time I’m done,
I hope to convince at least some of you
that maybe kissing a donkey when you have a toothache
isn’t such a bad idea.
I should start by saying I am not a scientist;
I am a science writer, which means I’m a storyteller.
Like the Brothers Grimm,
I use stories to try to find a more profound and deep truth,
the difference being that my stories are true –
are based in fact –
because I find that truth is actually cooler,
more interesting and more astounding
than anything you could ever come up with in fiction.
I also don’t come to this idly.
I was raised in Christian Science,
which means I didn’t go to a doctor until I was 18 years old.
If you who don’t know,
Christian Science is an American religion that relies on faith healing,
and basically, Christian Scientists believe that all the matter around us
are sort of a mental construct,
and that they’re reliant on us –
or a higher truth that’s beyond that –
that controls it and is also connected to your mind.
It’s kind of like –
You ever see the Matrix and how Neo could see the world around him,
but there was also this higher thing that was beyond it?
That’s sort of how it works,
and it’s kind of a weird way to grow up –
thinking that the entire universe is a mental construct.
I mean, try explaining that to your third grade show-and-tell;
it’s a little complicated.
And as I got older, I sort of lost touch with my religion,
and I started experimenting with drugs a little bit, you know?
Tylenol … aspirin …
(Laughter)
a little Bayer every now and again.
But I never lost that curiosity I had
for how I had been healed when I was a little kid.
What I came to understand was that, at least in part,
what I’d experienced was related to something called “the placebo effect.”
Now forget everything you think you know about the placebo effect,
the pills and all that other stuff you hear;
it’s a much wider and deeper thing than you think.
So that takes me to my first story,
and that will be in Bethesda, Maryland,
at the National Institutes of Health
where a scientist by the name of Luana Colloca
was nice enough to electrocute me for half an hour.
She hooked me up to a machine – it was wild –
and I saw two lights.
I saw green lights
and whenever I saw the green light, I’d get a little sort of zap,
a little pinch of a shock.
Whenever I saw the red light, I’d get a big shock.
This was one that made my foot twitch.
It was a real, real strong shock.
Then she went back and forth: red light, green light,
red light, green light,
until every time I saw that red light,
I was like, “Dear Lord, what is coming?”
And after a while,
it felt like maybe she had turned up the green light just a little bit,
like from a one to a two, but nothing like the red light.
And she walked in and said,
“Thank you very much. You’re all done.
By the way, on that last round we gave you the big one every single time.
And I was floored.
I mean, I didn’t feel any pain
whenever I saw that green light.
And until that point,
I sort of thought of the placebo effect as kind of a form of self-delusion
or maybe a story we told ourselves,
but what I realized was this was not me telling myself something;
this was something very real.
And I came to understand that the placebo effect is,
at least in part,
not self-delusion,
but it’s actually chemical.
Let me tell you what I mean by that.
If you could boil down the brain to one job,
if the brain just did one job,
if you had to get really specific,
what it is, it’s a prediction machine.
All day long, it’s making predictions.
They could be little predictions
like the ground will be hard when I step on it,
or when I drop something, it will fall.
Or it could be big ones about hunting in the plains next year,
or whether the Cubs will win the World Series.
But, basically, that’s what your brain does.
It takes the past,
applies it to the present
and tries to predict the future.
And so what a placebo effect is
is essentially when reality doesn’t match the prediction or the expectation.
And what’s interesting about your brain is when those things don’t match,
sometimes it’s easier to change reality than it is to change the expectation.
And here’s how your brain does that:
Imagine if you burned your hand on the stove, okay?
and you quickly put it into some cold water.
Now imagine that pain relief going up your arm,
into your vertebra, into your thalamus,
and then it moves into the ACC and the hippocampus
and works its way into the prefrontal cortex,
and you think, “Oh, I feel better.”
Okay?
Placebos work just like that, except they go backwards;
they start in the front
and work their way back into the deeper parts of your brain,
and all along the way, they’re releasing drugs as they go.
And your brain has a whole suite of drugs at its disposal;
it’s often called the internal pharmacy.
You’ve got serotonin.
You’ve got dopamine.
You’ve got cannabinoids, which are found in marijuana,
and you’ve also got opioids.
And opioids are probably what I felt when I was getting electrocuted.
Now, opioids bring me to my next story, which deals with chronic pain.
And for that, I want to cross the street from the NIH Labs,
to the Walter Reed medical center and meet Christopher Spevak.
Christopher Spevak is a fabulous doctor who works with veterans
who come back from war zones with terrible injuries –
many of them have lost limbs.
And with those injuries come a great deal of chronic pain,
and that’s Spevak specializes in.
Now, when he meets his patients,
he doesn’t ask about their symptoms or about the injury;
he asks about their childhood,
specifically about sensory experiences in their childhood.
So, maybe it’s the smell of eucalyptus trees
outside of their house when they were growing up.
Maybe it’s the sound of jazz music as their mom’s making dinner.
Maybe it’s – you know those little Werther’s caramels
that your grandmother always had for you when you were at her house?
It could be that.
And he ties those experiences to the drugs that he’s giving.
So every time you take an opioid pill,
you take a caramel,
or you smell some eucalyptus,
or you listen to jazz.
And over time, he starts backing off the drug,
and just giving you the sensory experience.
And what’s happened is your brain
has created an expectation that you will feel better,
and so it will step into the gap
and start self-medicating the way it normally would.
He’s had tremendous success with this:
He’s got some older patients from the Vietnam War
who’ve been on opioids for decades,
and the more recent patients
who he’s been working with this technique
have been able to completely ditch them within months.
It’s a phenomenally powerful thing.
And this is an important question because, as you probably know,
the opioid crisis in today’s world has become an epidemic.
And I found this really ironic
because opioids and morphine
were like the quintessential enlightenment drug.
I talked earlier about drilling into your head and kissing donkeys.
That was sort of this dark-ages era way of treating people,
and the enlightenment brought us into an era of reason and science
and, most importantly, mechanisms, okay?
And the mechanism that made opioids so amazing
was that they mimic the brain chemicals that you already have in your head
to control pain.
Which was phenomenal.
Problem is the thing that makes them so effective at killing pain
also makes them very addictive.
Over the next 10 years,
drug use is predicted to kill some 500,000 people.
That’s more than guns.
That’s possibly more than cars.
Now you might say, “Why don’t we just give out pure opioids?”
But remember that one in four Americans suffer from chronic pain.
What are we supposed to do with them?
The reason why we are losing the war against opioid addiction
is that we are losing the war against chronic pain.
No one knows this better than Sean Mackey,
who’s an amazing scientist and physician at Stanford University.
He told me once – he’s a pain doctor –
he told me once,
“I’ve got a 40% chance of curing my patients;
if I was a baseball player, I’d be making millions,
but as a doctor, that is not good.”
And he’s this brilliant guy, an MD and a PhD,
and he hates being at such a disadvantage against the disease that he’s combating,
and he’s become almost desperate
for new solutions and new ways to think about pain,
so he started looking at meditation and mindfulness.
He even looks at transcranial magnetic stimulation,
which is this sort of device
that electrocutes your head in very small doses,
and it doesn’t really work much better than a placebo,
yet.
He’s also got a machine that you go inside of,
and you can see your own pain while it’s happening,
and you can try to bring your pain levels down –
you can watch it as your brain is processing it.
It’s phenomenal.
And he’s just hungry for any solutions he can find.
It’s funny because the one that always pops up in my memory
is where he says that if he gets a lapsed Catholic in his office,
one of the things he’ll say is
“Why don’t you try going back to church?”
And he doesn’t do this because he thinks God’s going to heal this person;
he does it because it’s a way to start to get control of your disease.
It’s a way to create an expectation that you will have pain relief.
This is not about superstition;
this is about belief.
This is about the same kind of thing Spevak was tapping into,
and the same thing I was tapping into in that chair.
Call it a new sort of enlightenment:
tricking the brain to heal itself.
See, the old enlightenment brought us out of superstition
and into a world of science and reason.
But I think we need a new sort of enlightenment
that brings us into a new way of looking at pain control.
What’s ironic is that it actually brings us back to the same mechanism
that was involved in the Dark Ages,
which, you can call it belief,
or you can call it expectation,
or, if you like, you can call it placebo or brain chemistry,
but you’re tapping into the pain relief that’s already inside all of us right now.
Thank you.
(Applause)
Let me give you a quick headache remedy.
It comes from Aretaeus of Cappadocia.
He was a first century B.C. philosopher, physician,
and kind of a quack.
It went like this:
you make an incision right here along the hairline,
and then you chisel down through the bone
into that spongy layer between the skull and the brain,
and then you let it all heal over,
and once it’s healed, no more headache.
He wasn’t the only one who had some interesting ideas
about pain relief in olden days.
There was, of course, eel innards that are dried in an oven –
you could use those.
Or you could take ox bile,
mix it with some suet and some urine,
rub it all over your body and then sit next to a fire
until you couldn’t handle the pain anymore,
and when you stepped away,
the pain in the other part of the body would be gone.
My favorite is if you have a toothache,
find a donkey and give it a big kiss.
(Laughter)
Now you laugh, except the people back in those times
actually believed these things worked.
Otherwise why would they go through it, right?
Why, indeed?
I would argue that the reason they went through it
is because it actually did work.
And by the time I’m done,
I hope to convince at least some of you
that maybe kissing a donkey when you have a toothache
isn’t such a bad idea.
I should start by saying I am not a scientist;
I am a science writer, which means I’m a storyteller.
Like the Brothers Grimm,
I use stories to try to find a more profound and deep truth,
the difference being that my stories are true –
are based in fact –
because I find that truth is actually cooler,
more interesting and more astounding
than anything you could ever come up with in fiction.
I also don’t come to this idly.
I was raised in Christian Science,
which means I didn’t go to a doctor until I was 18 years old.
If you who don’t know,
Christian Science is an American religion that relies on faith healing,
and basically, Christian Scientists believe that all the matter around us
are sort of a mental construct,
and that they’re reliant on us –
or a higher truth that’s beyond that –
that controls it and is also connected to your mind.
It’s kind of like –
You ever see the Matrix and how Neo could see the world around him,
but there was also this higher thing that was beyond it?
That’s sort of how it works,
and it’s kind of a weird way to grow up –
thinking that the entire universe is a mental construct.
I mean, try explaining that to your third grade show-and-tell;
it’s a little complicated.
And as I got older, I sort of lost touch with my religion,
and I started experimenting with drugs a little bit, you know?
Tylenol … aspirin …
(Laughter)
a little Bayer every now and again.
But I never lost that curiosity I had
for how I had been healed when I was a little kid.
What I came to understand was that, at least in part,
what I’d experienced was related to something called “the placebo effect.”
Now forget everything you think you know about the placebo effect,
the pills and all that other stuff you hear;
it’s a much wider and deeper thing than you think.
So that takes me to my first story,
and that will be in Bethesda, Maryland,
at the National Institutes of Health
where a scientist by the name of Luana Colloca
was nice enough to electrocute me for half an hour.
She hooked me up to a machine – it was wild –
and I saw two lights.
I saw green lights
and whenever I saw the green light, I’d get a little sort of zap,
a little pinch of a shock.
Whenever I saw the red light, I’d get a big shock.
This was one that made my foot twitch.
It was a real, real strong shock.
Then she went back and forth: red light, green light,
red light, green light,
until every time I saw that red light,
I was like, “Dear Lord, what is coming?”
And after a while,
it felt like maybe she had turned up the green light just a little bit,
like from a one to a two, but nothing like the red light.
And she walked in and said,
“Thank you very much. You’re all done.
By the way, on that last round we gave you the big one every single time.
And I was floored.
I mean, I didn’t feel any pain
whenever I saw that green light.
And until that point,
I sort of thought of the placebo effect as kind of a form of self-delusion
or maybe a story we told ourselves,
but what I realized was this was not me telling myself something;
this was something very real.
And I came to understand that the placebo effect is,
at least in part,
not self-delusion,
but it’s actually chemical.
Let me tell you what I mean by that.
If you could boil down the brain to one job,
if the brain just did one job,
if you had to get really specific,
what it is, it’s a prediction machine.
All day long, it’s making predictions.
They could be little predictions
like the ground will be hard when I step on it,
or when I drop something, it will fall.
Or it could be big ones about hunting in the plains next year,
or whether the Cubs will win the World Series.
But, basically, that’s what your brain does.
It takes the past,
applies it to the present
and tries to predict the future.
And so what a placebo effect is
is essentially when reality doesn’t match the prediction or the expectation.
And what’s interesting about your brain is when those things don’t match,
sometimes it’s easier to change reality than it is to change the expectation.
And here’s how your brain does that:
Imagine if you burned your hand on the stove, okay?
and you quickly put it into some cold water.
Now imagine that pain relief going up your arm,
into your vertebra, into your thalamus,
and then it moves into the ACC and the hippocampus
and works its way into the prefrontal cortex,
and you think, “Oh, I feel better.”
Okay?
Placebos work just like that, except they go backwards;
they start in the front
and work their way back into the deeper parts of your brain,
and all along the way, they’re releasing drugs as they go.
And your brain has a whole suite of drugs at its disposal;
it’s often called the internal pharmacy.
You’ve got serotonin.
You’ve got dopamine.
You’ve got cannabinoids, which are found in marijuana,
and you’ve also got opioids.
And opioids are probably what I felt when I was getting electrocuted.
Now, opioids bring me to my next story, which deals with chronic pain.
And for that, I want to cross the street from the NIH Labs,
to the Walter Reed medical center and meet Christopher Spevak.
Christopher Spevak is a fabulous doctor who works with veterans
who come back from war zones with terrible injuries –
many of them have lost limbs.
And with those injuries come a great deal of chronic pain,
and that’s Spevak specializes in.
Now, when he meets his patients,
he doesn’t ask about their symptoms or about the injury;
he asks about their childhood,
specifically about sensory experiences in their childhood.
So, maybe it’s the smell of eucalyptus trees
outside of their house when they were growing up.
Maybe it’s the sound of jazz music as their mom’s making dinner.
Maybe it’s – you know those little Werther’s caramels
that your grandmother always had for you when you were at her house?
It could be that.
And he ties those experiences to the drugs that he’s giving.
So every time you take an opioid pill,
you take a caramel,
or you smell some eucalyptus,
or you listen to jazz.
And over time, he starts backing off the drug,
and just giving you the sensory experience.
And what’s happened is your brain
has created an expectation that you will feel better,
and so it will step into the gap
and start self-medicating the way it normally would.
He’s had tremendous success with this:
He’s got some older patients from the Vietnam War
who’ve been on opioids for decades,
and the more recent patients
who he’s been working with this technique
have been able to completely ditch them within months.
It’s a phenomenally powerful thing.
And this is an important question because, as you probably know,
the opioid crisis in today’s world has become an epidemic.
And I found this really ironic
because opioids and morphine
were like the quintessential enlightenment drug.
I talked earlier about drilling into your head and kissing donkeys.
That was sort of this dark-ages era way of treating people,
and the enlightenment brought us into an era of reason and science
and, most importantly, mechanisms, okay?
And the mechanism that made opioids so amazing
was that they mimic the brain chemicals that you already have in your head
to control pain.
Which was phenomenal.
Problem is the thing that makes them so effective at killing pain
also makes them very addictive.
Over the next 10 years,
drug use is predicted to kill some 500,000 people.
That’s more than guns.
That’s possibly more than cars.
Now you might say, “Why don’t we just give out pure opioids?”
But remember that one in four Americans suffer from chronic pain.
What are we supposed to do with them?
The reason why we are losing the war against opioid addiction
is that we are losing the war against chronic pain.
No one knows this better than Sean Mackey,
who’s an amazing scientist and physician at Stanford University.
He told me once – he’s a pain doctor –
he told me once,
“I’ve got a 40% chance of curing my patients;
if I was a baseball player, I’d be making millions,
but as a doctor, that is not good.”
And he’s this brilliant guy, an MD and a PhD,
and he hates being at such a disadvantage against the disease that he’s combating,
and he’s become almost desperate
for new solutions and new ways to think about pain,
so he started looking at meditation and mindfulness.
He even looks at transcranial magnetic stimulation,
which is this sort of device
that electrocutes your head in very small doses,
and it doesn’t really work much better than a placebo,
yet.
He’s also got a machine that you go inside of,
and you can see your own pain while it’s happening,
and you can try to bring your pain levels down –
you can watch it as your brain is processing it.
It’s phenomenal.
And he’s just hungry for any solutions he can find.
It’s funny because the one that always pops up in my memory
is where he says that if he gets a lapsed Catholic in his office,
one of the things he’ll say is
“Why don’t you try going back to church?”
And he doesn’t do this because he thinks God’s going to heal this person;
he does it because it’s a way to start to get control of your disease.
It’s a way to create an expectation that you will have pain relief.
This is not about superstition;
this is about belief.
This is about the same kind of thing Spevak was tapping into,
and the same thing I was tapping into in that chair.
Call it a new sort of enlightenment:
tricking the brain to heal itself.
See, the old enlightenment brought us out of superstition
and into a world of science and reason.
But I think we need a new sort of enlightenment
that brings us into a new way of looking at pain control.
What’s ironic is that it actually brings us back to the same mechanism
that was involved in the Dark Ages,
which, you can call it belief,
or you can call it expectation,
or, if you like, you can call it placebo or brain chemistry,
but you’re tapping into the pain relief that’s already inside all of us right now.
Thank you.
(Applause)
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