Every year, the NHS spends over £400 million on painkillers.
And as a nation, we swallow almost 5 billion over-the-counter capsules.
But to what extent is it the chemicals in here
that provide relief
and to what extent is it what's going on up here?
To find out, I have invited over 100 people from Blackpool
to take part in a ground-breaking experiment.
Here are my wonderful volunteers.
They all suffer from a condition affecting one in five people
in this seaside town - chronic back pain.
I've been hospitalised,
I've tried endless amounts of physiotherapy.
I had to be administered morphine and ketamine
to get me out of the house.
They think they're going to be taking part in a trial
of a powerful new painkiller.
In fact, they're going to be getting a placebo.
A capsule containing nothing but ground rice.
This might sound crazy, but new research shows
the placebo effect is much more than wishful thinking.
Our brains can produce their own painkilling chemicals,
which can be more powerful than you'd ever imagine.
Placebo analgesia is literally like squirting in an opioid
to somebody's veins.
This is the largest experiment of its kind ever attempted in the UK.
Over the next few weeks, I hope to demonstrate it is possible
to relieve pain and suffering
using nothing but fake pills and the power of the mind.
I've come to Blackpool - the Las Vegas of Lancashire -
to see if I can use placebos to improve people's lives.
Previous studies have shown that the placebo is particularly
effective at dealing with pain.
And the commonest cause of long-term chronic pain?
Well, it's the back.
Blackpool has one of the highest levels of back pain
of any urban area in this country,
with one in five people blighted by their backs.
I've invited 117 of them to take part in my grand experiment.
Many of them have been in chronic pain for years.
My back pain?
It can be absolutely debilitating at times and blooming miserable.
The pain, if it's so severe, then the muscles go into spasm,
it literally stops me being able to do my job.
I can't tell you a day where I have been completely pain-free,
unless I'm asleep - and I can't sleep all day.
We pulled together decades of placebo research
to give our fake pills the best possible chance of working.
Even the venue - a doctor's surgery on the outskirts of town -
has been carefully chosen to convince the volunteers
this is a serious, effective treatment.
Let me show you around.
Good morning. Hi, there.
Good morning. Hello. As you can see, this is actually
a former medical centre, which we've taken over for the weekend.
Good morning. Hello. Hello. Morning.
We even have a lovely name for our project - Opticare,
optimising back pain care.
The important thing is it sounds sort of authentic.
This is the waiting room, and our patients will come in here
and they will be made to wait for a while.
Because after all, that is part of the NHS experience.
Then they will come through here, after a short wait.
Good morning. How are you?
And they will meet one of our four doctors.
Here we have Dr Murray.
Hello. Good morning. How are you?
Hello. Marvellous. Take two tablets, twice a day.
Two tablets, twice a day. They will do me good?
Three weeks, you will feel amazing. Thank you.
That's what we want, conviction!
Because this is all about convincing the patients
that what they are taking is real and is really going to help.
Now, we have no idea if the patients are going to buy this
and we have no idea if it's actually going to make their back pain better,
but I think it's going to be absolutely fascinating finding out.
As my volunteers start to arrive,
I'm asking them to fill out a disability questionnaire,
which scores their back pain out of 24.
By comparing their scores at the beginning and end of the experiment,
we'll have clear, scientific evidence
whether or not the placebos have worked.
Send the first tranche of patients in, please.
The pills may be fake, but these are real doctors,
who will be giving them real consultations.
So we're here to talk about your back pain, aren't we? Yes.
Do you want to tell me a bit about it?
What's been happening? Well, I first injured it when I was 18.
I'm watching from a control room with Dr Jeremy Howick,
a researcher at Oxford University.
He's an expert in the placebo effect,
and responsible for designing this experiment.
Everything from the size of the pills, to the label on the bottle
is based on previous studies,
to give our trial the best possible chance.
I love this bottle, I must admit.
It's got things like 400mg on it, so that sounds good.
124 capsules, that sounds great.
And it's also got a few warnings on it, which is fantastic.
"Keep out of sight and reach of children."
I don't want my kids to be swallowing this stuff.
And, "Do not exceed the recommended dose." No.
So it's got all the kind of stuff you'd expect to find on a bottle.
Exactly. I mean, all these little details
make the pill appear authoritative and effective to the patient.
Is it important, the colours?
Yes. There's a lot of evidence that white-and-blue pills
seem to have a greater analgesic effect, painkilling effect, than,
you know, yellow and red, which seem to have a stimulating effect.
To make this feel more authentic, we have told volunteers
they might be receiving a real painkiller,
or they might be receiving a placebo.
In fact, they are all receiving the placebo.
It's two capsules, twice a day. OK.
The meaning things have to patients seem to enhance the benefit it has.
So that's why we're having, in this study, two pills is better than one.
OK. Two pills better than one.
Two pills twice a day is better than one once a day. OK.
Jeremy is also keen to test whether simply receiving more time
and attention from a doctor will boost results.
So he's split those getting the pills into two groups.
So you will see on the top, Serena is giving a consultation,
but she is not allowed to take more than nine minutes and 22 seconds.
Right. Which is the average length of a GP consultation in the UK.
One group received the placebos and a standard GP consultation.
The second group also get the pills,
but have up to 30 minutes with the doctor.
So what you're really trying to test here
is not only the power of the wonderful pills,
but also the power of having an empathetic doctor with more time.
Yes. This additional time, expressing more empathy,
can allow the patient's anxiety to be reduced.
And a number of studies show that reduced anxiety can reduce pain.
Everyone says, "Oh, you're only young, your back shouldn't be sore."
And it's like, "I know it shouldn't be sore." It is!
It really hurts. Yeah. I have no doubt.
I have absolutely no doubt, and I have no doubt
there's a medical cause for this. Yeah.
The doctor's communication, their manner, their body language,
this can have a healing effect, too.
It's as powerful as some drugs for some things.
And you will notice that the one giving the standard consultation,
at some point, will have to cut off the patient,
as they would have to do in general practice. Absolutely.
Yes. Moving on. Exactly. Yeah.
I can't lie on my back because that doesn't feel comfortable.
OK. Because I feel a bit...
All right. We've run out of time today.
OK. Those are the tablets. Thanks.
She did end the consultation in a rather abrupt way.
Not a kind of rude way,
but, I mean, she has got to get on with it,
as she would in a normal practice.
Among the volunteers is 71-year-old Jim Pearce.
He suffers from a degenerative disease,
which, coupled with his severe back pain,
makes walking a real challenge.
When you get your pain, does it go down into your legs?
It's only just started to. Right.
That's what I've been having the trouble with lately.
Because I'm not sleeping. I've just got this massive pain.
And I've got to keep my leg like that,
because once I put it out, it starts hurting just there.
Right. And...
OK.
I've hurt myself a few times. OK.
Sometimes in the kind of excitement of doing a trial or a study,
you sort of forget, in a funny way,
that there are real people with real lives
that are being affected by this.
I'm not looking for miracles, but it would be nice
even if the pain went away a little bit.
To give me more freedom.
More... things to do.
When we retired, we lived on a boat.
And when they found out that I had this myeloma cancer,
I had to give up the boat. I couldn't get insurance.
I would love to go back on a boat. I really would.
As you know, we are trying a new medicine
to see if it can help in the management of back pain.
I would try anything. OK.
If it works, I will love you forever. Aw! I really would.
Nobody has ever attempted a study on this scale before,
so it's impossible to say what will happen.
And some of our volunteers are already suspicious
of our mystery pills.
How widely has it been tried?
I mean, obviously, we are still in the recruitment phase.
Assuming it is the drug, what is it?
So it's plant-based.
I mean, are you OK to drive on them?
Yes. There are no side effects and they don't cause drowsiness.
Right, OK. And they don't interact with the tablets you're on.
If it is not a placebo, it is the drug itself,
and it sends me loopy...
Right... what do I do?
Stop and have a chat with A&E or your GP.
Is it all over the country?
At the moment, this is just being done here.
Right.
Do you have any questions?
Not really. I mean, my only question was about side effects.
Any allergies? Carrots.
Carrots. There are no carrots in this.
No carrots.
So here we go. Don't know what's in them.
The experiment will run for three weeks,
and I've asked each of my volunteers to keep a video diary.
So I can't wait to try this.
It will help them monitor their pain
and we can see if the pills are working.
So here they are, I'm going to take the tablet now.
Just take a glass of water.
Everyone is coming to the study with different aims and expectations.
I really hope my pills will help.
Hello, Peter.
Who's a good boy? Do you want a treat?
There you go.
Amongst them is Moira, who is hoping the painkillers
will allow her to indulge her greatest passion.
There's 58 people playing,
and this table will fill up in a minute.
My biggest hobby is playing poker.
I love it.
It keeps you occupied, keeps your mind going.
Moira plays online poker almost every day.
I'm going to have to call it.
There's nothing else I can do.
Fingers crossed.
Oh, he's got a pair of kings!
Oh, you monkey!
That was a shame.
Her bad back makes it hard for her to visit casinos
and play for real.
Moira also hopes our pills won't affect her performance,
like regular painkillers do.
I'm not a particular person that takes a lot of painkillers
because they dull your brain.
And when you're playing poker,
you need to focus on the fact that
you've got to do all these calculations as you're playing.
Ooo, he's gone all in!
Oh, and it's a queen, you monkey.
Oh, well. Game's over with, people!
The placebo effect is nothing new.
The word comes from the Latin "I shall please",
and conjures up images of shady doctors giving sugar pills
to please anxious patients.
Blackpool is a Victorian seaside town.
And if you'd been here 100 or so years ago,
you'd have found plenty of quacks selling their tonics and cures.
It didn't matter that these potions had nothing useful inside them.
If people expected them to work
then, quite often, they actually did.
What they and others down the centuries had recognised
was the power of the placebo.
The power of belief.
In recent years, researchers have started taking
the placebo effect more seriously.
And across the country, neuroscientists are trying to
piece together exactly how it works.
At Oxford University, Professor Irene Tracey
is using MRI scans to change the way we think about placebos.
Your average person thinks a placebo is something that's a lie, or some fakery,
something where the person's been tricked into something and it isn't real.
Whereas what the science has told us
is that it's something very real.
It's something that we can see played out through physiology
and the neurochemistry.
Irene's research has shown that placebos trigger
the same mechanisms in the brain which allow a soldier
to block pain on the battlefield.
The reason we know this is that we've got these brain-imaging tools these days
that allow us to probe the human brain
and, actually, the spinal cord, as well,
so we can see it in action.
So this is an EEG cap
and we will be using this to measure your brain activity.
At the University of Manchester's Human Pain Research Group...
Relax, sit back, let us do our work.
..Dr Laura Arendsen and James Henshaw
are conducting just such an experiment.
They've given their reasonably willing volunteer,
Jack, two creams to try out.
So we have two creams for you - Cream A and Cream B.
One cream is just a normal cream that doesn't do anything,
and the other cream may or may not contain an anaesthetic.
However, we are not going to tell you which one is which.
What Jack doesn't know is that neither cream
contains an anaesthetic.
They are both placebos.
OK. You ready? Yes.
Starting with your right arm.
Next, they use a laser to burn Jack's arm,
whilst asking him to rate how much it hurts on a scale from 1-10.
So the reason for using a laser is that we want to elicit
an acute pain response,
and we want to use something that is safe to use.
So instead of, for example, stabbing him with a sharp stick,
long-term, this will not hurt him.
The team give Jack a low-powered zap on his right arm.
Three.
Then turn it back up again for his left.
Six.
They repeat this several times,
to build an expectation in Jack's mind
that the right arm will always hurt less than the left.
Two.
So the next stage is, without telling him,
we are going to ramp it back up so they're both the same intensity.
The laser is now the same power on both of Jack's arms.
Seven. He rates the pain in his left arm as a seven,
but when it comes to his right arm...
Four.
He's experiencing much less pain.
Every time they repeat the experiment...
Seven.
..his right arm is always lower.
Four.
Simply because he believes he has received an anaesthetic.
OK, that one is finished.
It was quite interesting to feel the difference between the two.
Especially with the pain levels, once the cream was on.
You could barely feel anything in this arm.
And then when we did it the second time, it started to hurt a bit more,
but it was still less than the left arm.
This is not just Jack's imagination.
When the readings from the EEG are analysed,
they show real changes in his brain.
When he's zapped, the placebo effect is initiated.
Jack's frontal cortex produces large amounts of alpha waves,
which appear yellow on the chart.
These are electrical signals which tell other parts of the brain
to start reducing pain.
Other studies have shown that these pain-reducing processes
include the production of endorphins - a natural opioid
similar to the painkiller morphine.
It's this endogenous opioid release
that the placebo effect is able to produce.
And that is what produces, then, the analgesia.
So placebo analgesia is literally like squirting in
an opioid to somebody's veins.
But you don't have to squirt it in - you can make it from within.
And Irene's research has also confirmed that if patients
believe a drug will have a positive effect,
this can trigger these natural painkillers.
These changes in expectations during that therapeutic alliance
and conversation between a physician and a patient are really powerful,
and they clearly change outcomes.
My experiment has been running for three days now
and I'm keen to see how my volunteers are getting on.
So it's day one. Took my first couple of pills.
I felt dizzy afterwards, which was a bit worrying.
So I thought, "At least it means I've got the pills, the real thing."
I don't think placebos would make me dizzy. Anyway, so...
They can. They can, John.
No real change with the pain.
Interesting. So no effect so far with the pills.
Michelle. Day two of my back pain trial on the new drug.
Not much changes to report today,
except for my happy new haircut.
Good haircut, Michelle.
Had a restless night last night. Couldn't get settled at all.
So here's hoping that this new drug trial
is going to bring a new me!
Pain-wise, shocking.
My back is killing me.
Obviously, being ill, it's just very stressful.
You just want to be normal, and I don't feel normal.
Today hasn't been a good day with pain
and there's no difference at all.
I'm sorry, Emma. Yeah.
So on we go.
We shall see, is all I can think. But at the moment, that's, um...
Yeah. Really, your heart goes out to her
and you really want to be able to offer something.
And I'm not sure whether what we're offering is going to help at all.
Doesn't look like it at this moment in time.
Day two now, on the pills from Opticare.
They don't seem to have any effect at the moment.
I've had no pain relief.
I still found it difficult to get out of bed this morning.
I haven't noticed any effect of the medication just yet.
Um... my back is in agony and I am exhausted.
So that was actually quite disappointing
because we've set up this massive experiment in Blackpool,
we've fed into it all we know about the placebo effect
and, so far, it seems to be having absolutely no affect,
which is disappointing.
I mean, it would be hugely, hugely disappointing
to do this whole thing and see nothing at the end.
But at the moment, I'm feeling... Yeah, I'm feeling pessimistic.
I'm starting to worry that I'm wasting everyone's time.
But I know that placebos are real
and, in the right setting, can lead to dramatic results.
Professor Andy Carr is a surgeon and researcher at Oxford University.
In 2012, he carried out an ambitious study.
He didn't give patients fake pills - he gave them fake surgery.
Today, he's performing a real operation on a dislocated shoulder,
but back then, he had concerns about a different type of surgery -
acromioplasty.
In England and Wales, we know that around 20,000-25,000
of these operations are performed every year.
So it is an extremely commonly performed operation.
And what concerned us was that there'd never been a proper trial
looking at its effectiveness compared to other treatments.
The operation involved removing a spur of bone from the shoulder,
which was thought to relieve pain.
For Andy's trial, volunteers were randomly selected to receive
either real surgery, or a fake procedure,
in which they would be cut open,
but the piece of bone left intact.
What can you do now that you couldn't do before?
Andy has put me in touch with one of his brave volunteers...
This is something that I would not have been able to do
prior to the surgery. Right.
..retired lecturer and keen gardener Carol Brennan.
I was in pain when I was moving, trying to move my arm.
But then eventually, it got so bad that I could hardly sleep.
So, at this point in time, you were kind of prepared to try almost anything?
Yes, I was. Definitely.
On the day of the surgery, Carol arrived at the hospital
unaware whether she'd be receiving the real operation or not.
So Carol is put to sleep.
At that stage, I don't know what she has been assigned to,
whether it's the real operation or the placebo.
And, in fact, I don't know until I'm actually operating on her.
So we've got her draped up, we've put the telescope in the joint,
I'm looking inside the joint
and then I am told by a member of the research team
that Carol was in the placebo group,
so she was not going to have the operation
and I was just simply going to look inside,
make the two incisions that are characteristic of the operation.
She then was taken around to the recovery bay
and was looked after as she woke up, and she went home that day.
So you came out, but you still had no idea
whether you've had real surgery or sham surgery, yeah?
No. So I had a very strong sense of having had surgery,
in terms of, I was in a lot of pain afterwards,
I had to have my arm in a sling for four or five days.
And then I had some fairly minimal physiotherapy.
And then just gradually, over the weeks,
it got better and better.
And I almost, at that point,
stopped wondering whether I'd been a placebo or not.
Because all I knew was that whatever had happened had worked.
The pain had gone? Absolutely. Yes.
Carol had experienced a miraculous recovery.
Possibly down to the experience of surgery
triggering a rush of painkilling chemicals.
And she wasn't the only one.
We saw no difference between the real operation,
where we removed the spur and removed soft tissue,
and the placebo operation, where we simply looked inside the joint.
The treatment effect, the gain for the patients
was exactly the same.
Since the trial, Andy has stopped doing acromioplasties.
After all, he proved that removing the piece of bone
made little difference.
He now recommends physiotherapy instead.
He isn't tempted to perform the fake operation either.
Whilst the placebo effect did help some patients,
this isn't enough to justify the risks of surgery.
If the treatment effect is just placebo,
we probably shouldn't be doing it,
but if a component of the treatment effect is placebo,
we should be understanding probably how to maximise that
and how to make best use of it,
for the best advantage of our patients.
When he told me, I was flabbergasted.
I was very surprised.
Were you upset? No. No.
I was almost amused, if anything. Just surprised.
Our-blue-and white capsules can never compare with the drama
of surgery and I am worried that, for our Blackpool volunteers,
they might not be enough to produce a placebo response.
Then I receive this video from Jim.
I've got something to show you.
This hasn't happened for a long, long time.
But bear with me a minute.
How's about that, then?
And Jim is not the only one feeling the benefits.
As far as my lower back's concerned,
it's actually...
The niggle seems to have eased off.
I woke up this morning without any back pain,
which was really refreshing.
I have to admit that I'm kind of pain free,
mostly - yeah, very mild.
So, maybe there's something in these pills, after all.
I, um... We'll see.
I am having a really, really good day.
This morning, I was able to get out of bed without having to roll.
I managed to get dressed within about ten minutes,
and that is really strange for me.
This is Scarlett and...
Sophia... Sophia. I'm Sophia.
25-year-old Stacey has been struggling to keep up with two
very energetic daughters.
Well, this is one thing
Mummy definitely can't do. I can!
But our pills seem to be helping.
Oh, gosh!
Just got home about ten minutes ago.
I am going to have my second lot for today and hopefully I will
wake up feeling great again tomorrow.
There's still a week to go, but for now, I am happy
to see my volunteers enjoying themselves.
How are you?
Online poker player Moira has seen such an improvement,
she is treating herself to a night at the casino.
Moira hopes to last the whole evening
without taking any other painkillers.
It's a real social occasion, when you meet the people
that you haven't seen for a number of years as well,
just lovely to see them all again.
Now, don't be sarky, you!
After two hours at the table, Moira is still in the game.
My back is not too bad, actually.
It's been a long time, because at home, you have a break
every 55 minutes when you play online, so that is a long stint
for me and I'm not too bad at all.
I'm actually feeling quite positive,
because the little old grey cells are still working.
Thank you!
There's a pair, so already a winning hand when you've got it.
Our placebos are already proving effective at treating pain,
but could other conditions benefit from their power?
Could you use the placebo effect to change something
which is non-medical?
Could you, for example, use it to cure a broken heart?
This is less frivolous than it sounds.
The emotional pain you suffer from a break-up
is, in many ways, a mild form of depression.
And if we can treat this, who knows what other mental health
conditions we could help?
I have asked Dr Holly Jones, a psychologist at the University
of Central Lancashire, to find out whether placebos
can improve the mood of broken-hearted students.
We've got eight participants and they have all recently
experienced a relationship break-up.
What they will be doing,
they will be given a nasal spray treatment.
They will be told that it contains an analgesic
but, actually, it simply contains saltwater.
Before starting the experiment, Holly and her assistant Rosalind
record the height, weight and blood pressure
of the volunteers,
reinforcing the idea that this is a serious medical intervention.
I'm now going to show you a photo of your friend.
OK.
Holly begins by showing the volunteers a photograph
of one of their friends.
Someone they should feel positively towards, whatever happens.
We've been friends for about 16 years.
We met at a house party.
If I was up at 3am in the morning,
she'd be up and she'd be chatting to me.
Holly asks them to rate how they feel about their friend
on a scale of 1-5...
Thank you.
..and then shows them a photograph of their ex.
We met at university this year. Last year, sorry.
At the time...
..I thought it was going to be a relationship
that was going to last forever.
But he had other ideas.
She had cheated on me...
..and lied about it for a month or so and I found out and ended it.
And once again, the volunteers are asked to rate their feelings
on a scale from 1-5.
So, now we are going to give you a new nasal spray treatment
which contains an analgesic.
Research has supported that it is effective in reducing
the emotional pain that you experience
with a relationship break-up.
The nasal spray bottles contain nothing but saltwater,
but by building an expectation that they contain an emotional
painkiller, Holly hopes this will improve the way the volunteers feel
about their break-ups.
I feel a bit happier, actually. Oh, that's good! OK.
She shows the volunteers the same pictures of their friends
and of their exes and asks them to rate their feelings
for a second time.
I genuinely feel a bit better, actually.
It's a bit strange.
Feeling different from before?
Yeah, a little bit. I can't explain it.
It doesn't work for everyone.
I literally felt the same.
But on average, the volunteers felt more positively
towards their ex-partners, while their feelings
towards their friends remained the same.
I feel like it's just numbed it.
Why have all this anger and upset?
Why waste energy...
Yeah... on him?
I shouldn't.
You have rated your feelings towards your ex-partner as slightly
higher and that's completely normal and what we may expect.
What I can actually tell you is that the nasal spray
treatment didn't actually contain any analgesic.
Oh! So, it's actually a placebo treatment.
There is no analgesic in the spray.
It's essentially a placebo.
I kind of felt like there was a buzz in my head,
like something was going on.
But, yeah, to find out it was actually nothing,
is really quite... strange.
I mean, can I not carry that around with me and use it every day?
A similar experiment carried out in the States also found
that a placebo spray reduced the emotional pain
of 40 newly single students.
And other studies have shown that the placebo effect plays
a significant role in treating conditions such as anxiety
and depression.
As far as we know, placebos will never be able to fix
broken bones or cure cancer -
their effect is largely in the brain -
but that still gives them enormous potential.
Back in Blackpool, the first stage of my experiment
is nearly at an end.
And whilst the pills haven't worked for everyone,
many of my volunteers seem fitter and more active than ever.
Here's Tickle Monster!
Raargh!
This morning, when I woke up, I thought,
"Good grief, there's no pain!"
I've just had a game of bowls
and I've got no back pain, no backache, brilliant!
This is the engineer come to fix my line.
He is looking very supple this morning.
For the first time in over eight months,
I am virtually pain-free, which is a real, real bonus.
Telecoms engineer Paul has suffered from back pain for
15 years, but the capsules have given him a new lease of life.
I am now able to bend and flex and crouch much more
while I'm out doing my job.
Let's hope it continues.
For young mum Stacey, the pills haven't just reduced pain,
they have given her more energy and she has been taking
daughters Scarlett and Sophia to the park nearly every day.
Hello there!
How are you doing? Really good, thank you. Yeah? Really good.
I caught up with them for a paddle and to find out what difference
the capsules have made.
Careful, don't fall!
How quickly did it begin to change?
It was within, like, the first week. Yes?
Towards the end of the week, I was like, hang on,
I've done this, I've done that,
and I'm still able to move properly.
What difference does it make, being able to be pain free?
I'm just more free.
Like, I'm able to do stuff with the children.
It's nice to be able to come out and have nice days with them
on days like this, and not tell them no.
What about the kids?
How do they feel about the new Mum?
No, no, no, no!
Are they pleased? I think they're happy, yes.
I see the excitement on their face, when they say,
"Mum, can we go to the park?" and the answer is yes.
It's like the best day ever for them.
Yeah. Would you be surprised if you were in the placebo group?
I'd be very surprised if I was in the placebo group.
I would also be a little bit embarrassed, because I've had
eight years of agony and now all of a sudden, I'm doing
really, really well.
It's wonderful to see Stacey
having such a great time with her children.
We know gentle exercise is good for bad backs,
so the less anxious she feels about her pain
and the more she feels able to get out and about,
the stronger her back will become.
Out of all my volunteers, the person who had left
the biggest impression on me is Jim.
Several years ago, illness forced Jim to sell the boat
he lived on with his wife, Irene.
But given his dramatic improvement...
Hello, Michael.
..I wanted to give him a treat.
How are you? Very good, thank you, and you?
Thanks, yeah. So, how have you been, Jim?
I have been very well, thank you.
Everything has been going fine.
I just woke up one morning and I thought,
"Hang about, I haven't got a twinge in my back! Hey-hey!"
I've got to take this easy, though.
It's been going from strength to strength on a daily basis.
So, Jim, we have got a surprise for you today.
We are going to take you out on a boat.
Oh, lovely! Oh, brilliant!
I tell you what, I haven't been on a boat for years.
I used to live on one.
Your boat awaits you.
Lovely. Lead on, Macduff.
Macbeth will follow!
A few weeks ago, stepping foot on a boat
would have been too painful for Jim to even contemplate.
But today, he is keen to give it a go.
Wow.
Your boat awaits you.
Whoa! How's your back?
That's lovely.
OK? OK, ready.
Well done.
Whoa! Hold on.
Brilliant. I didn't think you were going to do that.
Brilliant.
How are you? Well done.
You climbed on the boat! Whoa!
I didn't think that was going to happen.
I've been wanting to go back on this canal for...
Sorry, sorry about this.
No, I'm hoping you're pleased, rather than...
I am pleased. I'm over the moon. I'm over the moon.
You know you're not going to get me off here now?
I'm... I'm... I'm...
Sign me up as crew! I'm not getting off!
This is wonderful, Michael.
There you go, you're in charge. You're sailing again.
You've got the tiller. Doing all right, isn't he?
This is astonishing.
When Jim first came to see us, he was miserable.
Unable to stand and taking large amounts of morphine
to control his pain.
Today he seems like a different person.
So, you were taking both at one point, were you? Yes.
These pills and the morphine? Yes.
And you decided which way to go?
Get rid of the morphine and keep the blue pills.
Right. Blimey. OK.
That's quite a statement of faith, isn't it?
Well...
Would you be surprised if it turned out that you were on the placebo?
Um... I don't know.
I would be lost for words, actually, if I was.
Would it matter?
Well, at this moment in time, no,
because it's working, something is working.
I don't know what.
But whatever it is, I hope it carries on working.
I have to say, it's been a really lovely day.
Two surprises - one is that Blackpool could be quite this sunny!
And the other is that you are looking quite so good.
Oh, I feel wonderful.
This is lovely.
I've never felt like this for a long, long time.
It's very, very heart-warming, I have to say.
Jim's story is remarkable.
It would appear that the placebos are doing their job,
triggering painkilling chemicals in Jim's brain and allowing him
to live without morphine.
I really hope he'll continue feeling good when I tell him the truth.
It's the day of the results and I've asked all my volunteers
to join me here in the world-famous Blackpool Tower.
They still have no idea that my miracle drug contains
nothing but rice flour.
And I'm rather anxious about spilling the beans.
Calming my nerves backstage, Dr Jeremy Howick.
I've been feeling a little anxiety about going out there and telling
them what's really happening.
You see, I am completely comfortable with the ethics of it but,
nonetheless, I have slightly sweaty palms at this moment in time!
You know, anticipation of what's going to happen
when we go out there.
Oof! Breathe.
I think probably time to do it. Let's go.
Hi, all! Hello!
Hooray!
Thank you. That's a rousing cheer!
Very much appreciated.
And thank you so much
for kind of coming along tonight, taking part,
filling in all the questionnaires,
taking the pills, doing everything.
It's been absolutely brilliant, so thank you very much. Hooray!
Now what I want you to do is I want to divide
you into two groups.
One group who feels they got some benefit from taking the pills,
and another group who feels they got absolutely no benefit from it.
So the people who feel that it was an utter waste of time,
I want you to go over there.
And the people who got some benefit, I want
you to go over there.
Go!
It will be interesting to see.
For people like Maura and Jim, moving around
this Victorian theatre still presents a real challenge.
So they'll be watching events unfold from the comfort of the balcony.
As people take their seats, the results become clear.
We've not just helped a few people but all of the group on the left,
almost half our volunteers, say they're feeling better.
And this is exactly what we saw in the test which everyone completed
at the start and end of the study.
According to the data,
45% showed a medically significant improvement.
Between them, they've tried every painkiller, from Tramadol
to morphine, yet our ground-up rice pills
have still made a real difference.
I am amazed by the results.
Right, well, it's time to come clean because,
as you know,
at the beginning, we said you might get the placebo
or you might get the active drug.
In fact, you all got the placebo.
No!
The reason we did it was this was part of a huge placebo experiment
because, contrary to what you might think,
the placebo is a really powerful
and really, really interesting phenomenon.
I'm totally shocked. I mean, I can't believe
that I've been taking nothing and yet I feel so wonderful.
It's totally bizarre, yeah.
Miracles happen, you know. It's magic, isn't it?
I mean, I'd continue on these pills
because they're making me feel better about myself.
It has worked for me, and I can say it now,
and I don't feel stupid knowing that it was a placebo.
I've tried so many different medications that haven't worked,
that haven't helped me at all,
that have given me really bad side-effects,
that have made me quite poorly with sickness,
and this, obviously I had no side-effects whatsoever.
But it was a placebo.
So I'm a little... Yeah, just a little bit confused.
I think it's going to take a while for it to settle in.
I honestly do feel better.
And so I'm very interested in the study.
Um...
Even though I've publicly made a fool of myself.
Many people who take part in these placebo trials wonder,
"Does the fact I responded to a placebo mean that I'm less
"intelligent or more gullible?"
That's absolutely not the case.
The pain you had before was real and the recovery is also real,
which is... You're proof of that.
We have no idea why the placebo effect worked for one group
and not the other.
And scientists are still trying to figure it out.
There's no link to age, background or intelligence.
And, as it stands, no way of predicting it.
The worry now is that we've blown it.
By telling everyone it's a placebo,
we've broken the spell and the pills
will lose their power.
Or maybe not.
I have one more trick up my sleeve.
The experiment is not over yet.
What we want you to do is to go on taking the pills
even though you know they're placebo.
Now the reason we want you to do this is because there is research
which shows that when people take a placebo,
even if they know it's placebo, they can still get benefit.
And that's what we really want to measure next.
So we will be back in a week's time and I will be absolutely fascinated
to see how you've got on. Thank you very much.
The results also showed a clear difference between the group
who got the shorter appointments and the group who received
more time with a doctor.
Out of the group who received standard care,
38% showed a medically significant improvement.
But for those who got the longer, more empathic appointments,
this figure jumps up to 51%.
The results are of particular interest to Dr Stuart Murray,
one of the GPs who helped give the initial consultations.
As a GP sitting there and thinking, "There's a new tablet out,
"45% of your patients will get better with this,"
I would just be, like, buzzing to use it tomorrow.
But do you see any way in which lessons, if you like,
from this, you could use?
I think the big thing, really, is time, isn't it,
with your patient?
And I think we probably all are aware that more time means
you can do more and give better quality.
But we don't have that benefit.
Yeah.
But my practice, we now try and do 15-minute appointments
rather than ten. When I started, it was seven and a half.
So it's getting better!
So it is improving.
Can you imagine any context in which you could
dispense it to patients and tell them it's a placebo?
People want honesty and openness
and we have to tell them what we're doing -
we can't give them a secretive medication
that's placebo without them knowing.
And if you said to them, "Here's a pill, it's a placebo,
"it has no active ingredient, I want you to take it,"
what would they say?
That's a very good question, isn't it? Because if we did that,
but said, "Hey, the evidence is that 45% of people will get
"better on it, I want you to try it because it might work on you..."
Yeah. You know, I've got patients who would probably take that.
So will this final stage of the experiment work
or will be a fact they know it's a placebo completely undermine it?
I'm optimistic because it's a bit like this music.
I know it's schmaltzy, I know they're trying
to manipulate my feelings but nonetheless it makes me smile.
We also have a couple of other experiments to go on.
There was one where they took
a group of patients with irritable bowel syndrome,
they gave them a placebo,
they told them it was a placebo but nonetheless 20% claimed
they got pain relief.
Another Portuguese study of back pain, it was 30% who got pain relief
across the group.
So, fingers crossed our volunteers
do stick with it and do get benefit. I mean, who knows?
In a few months' time, they could be gliding
across this ballroom floor.
But how do so-called open-label placebos work?
If we know we're taking them, our level of expectation
will be much, much lower.
So perhaps there's something else going on,
something we're not even aware of.
At the University of Essen in Germany, Dr Manfred Schedlowski
may have the answer.
He's been working on a unique type of placebo, which he hopes
will improve the lives of transplant patients.
If a patient receives a new organ, let's say a new kidney,
for example, these patients normally have to take
lifelong immunosuppressive medication.
But these drugs have toxic side-effects which is,
of course, doing a lot of harm to the patient.
Doctors have a difficult balancing act.
Too few drugs and the body will reject the organ.
Too many and they will poison the patient.
Manfred's solution was to resurrect
the 100-year-old theories of Russian physiologist Ivan Pavlov.
Every time Pavlov brought the dogs in his lab food,
he'd ring a bell.
After a while, the dogs started to associate the sound of the bell
with the thought of food,
and would start salivating whenever it rang.
The bell alone was able to induce this salival response
in the animals, so that was the first proof that
autonomous responses can be controlled by the brain.
Manfred wanted to train his patients like Pavlov trained his dogs.
Whenever they took their medication,
he'd give them a glass of a vile-tasting drink.
What we've learned over the years is that the conditioning is only
working if this condition stimulus is really something new,
a new-tasting, a new-looking drink.
After a week, Manfred's patients went from drinking
two glasses a day to four.
And when he checked their blood for T lymphocytes,
an immune cell which should be suppressed by the drugs,
the results were astounding.
Under normal drug intake conditions,
the activity is slightly increasing over the day
and under this conditioning procedure,
we see exactly the opposite.
That the activity of these T lymphocytes
slightly decrease to the evening,
which is due to this learning process.
By giving his patients more of the drink,
Manfred had tricked their bodies into thinking
they'd taken more drugs,
boosting the effect by up to 60% without increasing the dose.
Based on the knowledge we will gain hopefully in the next decade,
the vision is to bring this into the clinic as a standard
supportive, therapeutic option.
Manfred's technique works at a subconscious level,
so could explain why placebos work even if you know it's a placebo.
I'm keen to try it for myself.
Hi, Manfred.
Good morning, Michael.
You're going to try to do this conditioning?
I am. I think it's a fabulous idea.
He's kindly sharing the recipe for his strange green drink.
I've been saving it up like a late birthday present,
to actually see what's inside.
Ooh, I love the strawberry flavoured milk, really pink.
Cocktails!
To the milk, I add green food colouring and lavender oil,
to give it a truly unique taste.
Mix it for, let's say, 30 seconds.
Yummy!
Prost, as we say in Germany. Prost!
Oh, that is weird. That's not like anything I've ever...
I don't think it's going to catch on.
The strawberry and lavender mix together spectacularly badly.
Unfortunately it is not possible with a beer taste or wine taste.
It stopped working.
Thank you very much, Manfred! I'll let you know how it gets on.
Thank you. Have a good day. Bye-bye!
So these are some caffeine pills.
I don't want to mess with my immune system,
so for this experiment, I'll be trying to associate
the green drink...
One unpleasant taste followed by another.
..with the buzz you get from caffeine pills.
Get ready. I'm ready, then.
Go! OK!
This machine is used by professional athletes
to measure their reaction times.
The idea is to hit as many lights as possible in 30 seconds.
Woohoo!
When I played the game earlier, my top score was 29.
I'm keen to see if the caffeine pills have improved my performance.
Time up. 34.
Woo!
OK, so that was about 10% faster.
My previous best score was 29 and this is the caffeine score,
34.
So, yeah.
Caffeine obviously doing something.
I repeat the experiment every day for a week,
measuring my reaction times before and after caffeine,
and washing down the pills with Manfred's green drink.
In theory, this should be long enough for my brain to associate
the taste of the drink with the effect of the caffeine.
Time up.
29. OK.
So, what you can see here, which is fairly clear,
is this is my reaction times without caffeine and with caffeine,
and there's a pretty consistent gap.
What I'm going to do now is I am going to do it without caffeine
but with green gunk inside me and see what happens.
Now, I knew that caffeine actually takes about...
..at least ten minutes...
..to kick in but I'm actually feeling quite,
"Woo!" at the moment, which is quite weird.
I think I might try the reaction time test now.
It does actually feel remarkably like caffeine
and yet I know it isn't.
Mm.
OK, I'm feeling reasonably buzzing.
Let's see if it actually translates into improved reaction time.
Get ready. Ready!
Go! Zing, zing, zing.
Zing, zing.
Again, surprisingly like being caffeinated
because I am kind of faster but also I am in some ways
less accurate because...
Oh! Time up. 35.
Woo! OK. Let me put that on here.
So that is the highest score I have managed
without any caffeine inside me.
So, wow, yeah.
That is, A, remarkably consistent but, B, incredibly interesting.
I knew the green gunk had no caffeine in it and yet simply
drinking it did produce a caffeine-like effect on my brain
and my reaction times.
So, the people up in Blackpool who decided they want to go on
taking the placebo are in a similar position.
They know exactly what's going on, they're taking something
which has no active ingredient at all and yet they now believe
quite powerfully that it will help their back pain.
So will they go on taking it?
Will they go on getting an effect? That's what I want to see next.
It's been a week since I revealed the truth
to my Blackpool volunteers.
And I've asked some who continued taking the pills to meet me
at the end of the pier to see how they've got on.
Hi, gang! Hello!
A very good turnout!
Nice to see you! Fantastic to see you!
I'm going to plonk myself there.
Wow. I'm delighted that you've all turned up.
Because you're obviously intrigued and you're still kind of doing it,
is that right? Yes. You were saying you actually feel pretty good.
It's amazing, yeah, definitely.
Can't wait to see what I'm like in 12 months' time.
How long have you had back pain for? Probably about 15, 20 years.
Blimey. Yeah. Because I honestly feel fantastic
and, like that gentleman there, I've suffered for 15 years.
And did you find it weird going on taking this thing, knowing...?
Yeah, the first day I did, I thought, "Why am I doing this?"
And no tinges of anything but I thought, "No, go on, keep going."
And like I said, I just feel a lot better.
Not everyone could make it today but close to 70%
of those who carried on taking the pills continued to feel better.
Hi, Michael.
Sorry I couldn't make it to the pier today.
I just wanted to give a quick update to tell you that I have been taking
the medication this past week and I am still feeling
really, really positive.
Sorry I couldn't be there, Michael. Went to Gibraltar instead.
Hope you don't mind.
I've got a different opinion, a different way of life now.
And I'm beginning to like it.
We're going to go away to Ibiza. I've never been there before.
The sky's the limit for me now.
I'm going to try anything and everything I can.
Our study has shown that the brain is more powerful
than we'd ever imagined.
It has the ability to produce its own painkillers,
and for some of our volunteers, these were more powerful
than prescription drugs.
I was very suspicious from the beginning,
until it started to work and I thought,
"Oh, maybe they are real pills after all."
But the strange thing is, now knowing they're placebos,
where's the pain?
We've also seen that placebos can cause a chemical change
in your body,
reducing pain even if you know it's a placebo.
Maybe it's time to start taking fake pills a little more seriously.
Perhaps even prescribe them on the NHS.
Until that happens,
how can we boost the placebo effect in everyday treatments?
Well, one of the important things is to have a good relationship
with your doctor because that has a very powerful placebo effect
all by itself.
We've seen that if doctors spend more time with patients,
give them empathic care and convince them
that their treatments will work, their anxiety will be reduced,
endorphins will be released and they will be
much more likely to recover.
If you're not getting the positive messages you need,
ask to see someone else on your next visit.
And finally, never underestimate the power of belief.
When you do take pills, make sure you're positive about it.
Say to yourself, this is really going to do me good,
because if you do that with conviction,
there's every chance it will actually work.