### page 6

The practitioner began reassuring Dee, saying, “It doesn’t matter whether this religion works or not. God loves your child.” Over the next couple of minutes, everything changed for Dee. She let go of herself and put her trust in God. The world was transformed from a place where her son was dying and her community was helpless to save him into a world in which everything was perfect and God’s love enveloped her family like a warm, comforting blanket. Dee walked into the next room and saw what most people would describe as a miracle. Her child was sitting up, happy in his father’s arms, his color returned, a smile on his face.

### page 7

Christian Science is an American religion founded in 1866. Its charismatic founder, Mary Baker Eddy, claimed to have discovered the true meaning of Scripture: that all Christians have the ability to heal, just as Jesus did. Roughly speaking, Christian Scientists believe that all matter—your car, this book, or a shot of antibiotic—is superseded by a deeper reality reflecting the mind of God. In that reality, everyone and everything is perfect. Thus a healing comes not by changing the body but through glimpsing a more perfect, truer version of yourself.

### page 7

[M]ore than 2,000 Christian Scientists claim to have been spontaneously healed of medically diagnosed conditions across the spectrum: polio, bone cancer, ruptured appendixes, goiter, crossed eyes.

### page 11

These people aren’t lying, and they aren’t fooling themselves. Something else is happening. Something was giving me the power to heal myself as a child.

### page 12

In 1996, the philosopher and artificial intelligence pioneer Daniel Dennett wrote, “A mind is fundamentally an anticipator, an expectation-generator.”

### page 15

The world, it turns out, is not what it seems. More important, it’s not what we expect it to be, and in that fact lies unimaginable power.

### page 17

Maybe physicians needed to find a cure that came in a package similar to the disease itself. “Similia similibus curantur,” he said: Like cures like.

### page 18

Grams’s homeopath recommended belladonna, or deadly nightshade, a poisonous bush used throughout history for political assassination.

### page 18

there is no scientific reason why deadly nightshade, let alone highly diluted deadly nightshade, should have helped Grams’s panic disorder when prescription drugs had failed. But it did: Her symptoms dissipated.

### page 19

But the more she dug into the scientific literature, the more she learned that the homeopathic treatments she had been administering showed zero merit in careful scientific tests.

### page 19

What’s going on here? Homeopathy improved the health of Grams, her patients, and hundreds of thousands of other people and is one of the most popular forms of alternative medicine in existence. How does it work so well if it’s not real?

### page 21

Around 1025, the legendary Persian doctor and mathematician Avicenna wrote his Canon of Medicine, which lays out parameters for clinical tests of new drugs that are surprisingly in sync with modern standards.

### page 21

Today’s laboratory experiments follow similar rules—except sadly we substitute mice for lions. (Just imagine how much more interesting lab work would be.)

### page 23

Mesmer observed that, like the tides in the sea and the planets in the sky, the human body was awash in magnetism. He reasoned that the same forces that drew metal objects together created a sort of invisible “universally spread fluid” that swirls around us (kind of like the Force from Star Wars).

### page 30

[Y]ou eating from the forbidden fruit of knowledge, so that the next time you pop an Advil, you won’t feel anything until it kicks in? Never fear. Classical conditioning happens largely on an unconscious level. You can no more prevent your placebo response than Pavlov’s puppy can keep from drooling. This has even been shown in the laboratory.

### page 30

This theater plays out in thousands of ways. For instance, depression patients respond better to yellow placebo pills than to blue ones. Bigger ones work better than smaller ones, but only to a certain point (at which the pill is just too big to believe, I suppose). Fake injections work better than fake pills. And if you’re French, suppositories work better than either. Take a quiet moment to ponder the significance of that.

### page 34

Soon drug testing would have to be 1. randomized (distributed to patients randomly), 2. double-blind (neither patients nor doctors would know who got what), and 3. placebo-controlled (shown to be more effective than a placebo).

### page 38

For the first time in history there was a law stating that, to be allowed on the market, a drug had to beat something. From here on, every new pharmaceutical now has to be measured against the effect of a placebo treatment.

### page 39

Because placebos are still largely viewed as a nuisance—a bizarre psychological reaction that affects weak and gullible people and keeps the real patients from getting the drugs that they need. But today that view is radically changing. The only way we have to separate an effective

### page 43

Placebos and expectation are part of all medicine. They kick in the moment we swallow that pill and the moment we step into the doctor’s office and see that white coat. None of us is immune to it, and those who fall under its spell aren’t weak or gullible. This is who we are.

### page 48

But every time I saw the green screen, I swear I felt less pain. A lot less. I’m not an idiot—I can tell the difference between a pinprick and squeezing fire.

### page 49

In real life, placebo responses can be triggered by many things—the desire to please a doctor, for instance, or just to get better.

### page 56

What he saw was backward, with the pain signals starting in the prefrontal cortex—the most advanced logic center of the brain—and working back to the more primitive regions. This seemed to suggest a sort of collision of information: half originating in the body as pain, and half originating in the advanced part of the brain as expectation. And whatever comes out of that collision is what you feel.

### page 57

Enter one of my favorite placebo treatments, acupuncture. As with so many forms of folk medicine, acupuncture doesn’t reliably outperform a placebo. When it does, it’s for especially placebo-prone conditions like pain or nausea. But although acupuncture doesn’t often outperform placebos, it still performs really well, and many respected scientists are not yet ready to label it strictly brain chemistry. Ted Kaptchuk even found that the brain’s response to acupuncture is markedly different than it is to other placebos. It performs so well, it seems to be in its own class of placebo.

### page 59

What if acupuncture is an active placebo? What if that tingling sensation in my nerves and pain in my muscles is a message to my brain that this exercise with needles is doing something? That would explain why it performs so well in trials, yet not well enough to reliably beat placebos.

### page 61

Parkinson’s disease is a somewhat mysterious and incurable condition whereby neurons deep in the brain responsible for generating dopamine die. Why they die isn’t clear, but since dopamine is so important for movement, patients are increasingly unable to walk, stand, or hold a pen without shaking.

### page 65

People, it seems, are programmed with a preexisting need to go with the herd. In an instant, people tapped into a more powerful placebo response than if they had spent hours conditioning themselves. Let that sink in for a second. Someone else’s opinion is not only powerful, it can be more powerful than your own. It can be more powerful than your experience and even more powerful than repeated conditioning. We are hardwired to follow other people’s opinions.

### page 67

Thus began a bizarre dual health care system that continues in China to this day. On one side is Western medicine with its MRIs, morphine, surgeries, and so on. On the other is TCM, which treats patients with acupuncture, herbs, animal parts, and massage. Just like conventional medicine, TCM has its own hospitals and drugstores; its students go through extensive schooling (though it’s usually not as long as that of their Western-medicine counterparts).

### page 67

Every remedy that has ever been used in TCM—from ginseng to rhinoceros horn to mercury—is theoretically just as valid today as it ever was. In other words, evidence is not the primary driver.

### page 68

“In Chinese medicine we don’t have ‘bacteria.’ We don’t have this word. We don’t have ‘virus.’ We consider maybe this is the chi or the blood movement,” she says. “For Chinese medicine, what we adjust is chi, blood, the yin and the yang.”

### page 68

Modern science cannot measure yin or yang, the Chinese complementary feminine and masculine principles, and no serious scientists—East or West—have been able to demonstrate the existence of chi.

### page 68

A person’s chi, their vital energy, can change with the seasons, the time of day, and a hundred other things. When I ask her how she can prove this, she points to tradition. Over thousands of years TCM has been honed by millions of physicians, evolving naturally over time to where it is today. As with homeopathy, TCM has a coherent story to tell that works perfectly within its own logic but contradicts biology and physics. And as with homeopathic remedies, TCM treatments are often as much about the description of the pain as the physiology.

### page 69

For Zhang, the point of the story is that the chemicals in, say, ginseng or deer antler are not as important as the intangible, ineffable quality of the healer. There are many roads, she says, but the destination is the same.

### page 70

Sitting there drinking my third pot of tea, all this starts to sound very familiar. I am reminded for a moment of my parents and their community of faith healers in California. “What you are describing is religion,”

### page 70

Zhang says that Western medicine is a straight line—always refining itself, always moving forward—while Chinese medicine is a circle around a fixed dot. The fundamentals never change, just your interpretations of them.

### page 71

According to the theory of Chinese medicine, you can tell a lot about your health by looking at your foot. Each muscle is tied to an organ in the body through meridians, or energy highways. Because the feet and toes are farthest from the heart, they are seen as good diagnostic tools—the 10 little piggies in the coal mine, if you will.

### page 71

There is no physiological mechanism by which the foot could tell you something about the urinary tract. But that doesn’t bother Wang. He’s happy in his practice and knows he’s helping people (though my arm pain is no better after seeing him). When I ask him how he can be so sure that his work is effective, he has a simple, familiar response: “For so many thousands of years the Chinese people have been the most populous on the Earth, and they have all gone to Chinese medicine to cure their illnesses. How can we doubt it?”

### page 73

Outsiders often wonder how people can stay connected to a faith like this—thinking, “Eventually, won’t they naturally drift toward solutions that are reinforced by success?” But Christian Science, like TCM, is being reinforced. Humans aren’t stupid. Like everyone, Christian Scientists are trying to put their faith in treatments that work. The results can be stunning. I’ve seen Christian Science heal people of lifelong pain. I watched my grandmother collapse and then recover after my father held her and whispered song lyrics to her. I’ve also seen it fail. One member of our community had cataracts for many years, which easily could have been treated by an eye surgeon.

### page 75

Gene therapy—the notion that you can tinker directly with the genes of ailing human cells—has held tremendous promise for many years. But like stem cell therapy, cold fusion, and reboots of The Muppet Show, it’s beginning to look like a breakthrough that’s never going to happen.

### page 76

This may seem cruel to you and me, but Parkinson’s is a devious disease. One of the reasons it has been so hard to cure is that it seems to respond more to placebo treatments than other degenerative brain ailments do.

### page 78

After the call, she got the details of the study, and what she saw stopped her cold. Pauletich had been in the placebo group.

### page 78

The problem of placebo responders is the central challenge to modern medicine. The placebo response not only has the power to kill a proposed drug that doesn’t work; it also has the power to block one that does.

### page 79

The development of Prozac was bedeviled by high placebo rates that made it hard to tell if it worked. It obviously made it to your pharmacist’s shelf, but nowadays many scientists say it is not effective enough to outperform placebos. (It’s still on the market because once a drug clears the FDA, it cannot be recalled just because the placebo effect gets stronger.)

### page 80

One unpleasant 1961 paper written in Louisiana declared that African Americans were particularly vulnerable to placebos, according to one unaffiliated scientist, because of a “prevalent attitude amongst the negroes to please their doctor.”

### page 81

In the past couple of decades, scientists have shifted to a theory called dispositional optimism, or the measure of how glass-half-full you are as a possible measure of how placebo prone you are.

### page 82

When she says she once dabbled in a Reiki-like form of aura cleansing and even cured herself of carpal tunnel syndrome through acupuncture, I categorize her as a well-meaning hippie on a quest to undermine the big bad pharmaceutical industry.

### page 87

Met/mets—those people who were born with lazy enzymes and a little too much dopamine in their systems—were more prone to placebo responses.

### page 87

The concept makes great evolutionary sense as well. Just as it’s good to have some members of a population who are stronger, faster, or smarter than others, it’s probably good to have varying levels of suggestibility. Some people need to be clear-eyed and unmoved, like the val/vals. But nature thrives on variety and has given us an equal number of suggestible people who have an extraordinary genetic tool that allows them to heal themselves.

### page 90

It’s a crack in the wall that suggests a reason why some people seem to respond to one placebo and not another, why the placebo response can seem so clear in one person and not in another, and why it seems vaguely related to personality and at the same time totally divorced from it. Homeopathy patients, Christian Scientists, TCM—suddenly all these phenomena make more sense. What if the reason some people experience such relief from prayer healing and unproven therapies while others don’t is that they simply have different genetic maps for self-medication?

### page 195

In fact, placebos and expectation are so effective against depression that it is difficult to find a drug that’s more powerful. From 1987 to 1999 the pharmaceutical industry exploded with depression meds like Prozac, Paxil, Zoloft, Luvox, and Celexa—each of which has become a blockbuster drug and presumably helped millions of suffering people. But if you look at drug studies during this time, about 75 to 80 percent of their efficacy can be attributed to placebo effects. And if you look carefully, there was no real difference between high doses and low doses, which is odd and suggests the meds weren’t as effective as we thought. (Usually, for a truly effective drug, you would expect a difference. Imagine a high dose of morphine versus a small one.) What’s more, these effects seem to be long-lived—for weeks and months even. It didn’t do any good to exclude placebo responders in the first few weeks; others just filled their place. This high placebo response has been one of the main reasons why depression has been so difficult and expensive to treat.

### page 196

Some experts even say that if Prozac had to compete against the placebo effect today, it would not have been cleared by the FDA.

### page 198

Scientists have studied how dopamine can crash in lovers who stay together long periods of time without maintaining their relationship.

### page 198

Thus was born sildenafil citrate, more commonly known as Viagra. It hit the market in 1997, and almost overnight erectile dysfunction was cured in all but the most serious cases. Never before had an entire class of ancient herbal and alternative treatments become so obsolete so quickly.

### page 198

The placebo group had about a 20 percent success rate as soon as they popped the pill and about 50 percent if they persisted. Even men with erectile dysfunction resulting from spinal injury have been able to have sex after taking a placebo.

### page 199

Conversely, one study revealed that if you tell someone that the drug he’s taking will cause erectile dysfunction, loss of libido, or ejaculation problems, he’s three times as likely to experience one of those problems as a man taking the same drug who was not given one of those assessments.

### page 199

Perhaps some historical fertility cures—rosemary, parsley, and hazelnut—do indeed have some as-yet-undiscovered mechanism, some pharmacological value. Perhaps it’s just a numbers game. The more time that goes by while a couple tries various remedies, the more likely that they will get pregnant. Or perhaps there is something more.

### page 201

Having seen and heard about many healings as a boy, I noticed that the stories became more dramatic as time went on. Recoveries became instant recoveries. A doctor with a frank diagnosis became a doctor who had given up all hope. A particularly low point in the disease became a deathbed. Healing became a miracle.

### page 203

But that didn’t stop health gurus from picking it up. The most notable was Dr. Oz, who called it a “miracle pill.” It’s not the first time he’s held up snake oil as medicine (a Canadian study showed that fewer than half his recommendations are backed up, and 14 percent are actually contradicted, by science), but it did force him to admit to Congress that on his show, he’s an entertainer, not a doctor.

### page 204

Generally, “maintaining” means lots of affectionate and sexual touching. Without that, the dopamine spike tends to drop over time as part of something called the Coolidge effect. The best way to bring it up to its original level is to bring in a new mate (the effect exists in both sexes but is stronger in men). The effect is named for President Calvin Coolidge, whose wife supposedly once noted to him how much sex roosters have. He responded that a rooster has more than one hen to choose from.

### page 206

Three thousand years ago, people gathered in sacred spaces to chant themselves into a hypnotic state. They rubbed dung on open wounds and mixed potent herbs with inert ones, hoping that one of them would cure their diseases. They told stories that became ever more improbable.

### page 206

Perhaps we should stop acting as if there is some kind of line between the mind and the body. In the same way that placebos can be as powerful as drugs or a few hypnotic words can erase real pain, any disease that cripples a person, whether it begins in the body or the mind, is absolutely real.

### page 206

The first thing University of Washington researcher David Patterson did when he tried to hypnotize me was get to know my personal history.

### page 207

It wasn’t that he thought my dad’s arm pain was connected to mine; he just needed a story that resonated with me and thus tapped into my belief and expectation.

### page 207

A few years ago, some supplement makers got into hot water because tests revealed that their garlic pills turned out to contain not garlic but rice powder. The pills were having the same placebo effect as before, but somehow consumers felt cheated. I can’t resolve this paradox any more than I can explain it. Con men have been with us since the time of Hippocrates, and a part of us has hated them for their ability to trick us—even if it’s for our own good.

### page 208

Rule #1: Don’t endanger yourself. Some alternative health remedies are physically dangerous. Mercury is a poison, chiropractic treatment can seriously damage your spine, and a careless hypnotist can implant terrifying memories that may not be yours.

### page 208

In early 2015, the New York State attorney general investigated a few of the plant supplements for sale at GNC, Target, Walgreens, and Walmart. Forty-five percent of the pills contained no plant matter at all; 33 percent contained something different from what was on the label; and just 22 percent actually tested positive for the plant that was supposed to be in the bottle.

### page 208

if you think you might be suggestible, try combining mainstream medicine with alternative therapies to treat the pain, nausea, or depression that might accompany either a disease or its treatment. But as soon as your shaman, homeopath, or acupuncturist suggests you stop using scientifically proven techniques, they are putting you in serious danger.

### page 209

Rule #2: Don’t go broke. It’s true that more expensive placebos work better than cheaper ones, but there is a limit. Ranjana Srivastava, an author and oncologist in Melbourne, Australia, has written about the challenges of treating cancer and the relationship between doctor and patient. Her patients have spent thousands on vitamin infusions, smoke therapies, and lavender extracts. She says patients regularly come to her broke and near death after chasing placebos that haven’t worked out.

### page 210

Rule #3: Don’t send any creature to extinction.

### page 210

Rule #4: Know thyself. As we have seen, for many people the suspicion that a treatment might be a placebo does not change its ability to heal. There’s nothing wrong with wondering in the back of your mind whether the herbal immune-boosting shake in front of you is nothing more than a placebo wrapped in wheatgrass puree.

### page 210

First of all, know what kind of person you are. Are you someone who might be suggestible to the power of a certain placebo? If so, what kind?

### page 211

Second, get to know your condition (or symptoms, if you prefer). Is this a problem that taps into dopamine and expectation?

### page 211

While you are getting to know yourself, try to determine how suggestible you are. If you are looking to cure a physical problem, quit smoking, or beat depression, give hypnosis a try to see if you are hypnotically susceptible. If you are, hold on to that information, like your blood type or your vaccination records. It’s a tool that you can use to find relief and improve your life.

### page 212

But the minute someone, whether a licensed therapist or your next-door neighbor who dabbles in hypnosis, suggests they can help you retrieve lost memories or improve a memory you do have, walk away. Be careful with techniques like past-life regression or regression to the womb—anything where you’d be retrieving memories you did not have before.

### page 213

Over the course of writing this book, a part of me genuinely hoped I would find something so odd, so impressive as to be truly unexplainable. An honest-to-God miracle cure. I never found it. Most recoveries I came across were, in the end, either completely explainable through science or impossible to verify. Are you disappointed? Don’t be. After all, what is a miracle but an event that’s completely unexplainable?

### page 214

[Y]et the most successful healings I investigated took the view that the healing had already happened. Mike Pauletich said this when he thought back on his recovery from Parkinson’s, and so do many Christian healing ministries and even Christian Science. It’s one thing to expect that healing will happen, but it seems far more effective to expect that it already has. Placebos might be a promise for the future, but they work only once you’ve ingested them, convinced that they have done their job.

### page 216

“Hey, aren’t you one of those kids who doesn’t go to doctors? What happens if you break your arm?” (Even the most devout Christian Scientist would go to a doctor in a case like that. There are exceptions, it turns out, to every rule.)

### page 216

Christian Science doesn’t work if it’s mixed with other treatments. It requires 100 percent faith and 100 percent dedication. So I ask her the question I have asked traditional Chinese doctors and witch doctors and New Age healers across the world: Since suggestibility and placebos are part of every treatment, what percentage of Christian Science healing is simply the body’s response to expectation?

### page 217

“You say that the test of science is that you have a hypothesis you put to the test, and then you draw conclusions for whether or not your hypothesis is correct. My sense is that God’s law isn’t a hypothesis; it’s a rule. I am not applying this science to test whether it’s true. I am applying this science to prove that it is true.”

### page 218

"I want to love God with all my heart—and part of that is not to have any other gods. And I think medicine is a god. I think matter is a god. And I realize that’s radical and that you might really be offended by that.” She says this so warmly and gently that I don’t even realize she’s just called everything I believe in a false idol.

### page 219

Already, studies are starting to suggest that many common forms of arthroscopic joint surgery may be no more successful than a sham surgery. Though if that knee operation made it possible to ski again, who are you to question it?