How Do Placebos Work?

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iStock

There’s a reason eating your grandmother’s chicken soup or dabbing your temples with essential oil of peppermint might make you feel better if you’re sick, and it’s probably not because they're truly curative. Your relief is likely the result of the placebo effect.

A placebo is an inert substance, such as a sugar pill or saline solution, that is specifically given to a patient because it's not intended to have a measurable effect on their physiology. Placebos are often used as controls in clinical trials and experiments to set a baseline by which to compare the effects of new drugs and medical treatments. They’re not supposed to be treatments in and of themselves. And yet studies show that placebos not only often have a measurable effect on the people who take them, but can actually improve someone's condition.

Researchers have documented this effect for pain treatment, irritable bowel syndrome, and high-altitude sickness, among other conditions. Even sham knee surgeries have been shown to produce nearly identical pain relief to actual meniscus surgery.

What's going on here?

GREAT EXPECTATIONS

John Kelley, deputy director of the Program in Placebo Studies (PiPS) at Beth Israel Deaconess Medical Center at Harvard Medical School, tells Mental Floss that a patient's expectations about whether or not a medication will work are central to the placebo effect. Even the color and size of placebo pills have been shown to affect the power of fake medicine. Both small and large pills elicit a stronger placebo effect than middle-sized ones. People assume that a tiny pill "must be really powerful medicine if it’s so small,” Kelley explains, while an oversized pill makes people think, ‘Wow, there’s a lot of medicine there. I’m getting a big treatment.’”

Another factor at work is whether an individual has had previous experience with the form of treatment, called conditioning, and has thus developed what Kelley calls “a conscious expectancy” that it will work again. The greater the conditioning, often the greater the placebo effect.

The human element is key, too. A patient's sense of the competence and warmth of their practitioner, and their comfort in the treatment setting—"a fancy, prestigious medical school versus a ramshackle, dubious-looking office,” Kelley says—can influence the placebo effect.

THE BIOLOGY OF BELIEF

Having an expectation of healing leads to the physiological relief of symptoms because there's a biological process underpinning our responses. “Every thought, emotion, and feeling we have has a biological substrate,” Kelley says. For example, the brains of people given placebos for pain medication have been shown to release naturally occurring opioids, which provide actual pain relief. Research has shown that anticipation stimulates the brain’s reward system, just as opioid drugs do.

What’s more, Kelley says, in trials where patients were conditioned to receive pain relief from either the opioid morphine or a placebo, and then subsequently were given the opioid-blocking drug Nalaxone, the drug prevented both the morphine and the placebo from giving the patients pain relief. Researchers suspect that merely having an expectation of relief recruited the brain to release the endogenous opioids—which were then blocked by the Nalaxone.

Similarly, placebo trials of Parkinson’s medications have also found that patients' brains release dopamine in response to placebos, temporarily relieving symptoms such as tremors and stiff muscles. Kelley says the brain likely uses different mechanisms to respond to different conditions, which could explain why, for example, it produces endogenous opioids for pain and dopamine for Parkinson’s.

Placebos can work even when recipients know they're taking a placebo. That was the case in one seminal study involving patients with irritable bowel syndrome [PDF], in which researchers found that giving patients pills clearly labeled as placebos reduced the severity of their symptoms versus control participants who received no pills at all.

More research is necessary to understand why placebos can work even when we know they shouldn't, but the lead researcher of the IBS study, Ted Kaptchuk, also with the PiPS program, told NPR that “a trusting relationship between the doctor and patient” is likely important. Perhaps the expectation of being cared for is enough to bring relief to some.

Kelley believes it may come down to a kind of selective attention. Even if a patient knows they're taking a placebo, they're “paying attention to one set of stimuli and avoiding another,” he says, which redirects their focus from pain to an experience of relief.

While scientists continue to unravel the mysterious power of the mind to influence the body, the next time you have a headache, maybe try a sugar pill instead of an aspirin; it can’t hurt, and it might even help.

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What Is the Shelf Life of Donated Eyes?

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iStock.com/Pedro_Turrini

Zoe-Anne Barcellos:

I can only answer for cornea and eye donation.

The FDA does all oversight (no pun intended) of organ disposition.

The main organs—heart, liver, pancreas, lungs, etc.—are transplanted within hours. They are just not viable if they are not being perfused constantly.

The other tissues—like bone, skin, tendons, etc.—do not need to be transplanted immediately. But I am not sure on the regulations of when they need to be transplanted.

With the eyes, there are four tissues that can be recovered.

We recover whole eyes for research and education purposes. These usually go much faster, but we can hold them up to a year.

Conjunctiva can also be recovered; conjunctiva is a clear covering over most of the eye (it is what gets irritated when you have pink eye). I have been working as a recovery tech for five years, and our office has not had a request for "conj" in all that time. I believe it is mostly used for research, but I could be wrong.

Sclera is the white area of your eye. It is fairly thick and flexible. If you have ever touched a reptile egg, that is what it reminds me of. We recover sclera for transplant. They use it for several things, but mainly to patch punctures. Similar to if you pop the inner tube of your bike and repair it. Sclera can also be used to repair ear drums. We can hold on to this for up to a year.

The main thing we recover is corneas. In the U.S., we must transplant these within seven days of recovery. (Recovery is usually within hours of death, but we can push it up to 20 hours after if needed.) Sometimes we have more corneas than we need, and then they are shipped overseas and transplanted up to 14 days after recovery. There is no real different outcome with the later transplant time, but the FDA in the U.S. made the rules. (You can sign up to be an organ, tissue, and eye donor here.)

This post originally appeared on Quora. Click here to view.

Why Are There No Snakes in Ireland?

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iStock

Legend tells of St. Patrick using the power of his faith to drive all of Ireland’s snakes into the sea. It’s an impressive image, but there’s no way it could have happened.

There never were any snakes in Ireland, partly for the same reason that there are no snakes in Hawaii, Iceland, New Zealand, Greenland, or Antarctica: the Emerald Isle is, well, an island.

Eightofnine via Wikimedia Commons // Public Domain

Once upon a time, Ireland was connected to a larger landmass. But that time was an ice age that kept the land far too chilly for cold-blooded reptiles. As the ice age ended around 10,000 years ago, glaciers melted, pouring even more cold water into the now-impassable expanse between Ireland and its neighbors.

Other animals, like wild boars, lynx, and brown bears, managed to make it across—as did a single reptile: the common lizard. Snakes, however, missed their chance.

The country’s serpent-free reputation has, somewhat perversely, turned snake ownership into a status symbol. There have been numerous reports of large pet snakes escaping or being released. As of yet, no species has managed to take hold in the wild—a small miracle in itself.

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