How Do Placebos Work?

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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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Why Do Supreme Court Justices Serve for Life?

Alex Wong, Getty Images
Alex Wong, Getty Images

There are few political appointments quite as important as a nomination to the U.S. Supreme Court. Unlike a cabinet secretary or an ambassador, justices serve for life. In the modern era, that often means more than three decades on the court—thanks to increased lifespans, justices appointed in the next century are expected to sit on the Supreme Court for an average of 35 years, compared to the average of around 16 years that judges served in the past. Because of this shift, some scholars have begun to question whether lifetime appointments are still appropriate, as the definition of “for life” has changed so much since the constitution was written. But why do justices serve for life, anyway?

Well, for one thing, the U.S. Constitution doesn’t exactly specify that justices and the court are in a “’til death do us part” relationship. Article III says that judges (of both the Supreme Court and lower federal courts) “shall hold their offices during good behavior.” So technically, a judge could be removed if they no longer meet the “good behavior” part of the clause, but there are otherwise no limits on their term. In practice, this means they have their seat for life, unless they are impeached and removed by Congress. Only 15 federal judges in U.S. history have ever been impeached by Congress—all lower court judges—and only eight have been removed from office, though some have resigned before their inevitable removal.

The only Supreme Court justice Congress has tried to impeach was Samuel Chase, who was appointed by George Washington in 1796. Chase was an openly partisan Federalist vehemently opposed to Thomas Jefferson’s Democratic-Republican policies, and he wasn’t afraid to say so, either in his role as a lower court judge or once he was appointed to the Supreme Court. In 1804, the House of Representatives, at then-president Jefferson’s urging, voted to impeach Chase, accusing him, among other things, of promoting his political views from the bench instead of ruling as a non-partisan judge. However, he was acquitted of all counts in the Senate, and went on to serve as a Supreme Court justice until his death in 1811.

The point of giving justices a seat on the bench for the rest of their lives (or, more commonly nowadays, until they decide to retire) is to shield the nation’s highest court from the kind of partisan fighting the Chase impeachment exemplified. The Supreme Court acts as a check against the power of Congress and the president. The lifetime appointment is designed to ensure that the justices are insulated from political pressure and that the court can serve as a truly independent branch of government.

Justices can’t be fired if they make unpopular decisions, in theory allowing them to focus on the law rather than politics. Justices might be nominated because a president sees them as a political or ideological ally, but once they’re on the bench, they can’t be recalled, even if their ideology shifts. Some data, for instance, suggests that many justices actually drift leftward as they age, no doubt infuriating the conservative presidents that appointed them.

The lack of term limits “is the best expedient which can be devised in any government, to secure a steady, upright and impartial administration of the laws,” Alexander Hamilton wrote in the Federalist No. 78. The judiciary, he believed, “is in continual jeopardy of being overpowered, awed, or influenced by its coordinate branches,” and “nothing can contribute so much to its firmness and independence, as permanency in office.” Without lifetime job security, he argued, judges might feel obligated to bow to the wishes of the president, Congress, or the public, rather than confining their work strictly to questions of the Constitution.

While lifetime appointments may be a longstanding tradition in the U.S., this approach isn’t the norm in other countries. Most other democracies in the world have mandatory retirement ages if not hard-and-fast term limits for high court judges. UK Supreme Court justices face mandatory retirement at age 70 (or 75 if they were appointed before 1995), as do judges on Australia’s High Court. Canadian Supreme Court justices have a mandatory retirement age of 75, while the 31 justices of India’s Supreme Court must retire by the age of 65. Meanwhile, the oldest justice now on the U.S. Supreme Court, Ruth Bader Ginsburg, is currently 85 and kicking. Oliver Wendell Holmes Jr., the oldest justice in U.S. history, retired in 1932 at age 90.

Though the U.S. Supreme Court has never had term limits before, there have recently been serious proposals to implement them. Term limits, advocates argue, could combat partisan imbalances on the court. Presidents wouldn’t get to appoint justices purely based on whether someone died while they were in office, and the stakes for political parties nominating a justice would be slightly lower, possibly leading presidents and Congress to compromise more on appointments. One popular suggestion among political analysts and scholars is to impose an 18-year term limit, though critics note that that particular plan does bring up the potential that at some point, a single president could end up appointing the majority of the justices on the court.

In any case, considering such a change would likely require a constitutional amendment, which means it’s probably not going to happen anytime soon. For the foreseeable future, being on the Supreme Court will continue to be a lifetime commitment.

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How Often Should You Poop?

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iStock

When it comes to No. 2, plenty of people aren’t really sure what’s normal. Are you supposed to go every day? What if you go 10 times a day? Is that a sign that you’re dying? What about once every three days? Short of asking everyone you know for their personal poop statistics, how do you know how often you’re supposed to hit the head?

Everyone’s system is a little different, and according to experts, regularity is more important than how often you do the deed. Though some lucky people might think of having a bowel movement as an integral part of their morning routine, most people don’t poop every day, as Lifehacker informs us. In fact, if you go anywhere between three times a day and three times a week, you’re within the normal range.

It’s when things change that you need to pay attention. If you typically go twice a day and you suddenly find yourself becoming a once-every-three-days person, something is wrong. The same thing goes if you normally go once every few days but suddenly start running to the toilet every day.

There are a number of factors that can influence how often you go, including your travel schedule, your medications, your exercise routine, your coffee habit, your stress levels, your hangover, and, of course, your diet. (You should be eating at least 25 to 30 grams of fiber a day, a goal that most Americans fall significantly short of.)

If you do experience a sudden change in how often you take a seat on the porcelain throne, you should probably see a doctor. It could be something serious, like celiac disease, cancer, or inflammatory bowel disease. Or perhaps you just need to eat a lot more kale. Only a doctor can tell you.

However, if you do have trouble going, please, don’t spend your whole day sitting on the toilet. It’s terrible for your butt. You shouldn’t spend more than 10 to 15 minutes on the toilet, as one expert told Men’s Health, or you’ll probably give yourself hemorrhoids.

But if you have a steady routine of pooping three times a day, by all means, keep doing what you’re doing. Just maybe get yourself a bidet.

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