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 is Friday the 13th Considered Unlucky?

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Today, people around the globe will feel uneasy about getting out of bed, leaving their homes, or going about their normal daily routines, all because of a superstition. These unfortunate folks suffer from paraskavedekatriaphobia, a common neurosis familiar to us all: the fear of Friday the 13th. But just where did this superstitious association come from, and how did it catch on?

The truth is that no one is absolutely sure where the idea that Friday the 13th is unlucky originated. Donald Dossey, the founder of the Stress Management Center and Phobia Institute in Asheville, North Carolina, suspects the fear can be traced back to a Norse myth about 12 gods who had a dinner at Valhalla—the fabled hall where legendary Norse heroes feasted for eternity after they died—that was interrupted by a 13th guest, the evil and mischievous god Loki.

According to legend, Loki tricked Höðr (the blind god of winter and son of Odin, the supreme god in Norse mythology) into shooting his brother Baldr (the benevolent god of summer who was also a son of Odin) with a magical spear tipped with mistletoe—the only substance that could defeat him. Thus the number 13 was branded as unlucky because of the ominous period of mourning following the loss of such powerful gods by this unwanted 13th guest.

For whatever reason, among many cultures, the number 12 emerged throughout history as a "complete" number: There are 12 months in a year, 12 signs of the zodiac, 12 Gods of Olympus, 12 sons of Odin, 12 labors of Hercules, 12 Jyotirlingas or Hindu shrines where Shiva is worshipped, 12 successors of Muhammad in Shia Islam, and 12 tribes of Israel. In Christianity, Jesus was betrayed by one of his 12 Apostles—Judas—who was the 13th guest to arrive for the Last Supper. Surpassing the number 12 ostensibly unbalances the ideal nature of things; because it is seen as irregular and disrespectful of a sense of perfection, the number 13 bears the stigma of misfortune and bad luck we know today.

WHY FRIDAY?

Friday joins in the mix mostly because all of the early accounts of Jesus’s crucifixion agree that it took place on Friday—the standard day for crucifixions in Rome. As Chaucer noted in The Canterbury Tales, "And on a Friday fell all this mischance." Yet perpetuating Friday as an unlucky day in America came from the late 19th-century American tradition of holding all executions on Fridays; Friday the 13th became the unluckiest of days simply because it combined two distinct superstitions into one. According to the Oxford University Press Dictionary of Superstitions, the first reference to Friday the 13th itself wasn’t until 1913. (So despite actually occurring on Friday, October 13, 1307, the popular notion that the Friday the 13th stigma comes from the date on which the famed order of the Knights Templar were wiped out by King Philip of France is just a coincidence.)

The repercussions of these phobias reverberated through American culture, particularly in the 20th century. Most skyscrapers and hotels lack a 13th floor, which specifically comes from the tendency in the early 1900s for buildings in New York City to omit the unlucky number (though the Empire State Building has a 13th floor). Some street addresses also skip from 12 to 14, while airports may skip the 13th gate. Allegedly, the popular Friday the 13th films were so-named just to cash in on this menacing date recognition, not because the filmmakers actually believed the date to be unlucky.

So, is Friday the 13th actually unlucky? Despite centuries of superstitious behavior, it largely seems like psychological mumbo jumbo. One 1993 study seemed to reveal that, statistically speaking, Friday the 13th is unlucky, but the study's authors told LiveScience that though the data was accurate, "the paper was just a bit of fun and not to be taken seriously." Other studies have shown no correlation between things like increased accidents or injuries and Friday the 13th.

And Friday the 13th isn't a big deal in other cultures, which have their own unlucky days: Greeks and Spanish-speaking countries consider Tuesday the 13th to be the unluckiest day, while Italians steer clear of Friday the 17th. So today, try to rest a little easy—Friday the 13th may not be so unlucky after all.

Additional Source: 13: The Story of the World’s Most Popular Superstition.

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Does the Full Moon Really Make People Act Crazy?

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Along with Mercury in retrograde, the full moon is a pretty popular scapegoat for bad luck and bizarre behavior. Encounter someone acting strangely? Blame it on the lunar phases! It's said that crime rates increase and emergency rooms are much busier during the full moon (though a 2004 study debunked this claim). Plus, there's that whole werewolf thing. Why would this be? The reasoning is that the moon, which affects the ocean's tides, probably exerts a similar effect on us, because the human body is made mostly of water.

This belief that the moon influences behavior is so widely held—reportedly, even 80 percent of nurses and 64 percent of doctors think it's true, according to a 1987 paper published in the Journal of Emergency Medicine [PDF]—that in 2012 a team of researchers at Université Laval's School of Psychology in Canada decided to find out if mental illness and the phases of the moon are linked [PDF].

To test the theory, the researchers evaluated 771 patients who visited emergency rooms at two hospitals in Montreal between March 2005 and April 2008. The patients chosen complained of chest pains, which doctors could not determine a medical cause for the pains. Many of the patients suffered from panic attacks, anxiety and mood disorders, or suicidal thoughts.

When the researchers compared the time of the visits to the phases of the moon, they found that there was no link between the incidence of psychological problems and the four lunar phases, with one exception: in the last lunar quarter, anxiety disorders were 32 percent less frequent. "This may be coincidental or due to factors we did not take into account," Dr. Geneviève Belleville, who directed the team of researchers, said. "But one thing is certain: we observed no full-moon or new-moon effect on psychological problems."

So rest easy (or maybe not): If people seem to act crazy during the full moon, their behavior is likely pretty similar during the rest of the lunar cycle as well.

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