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 Difference Between Heat Exhaustion and Heatstroke

YuriS/iStock via Getty Images
YuriS/iStock via Getty Images

When temperatures begin to climb, many of us can find ourselves growing physically uncomfortable. Indoors or out, warm weather can make us lethargic, sweaty, and nostalgic for winter. There are differences, though, between heat exhaustion—a precursor to more serious symptoms—and heatstroke. So what are they? And how can you treat them?

Heat exhaustion happens when the body begins to overheat as a result of exposure to excessive temperatures or high humidity. (Humidity affects the body's ability to cool off, because sweat cannot evaporate as easily in humid weather.) Sufferers may sweat profusely, feel lightheaded or dizzy, and have a weak or rapid pulse. Skin may become cool and moist. Nausea and headache are also common. With heat exhaustion, it’s necessary to move to a cooler place and drink plenty of fluids, though medical attention is not often required.

If those steps aren't taken, though, heatstroke can set in. This is much more serious and involves the body reaching a dangerous core temperature of 104°F or higher. People experiencing heatstroke may appear disoriented or confused, with flushed skin and rapid breathing. They may also lose consciousness. While heat exhaustion can be treated and monitored at home until symptoms resolve, heatstroke is a medical emergency that requires prompt attention by a health professional. Until help arrives, heatstroke should be treated with cool cloths or a bath, but sufferers should not be given anything to drink.

Although young children and those over the age of 65 are most susceptible to heat-related health issues, anyone can find themselves having a reaction to warm temperatures. If you’re outside, it’s best to drink plenty of fluids, wear light-fitting clothing, and avoid being out in the afternoons when it’s warmest. Because sunburn can compromise the body’s ability to cool itself, wearing sunscreen is also a good idea.

While it’s not always possible to avoid hot or humid weather, monitoring your body for symptoms and returning to a cool space out of the sun when necessary is the best way to stay healthy. If you have older relatives who live alone, it’s also a good idea to check on them when temperatures rise to make sure they’re doing well.

[h/t WWMT]

Why Are There 10 Hot Dogs to a Pack But Only 8 Buns?

tacar/iStock via Getty Images
tacar/iStock via Getty Images

Watching competitive eating champion Joey Chestnut cram dozens of hot dogs down his throat would make anyone crave a grilled log of processed meat this summer. But shopping for hot dogs can be a confusing experience. The dogs are typically sold in packs of 10, but the buns are sold in packs of eight. What's behind this strange dog and bun inequality?

According to the National Hot Dog and Sausage Council—yes, there is a National Hot Dog and Sausage Council—there’s a good reason for the discrepancy. For starters, distributors of hot dogs are almost always different from manufacturers of baked goods like rolls. The hot dogs are sold in packs of 10 because producers of meat (or meat-like) products selected that quantity when hot dogs started to sell at retail grocery stores in the 1940s. Oscar Mayer, which led the charge into direct-to-consumer hot dog packaging, sold hot dogs by the pound in accordance with how meat is typically priced. Having 10 dogs that weighed 1.6 ounces each seemed like the ideal distribution of weight.

Bakeries, meanwhile, have standards of their own. Buns and sandwich rolls are usually sold eight to a pack because the baking trays for the elongated buns are typically sized to fit that number. Two sets of four buns come off the tray, which is the reason why buns are often still attached to one another when you open a bag.

These standards were created independently of one another: Bakeries weren’t too preoccupied with hot dogs when they were settling on a four-roll tray standard, and hot dog manufacturers weren’t thinking about how difficult it would be for bakeries to break from their conveyor system to offer 10 buns to a pack.

It can be frustrating if you buy just one or two packages of each, but if you’re hosting a big enough party, the uneven number doesn’t matter. You just need to buy five packages of buns and four packages of hot dogs to have 40 matching pairs. No complicated calculations required.

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