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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10 Rad Gifts for Hikers

Greg Rosenke/Unsplash
Greg Rosenke/Unsplash

The popularity of bird-watching, camping, and hiking has skyrocketed this year. Whether your gift recipients are weekend warriors or seasoned dirtbags, they'll appreciate these tools and gear for getting most out of their hiking experience.

1. Stanley Nesting Two-Cup Cookset; $14

Amazon

Stanley’s compact and lightweight cookset includes a 20-ounce stainless steel pot with a locking handle, a vented lid, and two insulated 10-ounce tumblers. It’s the perfect size for brewing hot coffee, rehydrating soup, or boiling water while out on the trail with a buddy. And as some hardcore backpackers note in their Amazon reviews, your favorite hiker can take the tumblers out and stuff the pot with a camp stove, matches, and other necessities to make good use of space in their pack.

Buy it: Amazon

2. Osprey Sirrus and Stratos 24-Liter Hiking Packs; $140

Amazon

Osprey’s packs are designed with trail-tested details to maximize comfort and ease of use. The Sirrus pack (pictured) is sized for women, while the Stratos fits men’s proportions. Both include an internal sleeve for a hydration reservoir, exterior mesh and hipbelt pockets, an attachment for carrying trekking poles, and a built-in rain cover.

Buy them: Amazon, Amazon

3. Yeti Rambler 18-Ounce Bottle; $48

Amazon

Nothing beats ice-cold water after a summer hike or a sip of hot tea during a winter walk. The Yeti Rambler can serve up both: Beverages can stay hot or cold for hours thanks to its insulated construction, and its steel body (in a variety of colors) is basically indestructible. It will add weight to your hiker's pack, though—for a lighter-weight, non-insulated option, the tried-and-true Camelbak Chute water bottle is incredibly sturdy and leakproof.

Buy it: Amazon

4. Mappinners Greatest 100 Hikes of the National Parks Scratch-Off Poster; $30

Amazon

The perfect gift for park baggers in your life (or yourself), this 16-inch-by-20-inch poster features epic hikes like Angel’s Landing in Zion National Park and Half Dome in Yosemite National Park. Once the hike is complete, you can scratch off the gold foil to reveal an illustration of the park.

Buy it: Amazon

5. National Geographic Adventure Edition Road Atlas; $19

Amazon

Hikers can use this brand-new, updated road atlas to plan their next adventure. In addition to comprehensive maps of all 50 states, Puerto Rico, Canada, and Mexico, they'll get National Geographic’s top 100 outdoor destinations, useful details about the most popular national parks, and points on the maps noting off-the-beaten-path places to explore.  

Buy it: Amazon

6. Adventure Medical Kits Hiker First-Aid Kit; $25

Amazon

This handy 67-piece kit is stuffed with all the things you hope your hiker will never need in the wilderness. Not only does it contain supplies for pain, cuts and scrapes, burns, and blisters (every hiker’s nemesis!), the items are organized clearly in the bag to make it easy to find tweezers or an alcohol wipe in an emergency.

Buy it: Amazon

7. Hiker Hunger Ultralight Trekking Poles; $70

Amazon

Trekking poles will help increase your hiker's balance and stability and reduce strain on their lower body by distributing it to their arms and shoulders. This pair is made of carbon fiber, a super-strong and lightweight material. From the sweat-absorbing cork handles to the selection of pole tips for different terrain, these poles answer every need on the trail. 

Buy it: Amazon

8. Leatherman Signal Camping Multitool; $120

Amazon

What can’t this multitool do? This gadget contains 19 hiking-friendly tools in a 4.5-inch package, including pliers, screwdrivers, bottle opener, saw, knife, hammer, wire cutter, and even an emergency whistle.

Buy it: Amazon

9. RAVPower Power Bank; $24

Amazon

Don’t let your hiker get caught off the grid with a dead phone. They can charge RAVPower’s compact power bank before they head out on the trail, and then use it to quickly juice up a phone or tablet when the batteries get low. Its 3-inch-by-5-inch profile won’t take up much room in a pack or purse.

Buy it: Amazon

10. Pack of Four Indestructible Field Books; $14

Amazon

Neither rain, nor snow, nor hail will be a match for these waterproof, tearproof 3.5-inch-by-5.5-inch notebooks. Your hiker can stick one in their pocket along with a regular pen or pencil to record details of their hike or brainstorm their next viral Tweet.

Buy it: Amazon

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What Really Happens When Food Goes Down the 'Wrong Pipe'?

The dreaded 'wrong pipe' calamity can strike at any time.
The dreaded 'wrong pipe' calamity can strike at any time.
Photo by Adrienn from Pexels

Your average person isn’t expected to be well-versed in the linguistics of human anatomy, which is how we wind up with guns for biceps and noggins for heads. So when swallowing something is followed by throat irritation or coughing, the fleeting bit of discomfort is often described as food “going down the wrong pipe.” But what’s actually happening?

When food is consumed, HuffPost reports, more than 30 muscles activate to facilitate chewing and swallowing. When the food is ready to leave your tongue and head down to your stomach, it’s poised near the ends of two "pipes," the esophagus and the trachea. You want the food to take the esophageal route, which leads to the stomach. Your body knows this, which is why the voice box and epiglottis shift to close off the trachea, the “wrong pipe” of ingestion.

Since we don’t typically hold our breath when we eat, food can occasionally take a wrong turn into the trachea, an unpleasant scenario known as aspiration, which triggers an adrenaline response and provokes coughing and discomfort. Dislodging the food usually eases the sensation, but if it’s enough to become stuck, you have an obstructed airway and can now be officially said to be choking.

The “wrong pipe” can also be a result of eating while tired or otherwise distracted or the result of a mechanical problem owing to illness or injury.

You might also notice that this happens more often with liquids. A sip of water may provoke a coughing attack. That’s because liquids move much more quickly, giving the body less time to react.

In extreme cases, food or liquids headed in the “wrong” direction can wind up in the lungs and cause pneumonia. Fortunately, that’s uncommon, and coughing tends to get the food moving back into the esophagus.

The best way to minimize the chances of getting food stuck is to avoid talking with your mouth full—yes, your parents were right—and thoroughly chew sensible portions.

If you experience repeated bouts of aspiration, it’s possible an underlying swallowing disorder or neurological problem is to blame. An X-ray or other tests can help diagnose the issue.

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