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WonderHealth fact

Placebo pills can ease symptoms even when patients know they are dummies. In trials for irritable bowel syndrome and chronic low back pain, people who knowingly took pills with no active drug reported feeling better; this is called open-label placebo.

PLOS ONE, 2010

MindHealth

The story behind the card

Placebo effects were long thought to depend on deception: patients had to believe a pill was a real drug. Ted Kaptchuk, who directs a placebo research programme at Harvard Medical School, tested this in 2010 with 80 patients with irritable bowel syndrome. One group was told plainly that their pills contained no medicine, yet they reported more relief than a group given no pills. A 2016 trial in Portugal, on which he also worked, found similar results for chronic low back pain. Nobody is sure why: the ritual of taking a pill, the attention of clinicians and a lifetime of learned expectations may all play a part. The effect is on how symptoms feel; there is no evidence that dummy pills cure infections, tumours or other diseases.

Türkçe oku
Plasebo haplar, hasta bunun ilaç olmadığını bilse bile şikâyetleri hafifletebilir. İrritabl bağırsak sendromu ve kronik bel ağrısı üzerine yapılan deneylerde, içinde etken madde olmadığını bilerek hap alan hastalar kendini daha iyi hissettiğini söyledi. Buna açık etiketli plasebo denir.
PLOS ONE, 2010

Plasebo etkisinin uzun süre aldatmaya dayandığı düşünüldü: Hastanın, hapın gerçek bir ilaç olduğuna inanması gerekiyordu. Harvard Tıp Fakültesi'nde plasebo araştırmaları programını yöneten Ted Kaptchuk, 2010'da bunu irritabl bağırsak sendromlu 80 hastayla sınadı. Bir gruba haplarda hiçbir ilaç olmadığı açıkça söylendi; yine de bu hastalar, hiç hap almayan gruba göre daha çok rahatladıklarını bildirdi. Kaptchuk'un da yer aldığı 2016 tarihli bir Portekiz çalışması, kronik bel ağrısında benzer sonuçlar buldu. Bunun nasıl işlediği tam bilinmiyor: Hap içme ritüeli, sağlık çalışanlarının gösterdiği ilgi ve ömür boyu öğrenilmiş beklentiler rol oynuyor olabilir. Etki, belirtilerin nasıl hissedildiğiyle sınırlıdır; etkisiz hapların enfeksiyonu, tümörü ya da başka bir hastalığı iyileştirdiğine dair hiçbir kanıt yoktur.

Sources and further reading

Background reading: Placebo
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Many people in pre-industrial Europe slept in two stretches, a 'first sleep' and a 'second sleep', with an hour or more awake in between. Historian A. Roger Ekirch found more than 500 references to the pattern, though how widespread it was is still debated.

Ekirch found the references in diaries, court records, medical books and literature: people woke after a first sleep to pray, talk, work or simply rest, then went back to bed. He argues that artificial lighting and changing daily routines pushed the pattern out. In 1992 the psychiatrist Thomas Wehr kept volunteers in 14 hours of darkness each night for a month; they settled into two blocks of about four hours' sleep with a wakeful gap between. But a 2015 study of three societies without electricity, in Tanzania, Namibia and Bolivia, found that people there slept in one stretch, a finding Ekirch disputes.

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Silence between pieces of music can relax the body more than the music itself. In a 2006 study of 24 people, fast music raised heart rate, blood pressure and breathing; during a two-minute pause all three fell, even below the levels measured before the music began.

Physician Luciano Bernardi of the University of Pavia in Italy, with Cesare Porta and Peter Sleight, tested 12 practising musicians and 12 people of the same age without musical training. Each listened to six styles in random order, including rap, techno, Indian raga and classical music, with a two-minute pause inserted at a random point. Tempo mattered more than style: faster music and simpler rhythms were the most stimulating, while slow or meditative music had a calming effect. The musicians' breathing followed the tempo more closely than the others'. The authors suggested that alternating music and pauses might help with stress, but a single small laboratory study is only a starting point.

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Inemuri, often translated as 'sleeping while present', is the Japanese custom of dozing in a meeting or other social or work setting while still counting as part of it. It is not simply any sleep in public: the sleeper is expected to stay ready to rejoin the situation.

The word is written 居眠り, from 'i', to be present, and 'nemuri', sleep. Brigitte Steger, a Cambridge scholar of Japanese society who has written widely about sleep in Japan, describes it as governed by unwritten rules. The higher someone's status, the more acceptable it is: a senior manager or a member of parliament nodding off in a long session can even be read as a sign of dedication, of someone who has worked to exhaustion, while a junior employee has far less licence. The sleeper should keep a proper posture and stay socially 'present', ready to respond if addressed. It is common on crowded commuter trains, but it is a tolerated custom, not an official workplace virtue.

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Deliberately smiling can make people feel slightly happier. In 2022 a study of nearly 4,000 people in 19 countries found that posing a smile, or copying a smiling face, raised reported happiness a little; a subtler method, holding a pen between the teeth, gave less clear results.

The idea that the face can feed back into feelings, called the facial feedback hypothesis, goes back to Charles Darwin and William James. In a famous 1988 experiment, Fritz Strack and colleagues had people hold a pen in their teeth, which forces a smile, or between their lips, which prevents one, and those in the first group rated cartoons as funnier. In 2016, seventeen laboratories repeated that experiment exactly and found no effect. A 2019 review of 138 studies concluded that the effect is real but small and varies from study to study. The 2022 Many Smiles Collaboration, led by Nicholas Coles and designed jointly by supporters and sceptics of the idea, found that deliberate smiling could both strengthen and start feelings of happiness, while the pen method remained inconclusive.

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Your gut and brain communicate through nerves, hormones, immune signals and microbes, which is why stress and digestion can affect each other.

Scientists call this link the gut–brain axis. The gut has its own network of about 500 million nerve cells, the enteric nervous system, sometimes called the “second brain”, which can run digestion largely by itself. It is connected to the brain mainly through the vagus nerve, a long nerve running from the brainstem down to the abdomen, and most of its fibres carry messages upwards, from the gut to the brain. More than 90 per cent of the body's serotonin, a chemical messenger, is found in the gut. Gut bacteria play a part too: in a 2004 Japanese study, mice raised entirely free of germs overreacted to stress. Stress can speed up or slow down the gut, one reason it often worsens irritable bowel syndrome, a common gut disorder. Most research on the microbes' role has been in animals, and human evidence is still limited.

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