How To Leverage Placebo Effect For Yourself
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Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago
The placebo effect is a well-known, well-evidenced factor that is very relevant when it comes to the testing and implementation of medical treatments:
NIH | National Center for Biotechnology Information | Placebo Effect
Some things that make placebo effect stronger include:
- Larger pills instead of small ones: because there’s got to be more going on in there, right?
- Thematically-colored pills: e.g. red for stimulant effects, blue for relaxing effects
- Things that seem expensive: e.g. a well-made large heavy machine, over a cheap-looking flimsy plastic device. Similarly, medication from a small glass jar with a childproof lock, rather than popped out from a cheap blister-pack.
- Things that seem rational: if there’s an explanation for how it works that you understand and find rational, or at least you believe you understand and find rational ← this works in advertising, too; if there’s a “because”, it lands better almost regardless of what follows the word “because”
- Things delivered confidently by a professional: this is similar to the “argument from authority” fallacy (whereby a proposed authority will be more likely trusted, even if this is not their area of expertise at all, e.g. celebrity endorsements), but in the case of placebo trials, this often looks like a well-dressed middle-aged or older man with an expensive haircut calling for a young confident-looking aide in a lab coat to administer the medicine, and is received better than a slightly frazzled academic saying “and, uh, this one’s yours” while handing you a pill.
- Things with ritual attached: this can be related to the above (the more pomp and circumstance is given to the administration of the treatment, the better), but it can also be as simple as an instruction on an at-home-trial medication saying “take 20 minutes before bed”. Because, if it weren’t important, they wouldn’t bother to specify that, right? So it must be important!
And now for a quick personality test
Did you see the above as a list of dastardly tricks to watch out for, or did you see the above as a list of things that can make your actual medication more effective?
It’s arguably both, of course, but the latter more optimistic view is a lot more useful than the former more pessimistic one.
Since placebo effect works at least somewhat even when you know about it, there is nothing to stop you from leveraging it for your own benefit when taking medication or doing health-related things.
Next time you take your meds or supplements or similar, pause for a moment for each one to remember what it is and what it will be doing for you. This is a lot like the principles (which are physiological as well as psychological) of mindful eating, by the way:
How To Get More Nutrition From The Same Food
Placebo makes some surprising things evidence-based
We’ve addressed placebo effect sometimes as part of an assessment of a given alternative therapy, often in our “Mythbusting Friday” edition of 10almonds.
- In some cases, placebo is adjuvant to the therapy, i.e. it is one of multiple mechanisms of action (example: chiropractic or acupuncture)
- In some cases, placebo is the only known mechanism of action (example: homeopathy)
- In some cases, even placebo can’t help (example: ear candling)
One other fascinating and far-reaching (in a potentially good way) thing that placebo makes evidence-based is: prayer
…which is particularly interesting for something that is fundamentally faith-based, i.e. the opposite of evidence-based.
Now, we’re a health science publication, not a theological publication, so we’ll consider actual divine intervention to be beyond the scope of mechanisms of action we can examine, but there’s been a lot of research done into the extent to which prayer is beneficial as a therapy, what things it may be beneficial for, and what factors affect whether it helps:
Prayer and healing: A medical and scientific perspective on randomized controlled trials
👆 full paper here, and it is very worthwhile reading if you have time, whether or not you are religious personally
Placebo works best when there’s a clear possibility for psychosomatic effect
We’ve mentioned before, and we’ll mention again:
- psychosomatic effect does not mean: “imagining it”
- psychosomatic effect means: “your brain regulates almost everything else in your body, directly or indirectly, including your autonomic functions, and especially notably when it comes to illness, your immune responses”
So, a placebo might well heal your rash or even shrink a tumor, but it probably won’t regrow a missing limb, for instance.
And, this is important: it’s not about how credible/miraculous the outcome will be!
Rather, it is because we have existing pre-programmed internal bodily processes for healing rashes and shrinking tumors, that just need to be activated—whereas we don’t have existing pre-programmed internal bodily processes for regrowing a missing limb, so that’s not something our brain can just tell our body to do.
So for this reason, in terms of what placebo can and can’t do:
- Get rid of cancer? Yes, sometimes—because the body has a process for doing that; enjoy your remission
- Fix a broken nail? No—because the body has no process for doing that; you’ll just have to cut it and wait for it to grow again
With that in mind, what will you use the not-so-mystical powers of placebo for? What ever you go for… Enjoy, and take care!
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How Not to Age – by Dr. Michael Greger
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This book is the reason today’s newsletter wasn’t out some hours previously; it was published today, and this reviewer (who got her pre-order copy at midnight GMT) needed to finish reading it first! Never let it be said we don’t bring you the very latest health news
First things first: it’s a great book, and it’s this reviewer’s favorite of Dr. Greger’s so far.
Unlike many popular physician authors, Dr. Greger doesn’t rehash a lot of old material, and instead favours prioritizing new material in each work. Where appropriate, he’ll send the reader to other books for more specific information (e.g: you want to know how to avoid premature death? Go read How Not To Die. You want to know how to lose weight? How Not To Diet. Etc).
In the category of new information, he has a lot to offer here. And with over 8,000 references, it’s information, not conjecture. On which note, we recommend the e-book version if that’s possible for you, for three reasons:
- It’s possible to just click the references and be taken straight to the cited paper itself online
- To try to keep the book’s size down, Dr. Greger has linked to other external resources too
- The only negative reviews on Amazon, so far, are people complaining that the print copy’s text is smaller than they’d like
For all its information-density (those 8,000+ references are packed into 600ish pages), the book is very readable even to a lay reader; the author is a very skilled writer.
As for the content, we can’t fit more than a few sentences here so forgive the brevity, but we’ll mention that he covers:
- Slowing 11 pathways of aging
- The optimal anti-aging regimen according to current best science
- Preserving function (specific individual aspects of aging, e.g. hearing, sight, cognitive function, sexual function, hair, bones, etc)
- “Dr. Greger’s Anti-Aging Eight”
In terms of “flavor” of anti-aging science, his approach can be summed up as: diet and lifestyle as foundation; specific supplements and interventions as cornerstones.
Bottom line: this is now the anti-aging book.
Click here to check out How Not To Age, and look after yourself with the best modern science!
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A new government inquiry will examine women’s pain and treatment. How and why is it different?
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The Victorian government has announced an inquiry into women’s pain. Given women are disproportionately affected by pain, such a thorough investigation is long overdue.
The inquiry, the first of its kind in Australia and the first we’re aware of internationally, is expected to take a year. It aims to improve care and services for Victorian girls and women experiencing pain in the future.
The gender pain gap
Globally, more women report chronic pain than men do. A survey of over 1,750 Victorian women found 40% are living with chronic pain.
Approximately half of chronic pain conditions have a higher prevalence in women compared to men, including low back pain and osteoarthritis. And female-specific pain conditions, such as endometriosis, are much more common than male-specific pain conditions such as chronic prostatitis/chronic pelvic pain syndrome.
These statistics are seen across the lifespan, with higher rates of chronic pain being reported in females as young as two years old. This discrepancy increases with age, with 28% of Australian women aged over 85 experiencing chronic pain compared to 18% of men.
It feels worse
Women also experience pain differently to men. There is some evidence to suggest that when diagnosed with the same condition, women are more likely to report higher pain scores than men.
Similarly, there is some evidence to suggest women are also more likely to report higher pain scores during experimental trials where the same painful pressure stimulus is applied to both women and men.
Pain is also more burdensome for women. Depression is twice as prevalent in women with chronic pain than men with chronic pain. Women are also more likely to report more health care use and be hospitalised due to their pain than men.
Women seem to feel pain more acutely and often feel ignored by doctors.
ShutterstockMedical misogyny
Women in pain are viewed and treated differently to men. Women are more likely to be told their pain is psychological and dismissed as not being real or “all in their head”.
Hollywood actor Selma Blair recently shared her experience of having her symptoms repeatedly dismissed by doctors and put down to “menstrual issues”, before being diagnosed with multiple sclerosis in 2018.
It’s an experience familiar to many women in Australia, where medical misogyny still runs deep. Our research has repeatedly shown Australian women with pelvic pain are similarly dismissed, leading to lengthy diagnostic delays and serious impacts on their quality of life.
Misogyny exists in research too
Historically, misogyny has also run deep in medical research, including pain research. Women have been viewed as smaller bodied men with different reproductive functions. As a result, most pre-clinical pain research has used male rodents as the default research subject. Some researchers say the menstrual cycle in female rodents adds additional variability and therefore uncertainty to experiments. And while variability due to the menstrual cycle may be true, it may be no greater than male-specific sources of variability (such as within-cage aggression and dominance) that can also influence research findings.
The exclusion of female subjects in pre-clinical studies has hindered our understanding of sex differences in pain and of response to treatment. Only recently have we begun to understand various genetic, neurochemical, and neuroimmune factors contribute to sex differences in pain prevalence and sensitivity. And sex differences exist in pain processing itself. For instance, in the spinal cord, male and female rodents process potentially painful stimuli through entirely different immune cells.
These differences have relevance for how pain should be treated in women, yet many of the existing pharmacological treatments for pain, including opioids, are largely or solely based upon research completed on male rodents.
When women seek care, their pain is also treated differently. Studies show women receive less pain medication after surgery compared to men. In fact, one study found while men were prescribed opioids after joint surgery, women were more likely to be prescribed antidepressants. In another study, women were more likely to receive sedatives for pain relief following surgery, while men were more likely to receive pain medication.
So, women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched. Women continue to be excluded, dismissed, and receive sub-optimal care, and the recently announced inquiry aims to improve this.
What will the inquiry involve?
Consumers, health-care professionals and health-care organisations will be invited to share their experiences of treatment services for women’s pain in Victoria as part of the year-long inquiry. These experiences will be used to describe the current service delivery system available to Victorian women with pain, and to plan more appropriate services to be delivered in the future.
Inquiry submissions are now open until March 12 2024. If you are a Victorian woman living with pain, or provide care to Victorian women with pain, we encourage you to submit.
The state has an excellent track record of improving women’s health in many areas, including heart, sexual, and reproductive health, but clearly, we have a way to go with women’s pain. We wait with bated breath to see the results of this much-needed investigation, and encourage other states and territories to take note of the findings.
Jane Chalmers, Senior Lecturer in Pain Sciences, University of South Australia and Amelia Mardon, PhD Candidate, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What Teas To Drink Before Bed (By Science!)
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Which Sleepy Tea?
Herbal “tea” preparations (henceforth we will write it without the quotation marks, although these are not true teas) are popular for winding down at the end of a long day ready for a relaxing sleep.
Today we’ll look at the science for them! We’ll be brief for each, because we’ve selected five and have only so much room, but here goes:
Camomile
Simply put, it works and has plenty of good science for it. Here’s just one example:
❝Noteworthy, our meta-analysis showed a significant improvement in sleep quality after chamomile administration❞
Also this writer’s favourite relaxation drink!
(example on Amazon if you want some)
Lavender
We didn’t find robust science for its popularly-claimed sedative properties, but it does appear to be anxiolytic, and anxiety gets in the way of sleep, so while lavender may not be a sedative, it may calm a racing mind all the same, thus facilitating better sleep:
(example on Amazon if you want some)
Magnolia
Animal study for the mechanism:
Human study for “it is observed to help humans sleep better”:
As you can see from the title, its sedative properties weren’t the point of the study, but if you click through to read it, you can see that they found (and recorded) this benefit anyway
(example on Amazon if you want some)
Passionflower
There’s not a lot of evidence for this one, but there is some. Here’s a small study (n=41) that found:
❝Of six sleep-diary measures analysed, sleep quality showed a significantly better rating for passionflower compared with placebo (t(40) = 2.70, p < 0.01). These initial findings suggest that the consumption of a low dose of Passiflora incarnata, in the form of tea, yields short-term subjective sleep benefits for healthy adults with mild fluctuations in sleep quality.❞
So, that’s not exactly a huge body of evidence, but it is promising.
(example on Amazon if you want some)
Valerian
We’ll be honest, the science for this one is sloppy. It’s very rare to find Valerian tested by itself (or sold by itself; we had to dig a bit to find one for the Amazon link below), and that skews the results of science and renders any conclusions questionable.
And the studies that were done? Dubious methods, and inconclusive results:
Nevertheless, if you want to try it for yourself, you can do a case study (i.e., n=1 sample) if not a randomized controlled trial, and let us know how it goes 🙂
(example on Amazon if you want some)
Summary
- Valerian we really don’t have the science to say anything about it
- Passionflower has some nascent science for it, but not much
- Lavender is probably not soporific, but it is anxiolytic
- Magnolia almost certainly helps, but isn’t nearly so well-backed as…
- Camomile comes out on top, easily—by both sheer weight of evidence, and by clear conclusive uncontroversial results.
Enjoy!
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Ovarian cancer is hard to detect. Focusing on these 4 symptoms can help with diagnosis
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Ovarian cancers are often found when they are already advanced and hard to treat.
Researchers have long believed this was because women first experienced symptoms when ovarian cancer was already well-established. Symptoms can also be hard to identify as they’re vague and similar to other conditions.
But a new study shows promising signs ovarian cancer can be detected in its early stages. The study targeted women with four specific symptoms – bloating, abdominal pain, needing to pee frequently, and feeling full quickly – and put them on a fast track to see a specialist.
As a result, even the most aggressive forms of ovarian cancer could be detected in their early stages.
So what did the study find? And what could it mean for detecting – and treating – ovarian cancer more quickly?
Ground Picture/Shutterstock Why is ovarian cancer hard to detect early?
Ovarian cancer cannot be detected via cervical cancer screening (which used to be called a pap smear) and pelvic exams aren’t useful as a screening test.
Current Australian guidelines recommend women get tested for ovarian cancer if they have symptoms for more than a month. But many of the symptoms – such as tiredness, constipation and changes in menstruation – are vague and overlap with other common illnesses.
This makes early detection a challenge. But it is crucial – a woman’s chances of surviving ovarian cancer are associated with how advanced the cancer is when she is diagnosed.
If the cancer is still confined to the original site with no spread, the five-year survival rate is 92%. But over half of women diagnosed with ovarian cancer first present when the cancer has already metastatised, meaning it has spread to other parts of the body.
If the cancer has spread to nearby lymph nodes, the survival rate is reduced to 72%. If the cancer has already metastasised and spread to distant sites at the time of diagnosis, the rate is only 31%.
There are mixed findings on whether detecting ovarian cancer earlier leads to better survival rates. For example, a trial in the UK that screened more than 200,000 women failed to reduce deaths.
That study screened the general public, rather than relying on self-reported symptoms. The new study suggests asking women to look for specific symptoms can lead to earlier diagnosis, meaning treatment can start more quickly.
What did the new study look at?
Between June 2015 and July 2022, the researchers recruited 2,596 women aged between 16 and 90 from 24 hospitals across the UK.
They were asked to monitor for these four symptoms:
- persistent abdominal distension (women often refer to this as bloating)
- feeling full shortly after starting to eat and/or loss of appetite
- pelvic or abdominal pain (which can feel like indigestion)
- needing to urinate urgently or more often.
Women who reported at least one of four symptoms persistently or frequently were put on a fast-track pathway. That means they were sent to see a gynaecologist within two weeks. The fast track pathway has been used in the UK since 2011, but is not specifically part of Australia’s guidelines.
Some 1,741 participants were put on this fast track. First, they did a blood test that measured the cancer antigen 125 (CA125). If a woman’s CA125 level was abnormal, she was sent to do a internal vaginal ultrasound.
What did they find?
The study indicates this process is better at detecting ovarian cancer than general screening of people who don’t have symptoms. Some 12% of women on the fast-track pathway were diagnosed with some kind of ovarian cancer.
A total of 6.8% of fast-tracked patients were diagnosed with high-grade serous ovarian cancer. It is the most aggressive form of cancer and responsible for 90% of ovarian cancer deaths.
Out of those women with the most aggressive form, one in four were diagnosed when the cancer was still in its early stages. That is important because it allowed treatment of the most lethal cancer before it had spread significantly through the body.
There were some promising signs in treating those with this aggressive form. The majority (95%) had surgery and three quarters (77%) had chemotherapy. Complete cytoreduction – meaning all of the cancer appears to have been removed – was achieved in six women out of ten (61%).
It’s a promising sign that there may be ways to “catch” and target ovarian cancer before it is well-established in the body.
What does this mean for detection?
The study’s findings suggest this method of early testing and referral for the symptoms leads to earlier detection of ovarian cancer. This may also improve outcomes, although the study did not track survival rates.
It also points to the importance of public awareness about symptoms.
Clinicians should be able to recognise all of the ways ovarian cancer can present, including vague symptoms like general fatigue.
But empowering members of the general public to recognise a narrower set of four symptoms can help trigger testing, detection and treatment of ovarian cancer earlier than we thought.
This could also save GPs advising every woman who has general tiredness or constipation to undergo an ovarian cancer test, making testing and treatment more targeted and efficient.
Many women remain unaware of the symptoms of ovarian cancer. This study shows recognising them may help early detection and treatment.
Jenny Doust, Clinical Professorial Research Fellow, Australian Women and Girls’ Health Research Centre, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The End of Stress – by Don Joseph Goewey
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So, we probably know to remember to take a deep breath once in a while, and adopt a “focus on what you can control, rather than what you can’t” attitude. In this book, Goewey covers a lot more.
After an overview of how we have a brain wired for stress, what it does to us, and why we should rewire that, he dives straight into such topics as:
- Letting go of fear—safely!
- Number-crunching the real risks
- Leading with good decisions, and trusting the process
- Actively practicing a peaceful mindset (some very good tips here)
- Transcending shame (and thus sidestepping the stress that it may otherwise bring)
The book brings together a lot of ideas and factors, seamlessly. From scientific data to case studies, to “try this and see”, encouraging us to try certain exercises for ourselves and be surprised at the results.
All in all, this is a great book on not just managing stress, but—as the title suggests—ending it in all and any cases it’s not useful to us. In other words, this book? It is useful to us.
Don’t Forget…
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Behaving During the Holidays
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝It’s hard to “behave” when it comes to holiday indulging…I’m on a low sodium, sugar restricted regimen from my doctor. Trying to get interested in bell peppers as a snack…wish me luck!❞
Good luck! Other low sodium, low sugar snacks include:
- Nuts! Unsalted, of course. We’re biased towards almonds 😉
- Mixed nuts are an especially healthy way to snack, though (assuming you don’t have an allergy, obviously)
- Air-popped popcorn (you can season it, just not with salt/sugar!)
- Fruit (but not fruit juice; it has to be in solid form)
- Peas (not a classic snack food, we know, but they can be enjoyed many ways)
- Seriously, try them frozen or raw! Frozen/raw peas are a great sweet snack.
- Chickpeas are great dried/roasted, by the way, and give much of the same pleasure as a salty snack without being salty! Obviously, this means cooking them without salt, but that’s fine, or if using tinned, choose “in water” rather than “in brine”
- Hummus is also a great healthy snack (check the ingredients for salt if not making it yourself, though) and can be enjoyed as a dip using raw vegetables (celery, carrot sticks, cruciferous vegetables, whatever you prefer)
Enjoy!
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- Nuts! Unsalted, of course. We’re biased towards almonds 😉
