cwick (Chadwick Matlin, deputy editor): :sniffle: Maggie, Anna and Christie, I’ve gathered you all to discuss the kind of question that could change EVERYTHING (and one well-timed for flu season): When I know it’s really important for me not to be sick for a day or two (say, if there’s an election coming), can I stop myself from feeling sick? Does my mind really have power over my matter? Is my brain that dope?
You’re not doctors, but in my book, you’re close enough: journalists who talk to doctors. So tell me: Do I have the power???
slackbot: I’m sorry you aren’t feeling well. There is Advil and Tylenol in the cabinet in front of Nate’s office/Vanessa’s desk.
cwick: Readers, that’s an auto-response triggered every time one of us says “sick” anywhere in our chat app. But if you ever need an Advil in the FiveThirtyEight office, now you know where to find it.
christie (Christie Aschwanden, lead writer for science): Hi, Chad! I love it when an editor sends writers off to get an answer to his personal medical problem.
maggiekb (Maggie Koerth-Baker, senior science writer): I get where he’s coming from, though. This is a pretty common belief. I mean, my super skeptic engineer husband is convinced that he saved all his illnesses for the end of the semester in college. Last test done. And then the deluge.
cwick: I suffered through a 102-degree fever the day after my wedding. I don’t think anything you say will convince me that I WASN’T holding it at bay the whole weekend.
christie: Because I like you, Chad, I asked a few experts. I have a few pet theories myself. But first, the expert opinion: “Sorry. No evidence of the willpower effect!” That’s according to Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
anna (Anna Maria Barry-Jester, senior reporter): Was that a “no evidence for or against” the willpower effect, Christie?
christie: I think he meant there was no evidence that there is a willpower effect.
And Marc Lipsitch, an epidemiologist at Harvard, said the same thing that several others did: “I don’t know of any research one way or another about these things.”
anna: (Thank you for that prescient answer to my at-that-point unasked question, Mr. Lipsitch.)
christie: One of my theories: It’s all about attention and focus. When you’re stressed about something else or hyperfocused on getting through finals week or meeting a deadline or getting out a grant proposal, all of your attention is going to that other task. When you get through it, you have more attention to pay to your symptoms, and you can kind of bask in them. So it’s not that you’re not sick (while you’re supposedly holding it off), it’s just that you’re in denial or you’re ignoring the symptoms.
anna: I can buy that (though I assume you’re talking about mild colds here).
christie: Yeah, I’m talking about the usual winter crud. Not the kind of illness that you can’t possibly ignore, like a heart attack.
anna: The one interesting thing I found was some research about colds and placebo. But before we get to that, there seems to be very little research on warding off illness altogether or delaying it and a lot more on reducing symptoms or shortening how long you are sick. Part of the problem there is that mild colds come and go, making them difficult to study.
christie: Good point, Anna. And that’s also what makes placebos so good at treating them.
anna: But a study from 2011 really intrigued me. It’s one study and it’s small … It looked at echinacea, an herbaceous flower commonly used to treat colds (the National Institutes of Health says some preparations may potentially treat colds, but the evidence is weak). The study essentially found that people who believed in the power of echinacea and were given a placebo pill had shorter colds (by a lot, 2.5 days!) than those who didn’t believe. Placebo: It’s a hell of a drug.
christie: If you take the placebo when you are feeling your worst, which is usually the low point no matter what, then what is really just the illness’s natural course appears like an effective treatment. (When it’s at its worst, it can only get better.)
anna: What about my favorite cold placebo, vitamins in the form of a fizzy additive to water? I take that before I get on a plane. Or ride the NYC subway.
christie: Oh, the fizzy vitamin water? People love those! And they’re a great placebo. But … a Cochrane review found that vitamin C did not reduce the incidence of colds and that “trials of high doses of vitamin C administered therapeutically, starting after the onset of symptoms, showed no consistent effect on the duration or severity of common cold symptoms.”
anna: Oh, I know that there isn’t particularly convincing evidence about the effect of vitamin C on colds. It is literally my favorite placebo, not pharmaceutical. The placebo effect is real.
christie: I wonder how they measured the duration of the cold in the echinacea study. Because if it’s derived from a self-reported “how do you feel?” question, there’s a lot of wiggle room. If you expect to feel better, you might in fact rate yourself as feeling better. Because how you feel is a rating of your experience. It’s open to suggestion.
anna: “Duration was defined as total time elapsed from enrollment until the last time answering yes to the question, ‘Do you think you still have a cold?’” I think that’s part of why that study intrigued me, Christie. Because it suggested that how people felt depended on whether they thought the treatment could work. I don’t see why that couldn’t in theory translate to keeping a cold at bay, as well.
christie: Agree, Anna. How we actually feel is a conglomeration of a lot of things, which include how we expect to feel.
cwick: So are we really talking about two different questions: Can I stop myself from feeling sick for a bit? (No, you dummy.) Can I make myself feel better once I am sick? (Maybe if you truly believe.)
maggiekb: I’m going to add one more question here, Chad. Instead of asking whether you can hold off your illness until your stressful life events are done, what about the question of whether stressful life events make you sick. And the answer to that, kind of surprisingly, is … well … maybe … yeah.
There’s a line of research — enough individual research papers to make a meta-analysis — that suggests stressful life events can make you more susceptible to things like the common cold.
christie: That’s a good point, Maggie. And that leads me to another theory: When you’re stressed about that thing in your life, you may be more susceptible to illnesses. You may be skimping on sleep, not eating well, drinking too much, skipping exercise, etc. The illness just catches up to you.
maggiekb: The studies on this are super interesting because they actually involve getting these sample groups of people, doing inventories about their stressful life events, and then exposing them all to cold virus intentionally. So for instance, in one 2012 study, the people who reported stress and stressful life events were twice as likely to get sick.
cwick: Wait, what does purposeful exposure to cold virus look like? Do I get misted? Do I get slobbered on? Does someone wipe their snotty hand on my face?
anna: In the nose, Chad.
christie: In one study, Chad, they gave nasal drops containing rhinovirus. Turns out, people who were sleep deprived were most likely to get sick.
maggiekb: Misting in some of these studies. Swabbing in others.
cwick: My nose is twitching just thinking about it.
anna: Which is to say, don’t pick your nose after riding the subway.
christie: And don’t touch your nose, eyes or mouth ever during flu season if you want to stay well. Seriously, good hygiene practices are your very best defense. Wash your hands with soap and water. Don’t cough on people (or get coughed on).
maggiekb: It’s not just cold/flu, either. There are some papers that show connections between stress and worse outcomes for HIV/AIDS. Including higher levels of virus in the bloodstream, an increased risk of picking up other infections, and increased risk of death.
I’m kind of fascinated now by this researcher at Carnegie Mellon who has basically made it his life’s work to figure out WHY stress is able to increase your risk of contracting a communicable disease. And you guys are going to love this … he’s the American Psychosomatic Society’s 2018 distinguished scientist.
christie: Wow, there’s an American Psychosomatic Society?
anna: Pardon, what?
cwick: Cheap joke: They dreamed it into reality
maggiekb: Anyway, his theory is that the receptors that bind to stress hormones can become resistant to those hormones. The more resistance, the worse your body is at suppressing inflammation. The more chronic inflammation, the worse things work … in terms of preventing illness.
anna: Chad, you really just want to know if you can will yourself into not getting sick, right? Do you care at all about what you can do to make that sickness … shorter, less … sick?
cwick: IDK, once I am sick, I sort of revel in complaining about it. If you shorten my colds, what would I have to talk about?
christie: Go ahead and joke, Chad, but I think we should be careful about stigmatizing the connection between mind and body health.
maggiekb: It’s not hokum. At least not completely.
christie: The mind is a crucial part of the body, so it’s not surprising that one’s psychological state of being can affect physical symptoms. Instead of joking that it’s “all in their heads,” we might be better off trying to harness this connection.
anna: Related: A recent New York Times magazine story delves into the new science of placebo and after reading it, it’s hard not to feel like a whole new era of treatment could be upon us. But it means completely revamping how we think about things like placebo.
christie: You know where this is leading, right, Chad? To my perpetual mantra: It’s complicated, and science is hard.
cwick: When will science get easier?
christie: Never! Sorry.