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Medicine Science

Beware the Nocebo Effect 239

Posted by Soulskill
from the this-story-may-cause-itchy-palms dept.
An article at the NY Times looks at research into the "nocebo" effect. Named after the placebo effect, it's the term for when patient expectations do harm, rather than good. "When a patient anticipates a pill’s possible side effects, he can suffer them even if the pill is fake." The article describes several instances of patients getting the placebo in a drug trial, but reporting the expected side effects of the drug, rather than the benefits or nothing at all. Quoting: "Consider the number of people in medical trials who, though receiving placebos, stop participating because of side effects. We found that 11 percent of people in fibromyalgia drug trials who were taking fake medication dropped out of the studies because of side effects like dizziness or nausea. Other researchers reported that the discontinuation rates because of side effects in placebo groups in migraine or tension drug trials were as much as 5 percent. Discontinuation rates in trials for statins ranged from 4 percent to 26 percent. ... In one remarkable case, a participant in an antidepressant drug trial was given placebo tablets — and then swallowed 26 of them in a suicide attempt. Even though the tablets were harmless, the participant's blood pressure dropped perilously low."
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Beware the Nocebo Effect

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  • by LurkerXXX (667952) on Friday August 10, 2012 @07:06PM (#40952733)

    Actually, most folks I know who said they have fibromyalgia have been misdiagnosed because they had non-standard symptoms for some other condition. Fibromyalgia just seems to be a catch-all for when they have some symptoms in one area and they can't figure out what else it could be.

  • by jfengel (409917) on Friday August 10, 2012 @07:36PM (#40953025) Homepage Journal

    Nocebo is a perfectly reasonable name. "Placebo" is from a Latin root meaning "to please". "Nocebo" means "I will harm". It may sound like a silly portmanteu, but "nocebo" has roots of comparable authenticity that give rise to how the word is used today.

    It would be a real stretch to make "placebo" refer to all psychosomatic effects. That would differ both from its Latin roots and from its common usage, which connotes positive effects (or at least, sought-for effects).

    It is a bit late for the New York Times to be figuring this out. "Nocebo" is more recent in English than "placebo" (it only took off in the 1980s), but it's not news to science.

  • by Intrepid imaginaut (1970940) on Friday August 10, 2012 @07:38PM (#40953057)

    There are many examples outside the laboratory to look at in order to see the power of the mind over the body. Mothers lifting overturned vehicles to free a trapped child, a prisoner in the Nazi concentration camps whose name escapes me at the moment describing seeing men literally give up, they ate their last potato, lay down, and died for no particular medical reason. On a more upbeat note, someone like Wim Hof, who can control the temperature of his body to an incredible degree, is a living example of what we can do. Science has really only begun to probe the full extent of the control that can be achieved.

  • Huh? (Score:3, Informative)

    by denzacar (181829) on Friday August 10, 2012 @08:12PM (#40953299) Journal

    The US is the only nation that allows pharma ads

    You [youtube.com] should [youtube.com] travel [youtube.com] more. [youtube.com]

  • by slew (2918) on Friday August 10, 2012 @08:39PM (#40953489)

    Some placebos are sugar pills...

    The good news (for you): almost no placebos in large medical trials are "sugar-filled" pills**.
    The bad news (for everyone): ingredients of placebos are mostly unregulated, usually not published, and are often formulated to attempt to duplicate the known side effects of the medicine in question in a relatively benign manner.

    **most actual pills, however, are sugar coated***, so in that sense almost all pills (including both real pills and placebo pills) are "sugar" pills...
    ***the coating of pills is often plastic phthalates (embedded with sugar and artificial colors), yet another thing to worry about when taking pills...

  • by similar_name (1164087) on Friday August 10, 2012 @09:43PM (#40953901)
    This article [healthiertalk.com] seems relevant.

    ... for the moment let's focus on the idea of what they call an "active placebo," designed to mimic the side effects of a tested drug.

  • by Anonymous Coward on Friday August 10, 2012 @10:04PM (#40954039)
    I do believe you missed the milli in mg.
  • by cranky_chemist (1592441) on Friday August 10, 2012 @11:23PM (#40954469)

    Actually, the ingredients of placebos can definitely induce side effects, and this is not a new problem. See http://www.reuters.com/article/2010/10/18/us-whats-placebo-idUSTRE69H51L20101018 [reuters.com]

  • by Anonymous Coward on Friday August 10, 2012 @11:29PM (#40954497)

    fructose is metabolized by the liver in a biochemical process nearly identical to alcohol (search YouTube for Dr. Robert Lustig's lecture "Sugar: The Bitter Truth"; he walks through the biochemistry in detail)

    I haven't seen that YouTube video so it's quite possible that what Dr Lustig means is different to what you're saying... but the metabolic pathways for ethanol and fructose metabolism are very, very different.

    The major pathways of ethanol metabolism are:

    (a) Ethanol --ADH--> acetaldehyde --ALDH--> acetic acid.
    (b) Microsomal ethanol oxidizing system (induced in chronic alcoholics).
    (c) Catalase enzyme (minor).

    The major pathways of fructose metabolism are:

    (a) Fructokinase enzyme in the liver, i.e. fructolysis (similar to glycolysis for glucose which occurs in most cells).
    (b) Hexokinase enzyme in most cells, but is usually inhibited by glucose.

  • by Anonymous Coward on Saturday August 11, 2012 @03:36AM (#40955321)

    You have any credible references to this notion? I am a mediical doctor and have read countless scientific articles, and never have I heard about any active effect purposely added to the treatment of the placebo control group. That would instantly invalidate the trial, and it wouldn't get published.

  • Re:100 mg? (Score:5, Informative)

    by Zouden (232738) on Saturday August 11, 2012 @06:13AM (#40955751)

    I have type I diabetes and I can assure you that 100mg of sugar will have absolutely no effect.

  • by Intrepid imaginaut (1970940) on Saturday August 11, 2012 @07:53AM (#40956131)

    I find it interesting that you translated what I said to "compare him to old anecdotal fairy tales of mystic powers". This I would view as a symptom of the bizarre extremist rational atheism (in fact irrational religion) which seems popular in certain circles, which views any expression of amazement at unusual events or people as being a direct challenge to all of science, when in fact its only a challenge to your dogmatism. That's dogmatism mind, not realism.

    And this after attempting to denigrate his achievements as just "staying warm", with a tip of the hat towards the old genetics canard. The man climbed 7/8ths of the way up Mount Everest in his shorts, sits up to his neck in ice for hours at a stretch (they had to cut him out with axes in one demonstration, the thing had frozen solid), and hey, he just ran a marathon in one of the hottest deserts on earth, 40 degrees celcius, at age 52, without water [dailymail.co.uk]. So much for just "staying warm".

    If you know about cold, as you claim, you know very well just how lethal exposure can be and how quickly it can kill - survival training basics, the rule of threes, three hours of exposure, three days without water, three weeks without food, thats how long it will take to become incapacitated. And thats in relatively livable conditions, not north of the Arctic circle, making his achievements all the more remarkable.

    My advice, grow an imagination and a sense of wonder, you're as much of a threat to science as any right wing religious nutjob at the moment.

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