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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 More

Beware the Nocebo Effect

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  • The Mind is amazing (Score:5, Insightful)

    by tomhath ( 637240 ) on Friday August 10, 2012 @05:46PM (#40952559)
    No surprise here, the mind controls the body. Why wouldn't the placebo effect work both ways?

    • No humans are weird (Score:3, Interesting)

      by cpu6502 ( 1960974 )

      They are so gullible that they will believe anything, even that they have upset stomachs (even when they don't). Or that Lush Rimbaugh is right. Or that celltowers are the cause of their headaches even if the tower is turned-off & the headaches are caused by other issues (like staying-up til midnight).

      • Re:No humans are weird (Score:5, Insightful)

        by Anonymous Coward on Friday August 10, 2012 @06:48PM (#40953127)

        or that Chiropractic treatment works. Or homeopathy, crystals, accupunture, tiger penis soup, Sea Horse balls, etc ...

        And I once argued with a psychologist about their efficacy (for therapy). For the patient to get better, they have to want to change; then doesn't that make it a placebo?

        "No!" blah balh blah blah.

        "I see. But when I take a antibiotic, it either works or it doesn't. My belief or desire for it to work is irrelevant."

        And then there are the very compelling arguments with data of the efficacy of anti-depressants.

        Yeah, yeah, yeah, go ahead acuse me of being a Scientologist. But even kooks can be right sometimes for the wrong reasons. for example, Mormons. They say you can't drink alcohol.

        • Dammit, don't talk against chiropractors. In eleven seconds, you are going to get a reply from Dr. Looney that says that chiropractic treatments cure cancer, AIDS, ingrown nails and the Flame virus.

        • Re:No humans are weird (Score:5, Insightful)

          by DMUTPeregrine ( 612791 ) on Friday August 10, 2012 @07:46PM (#40953543) Journal
          Psychological therapy works by using a conscious desire for change to find subconscious causes of undesired behavior and eliminate them. It is arguably psychosomatic, but not all psychosomatic effects are placebo effects.

        • "I see. But when I take a antibiotic, it either works or it doesn't. My belief or desire for it to work is irrelevant."

          Not entirely, as mentioned in the article, 26 placebo pills dangerously lowered the subject's blood pressure. Placebo effect can also boost or lower natural immunity, possibly to equal or greater effect than antibiotics, especially with MRSA and other drug tolerant strains.

        • There was a recent study that showed accupucture worked. No, not Chinese accupucture; it didn't actually matter where the needled were stuck, but there was a difference if they were stuck at all. Maybe it was a placebo effect but no matter, it had an effect.

          Personally my chiropractic experience was a success in that she showed me how my posture was the source of my periodic, debilitating headaches. (Muscles seized in the back of my neck.) Drastic changes to my posture (I sit strictly upright at all time

        • For the patient to get better, they have to want to change;

          "Patient has to want to change" is a shorthand/metaphor for "a patient has to accept the existence of a problem, and in order to find the cause of it so it can be treated, he or she must openly discuss the problem and the underlying issues with a trained professional".

          But when I take a antibiotic, it either works or it doesn't.

          Weeeell...
          Elevated stress can cause an increase in production of stomach acid, which can inhibit certain antibiotics, when taken orally.
          More like "thinking positive" than "believing", and weakening the effect than "not working" but you get the

        • Re: (Score:2, Interesting)

          by Anonymous Coward

          or that Chiropractic treatment works. Or homeopathy, crystals, accupunture, tiger penis soup, Sea Horse balls, etc ...

          Yes... and the people who believe in these "treatments" often believe that modern medicine, big pharma, all medical doctors, etc are "evil" - and these preconceptions may result in them experiencing (real) adverse side effects.

          And I once argued with a psychologist about their efficacy (for therapy). For the patient to get better, they have to want to change; then doesn't that make it a placebo?

          The difference with evidence-based therapies such as Cognitive Behavioural Therapy is that the combination of (a) the patient wanting to change, and (b) being treated with CBT produces better outcomes than simply wanting to change alone. Hence, the treatment is classified as being eff

      • Nah, sometimes it's the opposite problem, the body can trick itself into symptoms. As for the Upset Stomach, the throwup that you had to flush down the toilet wasn't fake.

        However it wasn't due to the drug, it was due to the subject/patient over stressing about tertiary factors.

    • Re:The Mind is amazing (Score:5, Informative)

      by Intrepid imaginaut ( 1970940 ) on Friday August 10, 2012 @06:38PM (#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.

      • Mothers lifting overturned vehicles to free a trapped child

        Hysterical strength is not "mind over the body".
        During times of extreme stress, our body essentially disengages the safeties and allows us to use our muscles to their full capacity.
        One can achieve the exact same levels of strength by electrocuting oneself, which forces all the muscle fibers to twitch at once.
        I don't recommend you try it though, since you'll end up (A) electrocuted and (B) with torn muscles.

        If it was truly a mind over body talent, there would be people (similar to Wim Hof) who could access i

        • Wim uses Buddhist meditation and yoga techniques, specifically Tummo (inner fire) yoga, to survive quite happily in conditions that would quite quickly kill most other people, so who knows what other doors we can open? The book isn't written yet by a long shot, if there's a mental switch in there I bet we can flip it! Buddhists, the hackers of the mind.

      • Re:The Mind is amazing (Score:4, Insightful)

        by Smauler ( 915644 ) on Saturday August 11, 2012 @01:25AM (#40955143)

        I can control my heartbeat at will, to some degree. If my heart gets a massive blockage in it, I won't be able to think it out.

        Mothers don't lift overturned vehicles, they lever them on pivots - an overturned vehicle is relatively easy to move around comparative to to weight it is, because it's sitting on it's top.

        Perpetuating the myth that mothers can do extraordinary feats in times of crisis slams guilt on those mothers that did not manage to save their child when then did all they could.

    • "No surprise here, the mind controls the body. Why wouldn't the placebo effect work both ways?"

      This actually goes a long way to prove that psychological abuse is actually physically damaging to the body, that bullshit about 'what doesn't kill you makes you stronger' or 'sticks and stones may break my bones but names will never hurt me' is bullshit.

      After all if you are a social outcast you are deprived of things your body needs (like say companionship or sex) compared to other people.

  • Too Bad I don't Take Medications... (Score:3, Insightful)

    by ilikenwf ( 1139495 ) on Friday August 10, 2012 @05:47PM (#40952569)

    And even if I did, I wouldn't get my info about them from the freaking commercials that list off what it's for, the horrendous side effects, as it shows a happy family playing outside, and then says "ask your doctor..." WTF?

    The US is the only nation that allows pharma ads, and they're really harming our society because people go to the doc and demand certain meds as a result of these commercials. Enjoy your diharrea, heart palpitations, mild depression and thoughts of suicide.

    This all relates back to the article, as these nocebo effects are a result of stupid people taking advice from even more idiotic marketing people about what drugs they need, for fake diseases like restless leg syndrome, and miracle cures that don't work and just cause you to die like the numerous discontinued drugs caught up in class action lawsuits for wrongful death.

    • Re: (Score:2, Insightful)

      by Anonymous Coward

      Fake disease? Restless leg syndrome is a real disease. Just because many claim to have the disease, while they dont, does not make the disease fake.

    • Your outlook on medication probably causes more problems from the nocebo effect...

      But you are right about the marketing at least.

    • Re: (Score:3)

      by geekoid ( 135745 )

      "restless leg syndrome,"
      fine, what do you call it when a persons legs don't stop moving while they sleep? It's not like there isn't volumes of actual documentation.

    • Most of their advertising is directed at doctors, so you can't go to the doctor without them trying to prescribe 2-3 drugs. Then when you experience side effects from those drugs, they'll try to prescribe more drugs to take care of the side effects.

    • Huh? (Score:3, Informative)

      by denzacar ( 181829 )

      The US is the only nation that allows pharma ads

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

    • Re: (Score:2)

      by khallow ( 566160 )

      The US is the only nation that allows pharma ads, and they're really harming our society because people go to the doc and demand certain meds as a result of these commercials. Enjoy your diharrea, heart palpitations, mild depression and thoughts of suicide.

      Sounds just fine to me. I imagine the real problem is that the above patients don't have to pay extra for the medications that they're demanding.

  • last example is very interesting (Score:3, Interesting)

    by Trepidity ( 597 ) <[delirium-slashdot] [at] [hackish.org]> on Friday August 10, 2012 @05:49PM (#40952583)

    I wonder if it's actually possible to commit suicide by swallowing placebos? Or is there some limit to the nocebo effect's severity that'd prevent that?

    • I wonder if it's actually possible to commit suicide by swallowing placebos? Or is there some limit to the nocebo effect's severity that'd prevent that?

      It can certainly lead to you hearing your neighbor's dog [imdb.com] talk to you.

    • Comment removed based on user account deletion

      • Re: (Score:2)

        by Smauler ( 915644 )

        Your evidence that the mind controls the body is that you grandmother died 2 years after your grandfather.

        Well, case closed, I guess.

    • Re: (Score:2)

      by geekoid ( 135745 )

      no. You will notice the the nocebo* effect are non specific symptoms. They same things that tend to 'go away' when taking a placebo.

      *nocebo is a stupid name. Scientists have known about this for some time. It's also a placebo effect.

      • Re:last example is very interesting (Score:5, Informative)

        by jfengel ( 409917 ) on Friday August 10, 2012 @06:36PM (#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.

    • Re: (Score:3)

      by Bookwyrm ( 3535 )

      Try this reference:
          http://en.wikipedia.org/wiki/Voodoo_death [wikipedia.org]

      'Psychosomatic death' is probably related to what you are thinking of.

    • Re: (Score:2)

      by Mashiki ( 184564 )

      Well, let's look at it this way. Let's take metformin [wikipedia.org] and the clinical trials(my sister was in it and is a type 1). And we use that, they used a different inert for that, because well sugar doesn't react well to type 1 diabetics. Now let's just change that, and instead they were sugar pills. And the diabetic took all the pills at once. Unless they brought their sugars back under control, it's very probable to commit suicide by high blood sugar reaction(varying effects including impairment and ketoacido

      • And in turn, they would have indeed committed suicide by placebo.

        That would be death by placebo TREATMENT, not by placebo EFFECT.
        A neutral, non-sugary, placebo pill would create the same placebo effect, but it would not trigger a high blood sugar reaction in diabetics.

        And I do believe that we are talking about the effect, not the treatment here.
        Cause, one could just as well choke on a placebo pill and die from a placebo treatment.
        Or slip on placebo pills spilled on top of the stairs and break one's neck.
        Or get run over by a truck transporting placebo pills.
        Or shot by a

    • Well, if they are sugar pills, a sufficient quantity might kill a diabetic.

    • Sure, the mind can cause physical illness, even death [wikipedia.org].

  • I'm frankly not surprised that people who imagine diseases imagine side-effects from placebos.

    • Didn't RTFA, so I can't say for certain. But since we're talking about the "control" group, I would assume these aren't people who are imagining that they have the disease. Otherwise, they're not much of a "control" group since they're perfectly healthy.

  • Hmm (Score:3)

    by lightknight ( 213164 ) on Friday August 10, 2012 @05:54PM (#40952627) Homepage

    And yet, supposedly, the effectiveness of placebos is rising. What does this tell us? Human beings are becoming more pliable / suggestive, which is not a good thing.

    For one, that level of pliability is probably a prelude to something really horrible, the least of which is a Justice / Legal system that will operate in "sideways mode." Not a problem until you're convicted of something you didn't do. But if you make sure you are always wealthy / powerful enough, it shouldn't ever be a problem.

    • I wonder how the placebo effect's "potency" varies from culture to culture?

    • Re: (Score:2)

      by Sir_Sri ( 199544 )

      I'm wondering if it's a stress response, which manifests differently in different people. For some people the idea that they're finally getting some help, or at least potentially getting it, is a huge stress reliever, which makes them better. For others the placebo isn't having the desired effect which stresses them out more, and it sort of feeds on itself making even their condition worse.

      That would probably correlate to increased stress over time, but without the desire to dig through data and try and a

  • "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". Aren't these also symptoms that fibromyalgia victims suffer? Could the participant merely be confusing a "side effect" with "fake pill simply not working"?

  • "he can suffer them even if the pill is fake."
    by 'them' they mean non specific symptoms, then yes.

  • If one believes that advanced human evolution will include the ability to control bodily processes with one's mind, including healing and maximization of performance, then it's also quite likely possible for it to work the other way.

  • Up until now, when my doctor prescribed something for me, I always looked at the datasheet the pharmacist gave me and sometimes looked the drug up on the NIH website to find out about the side effects. I am somewhat suggestible; would I be better off not looking at drug information lest I get psychosomatic side effects? I can see some potential problems, like dying due to my failing to read some other crucial parts of the datasheet.

    • I suggest looking at the data sheet, but paying close attention to the % of people experiencing the side effects. I'm pretty sure they have to report even very low incidence rates of side effects. If only a handful of test subjects got a particular side effect, then I'm pretty sure you can convince yourself that you're not *that* unlucky. Compare it to some other event with similar odds. Make sure the event you compare it to is a positive one though, like winning the lottery, lest you start a chain reaction

  • NEO: I thought it wasn't real.
    NEO: If you are killed in the Matrix you die here?
    MORPHEUS: The body cannot live without the mind.

    So, DONT tell the patient that side effects include death, OK.

  • I think it is "remarkable" that a subject in an antidepressant trial was given placebos, and attempted suicide. That seems a rather poor situation to put a depressed person in.

  • Here it comes! (Score:3)

    by Ol Olsoc ( 1175323 ) on Friday August 10, 2012 @10:15PM (#40954417)
    There is a whole industry of lawyers who read the side effects of medicines, then go trolling for "victims" to come forth so they can sue the drug company. It's pretty bizarre to watch the commercials, it's like reading a list.

    The funniest part is that they often say "If you have been injured or killed by" such and such drug.

    So if there is placebo side effects, there can now be lawsuits over taking almost nothing. Litigation paradise!

  • Or maybe they were allergic to some component of the placebo - such as corn sugar (a typical ingredient). Then they'd have REAL side effects.

  • I am sorry to disagree with the experts here, but I think they got it wrong. I merely object to the name 'nocebo effect'. What this article refers to is the placebo effect, you take something, believe it is the drug, and feel the effects of the drug. The name nocebo would be much better applied to the cases where the people get the actual drug, and believe it is a placebo, which can cancel out the drug's effects. Yes this is a purely semantic distinction, but if you think about it, I think you will find it
  • Even more interesting (to me) is the fact that placebos tend to work even if the patient is aware that they have ingested a placebo. The placebo effect and activities of mirror neurons are still very poorly understood. I think a lot of the comments here suggesting that "the increasing effectiveness of placebo suggests that our culture is becoming more gullible/suggestible" are premature and show the bias of the people making those comments. Whether or not their conclusions are accurate, correlation does not

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