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Beware the Nocebo Effect

Posted by Soulskill on 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."

8 of 239 comments (clear)

  1. last example is very interesting by Trepidity · · Score: 2, Interesting

    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?

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  2. No humans are weird by cpu6502 · · Score: 3, Interesting

    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).

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    1. Re:No humans are weird by Anonymous Coward · · Score: 2, Interesting

      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 effective.

      References (probably paywalled): http://www.uptodate.com/contents/overview-of-psychotherapy

      "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."

      I hate to burst your bubble, but this is an over-simplified and incorrect understanding of therapeutic interventions. One major reason why therapeutic trials are conducted as blinded (preferably double or triple blinded), randomized controlled trials is that your belief and/or desire for it to work *DOES* influence whether or not it works, i.e. in objective, measurable outcomes such as reduction in blood pressure.

      For virtually every disease treatment combination available, you will get a combination of outcomes that include:

      (a) patients who take the drug and get better (improvement in objective measurements),
      (b) patients who don't take the drug (or a placebo) and have no difference or get worse,
      (c) patients who take the drug and have no improvement - or even deteriorates, and
      (d) patients who don't take the drug and spontaneously improve.

      Clinical measurements of treatment effectiveness (odds ratios, relative risk, etc) measure the ratio of (a / (a + c)) / (b / (b + d)) to see whether a treatment "works".

  3. Re:Too Bad I don't Take Medications... by cvtan · · Score: 3, Interesting

    Have you noticed that the ads for restless leg syndrome drugs have vanished? Why is that?

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  4. Re:The Mind is amazing by amicusNYCL · · Score: 3, Interesting

    That could cause an anti-migraine pill to make the situation worse, or cause reduced kidney/liver function as my body works overtime to purge the sugar from my blood

    Would 100mg of sugar really cause problems for your liver?

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  5. Re:The Mind is amazing by Anonymous Coward · · Score: 5, Interesting

    Holy crap, a correct use of the phrase "begging the question"! You win one Internet.

  6. "inert ingredients" vs. inert by reiisi · · Score: 3, Interesting

    Inert means inert, yes.

    On the other hand, "inert ingredients" means ingredients that show up in a list in a standard as being supposed to be inert when used in a specific way. Thus, YMMV.

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  7. Re:The Mind is amazing by twocows · · Score: 4, Interesting

    Do you have a source for that? Genuinely interested, not doubting you.