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Beware the Nocebo Effect

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."

12 of 239 comments (clear)

  1. The Mind is amazing by tomhath · · Score: 4, Insightful

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

    1. Re:The Mind is amazing by arth1 · · Score: 5, Insightful

      Drinks with HFCS give me migraines, for example. A sugar placebo would certainly have side effects not even considering the mind over matter aspect of the situation.

      I think you might be begging the question here - precluding a nocebo effect based on something that may very well be a nocebo effect.
      Or have you been through double blind tests?

    2. Re:The Mind is amazing by Intrepid+imaginaut · · Score: 4, Informative

      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.

    3. Re:The Mind is amazing by slew · · Score: 5, Informative

      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...

    4. 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.

    5. Re:The Mind is amazing by Anonymous Coward · · Score: 4, Informative

      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.

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

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

  2. Re:Too Bad I don't Take Medications... by cpu6502 · · Score: 4, Funny

    "Horniness"

    --
    My AC stalker: " I personally agree with your posts most of the time, but that won't keep me from modding you troll"
  3. Re:last example is very interesting by jfengel · · Score: 5, Informative

    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.

  4. Re:No humans are weird by Anonymous Coward · · Score: 5, Insightful

    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.

  5. Re:No humans are weird by DMUTPeregrine · · Score: 5, Insightful

    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.

    --
    Not a sentence!
  6. Re:100 mg? by Zouden · · Score: 4, Informative

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

    --
    "A week in the lab saves an hour in the library"