Sunday, August 12, 2012

Nocibo Effect

NYT Illustration by Scott Balmer
"Beware the Nocibo Effect," a short piece in today's Sunday Review Section of the New York Times, points again to one of the most mysterious areas of modern medicine; the effect of expectation on outcome. Usually examined through the well documented placebo effect, this piece instead examines the "nocibo effect," or the harm done by the expectation that a medication will have side bad effects.

The authors, Paul Enck, a professor psychology at the University of Boblingen and Winfried Hauser, an associate professor of psychosomatic medicine at the University of Munich, reviewed 31 studies of the nocibo effect. Their review concludes that nocibo has a potent effect on patient experience and treatment outcome. For instance, eleven percent of patients in a drug trial for a fibromyalsia drug dropped out of the study because they experienced strong dizziness and/or nausea after being warned that the sugar pills they were taking may cause those symptoms.
In another study of an anti-depressant medication, one desperate patient swallowed 26 harmless placebo tablets in an attempt to kill himself. The patient's blood pressure "dropped perilously low," the researchers report.
The point of the piece is that doctors should be mindful when describing the potential side effects of medications they are prescribing. Fair enough. But more interesting by far is the tacit acknowledgement that there is a potent and hugely influential psycho-biological mechanism at play here that we really don't understand at all.

3 comments:

MaoClare said...

Really interesting. I wonder - can you create a Nocibo effect on yourself? For instance, I will turn off the radio or stop reading a story that describes the possiblesymptoms or complicaitons of a medical ailment (a non-serious one)that I might be experiencing because I'm afraid if I just hear about them, I'll bring them about in myself. If so, that's a bummer because then it's the elephant in the living room problem - try NOT to think about the elephant, which is impossible.

The Author said...

Yes, I think you can probably increase your chance of experiencing an effect or symptom by creating an expectation that it will occur. But expectation doesn't drive our health, it just influences it! Statistically speaking, you'd be more likely to get a headache if you expect to get one. And some people seem to be much more susceptible to the power of suggestion than others. As Socrates said, "know thyself." If you are particularly suggestible healthwise, it's probably a good idea to limit your exposure to scary stories. But don't bury your head in the sand: there are other much more potent influences on your health than suggestion and you've got to keep an eye on them, even if it means occasionally scaring yourself into some psychogenic symptoms.

MaoClare said...

Gordy,
The medical doctor and skeptic columnist Steven Novella has given an extensive dis to the placebo and nocebo effect here. I usually think he's on the money, but to say there is no biological placebo effect? I understand that he doesn't want to align himself with Deepak Chopra, but I wonder if that is want is driving the whoel if this assessment:
http://www.skepticblog.org/2012/08/20/nocebo-nonsense/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+skepticblog%2FcxSs+%28Skepticblog%29