|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.