6 ms·

Beware the Nocebo Effect

86 points by sew 14y ago

Jaecen 14y ago
The last sentence: "Words are the most powerful tool a doctor possesses, but words, like a two-edged sword, can maim as well as heal." I would really like to get one of those swords that heal on one side and maim on the other. Think of the possibilities!
tzs 14y ago
Part of this I suspect is that people might already have the symptoms of the side effect but not know it. Almost all of us have random coughs and sniffles and aches and pains, but don't notice them. Think, for instance, of those times when you've heard a friend or co-worker cough several times over a few minutes and you ask if they are alright, and they have no idea what you are talking about because they were not aware that they had coughed. When you tell someone the pill they just took might have a side effect of making them cough, they are going to notice those random coughs that they normally ignore, and attribute them to the pill.
- smashing 14y ago
  In some strange way, the placebo effect has its own placebo effect. People will tend to not voice their issues because they wish to stay on track for their treatment, get out of the doctor's office and on with their life. After all, a guy isn't going to just blurt out erectile problems if he is led to believe by the expert through the error of omission that erectile problems aren't a side effect. Its just too embarrassing.
dag11 14y ago
The example of the suicide attempt with fake medication causing the subject's blood pressure to drop to dangerously low levels got me thinking. If the belief that (s)he would die was almost enough to actually kill him/her, would it be possible for someone to end their own life with just their thoughts alone?
- tzs 14y ago
  Through meditation, people have learned to exhibit some amazing control over things that were thought to be entirely outside of conscious control. Perhaps the best example of this is Wim Hof: http://en.wikipedia.org/wiki/Wim_Hof http://en.wikipedia.org/wiki/Wim_Hof That man can spend nearly two hours sitting nearly naked immersed (except for his head) in an ice bath, without his core temperature dropping to dangerous levels and without suffering frostbite. He has also done such insane things as run a marathon in a desert without water. Here's the pubmed link to a paper by some researchers who studied Hof to see what the hell was going on: http://www.ncbi.nlm.nih.gov/pubmed/22685240 http://www.ncbi.nlm.nih.gov/pubmed/22685240 It certainly seems plausible to me that there are probably many more things that we currently think are not consciously controllable this way that will turn out to be. It would not at all be surprising if one or more of those turn out to be things that you could use to kill yourself.
- ChrisNorstrom 14y ago
  That's some deep stuff. Let's go further... If one gave sugar pills to 100 dreadfully depressed patients at their lowest point and claimed it would make their heart stop beating within a few hours. Would any of the patients actually die from believing it? And if an autopsy confirmed the dead patients died from heart failure would the death be ruled a murder, assisted suicide, or suicide?
- mistercow 14y ago
  There really isn't enough information in that anecdotal retelling to make heads or tails of it, but from that limited information, I'd say that person probably just had a panic attack. Panic attacks cause a spike in blood pressure for most people, but for some people the opposite will sometimes happen. I used to have them from needles, and in high school I went to the ER for suspected meningitis. They had me hooked up to monitor my vitals, and when a nurse stuck me with an IV, the room suddenly filled up with panicking medical personnel because my blood pressure hit the floor. So my guess would be the subject in question took a bunch of pills, freaked out and went to the ER, and then had a panic attack because they thought they were going to die. But to answer your question, I think that if you can, by panicking, alter your blood pressure (up or down) enough to kill yourself, that just means you had some pretty messed up cardiovascular issues. You wouldn't call that "killing yourself by thought alone"; you'd call it "dying of cardiovascular disease".
typpo 14y ago
The nocebo effect is quite powerful. I'm 22 years old and was in chronic pain for a year. I had trouble doing simple things like opening doors. Understanding nocebos helped me cure my carpal/cubital tunnel and thoracic outlet problems. After wasting a lot of money on ergonomic setups and doctors I read Aaron Iba's post on how he cured his RSI [1]. One of my takeaways from subsequent reading and research was that the nocebo effect played a huge role in how I associated computer usage and programming with pain. When you expect an autonomic symptom, you are much more likely to experience it. Since treating myself with this in mind, along with other techniques such as those outlined by Aaron, it's been a couple months since I've been in pain from using a computer. http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-pain.html http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-pain.htm...
mistercow 14y ago
One really important point about the placebo effect that a lot of people miss is that a lot of it is not a real physiological change caused by the placebo, but is a result of bias in both the subject and the experimenter. Over any period of time, a person will have a great many variations in mood, pain, etc. (which a subject is able to self-examine), and a great many variations of biological function (which a researcher is able to measure). When those variations correspond to effects that a subject or researcher has been primed to expect, the subject or researcher is more likely to notice that effect. This is simple confirmation bias. If you think trained scientists couldn't possibly stumble on that kind of pitfall, you should read about N-rays[1]. This is just as likely to be true for the "nocebo" effect as for the placebo effect. Dizziness, for example, is a very common symptom for people to experience for myriad benign reasons. Orthostatic hypotension (head rush) is a common cause of dizziness, and it is affected by a lot of minor factors like hydration, vasodilation, how long you've been sedentary, how fast you stand up, etc. This may happen to you three times in a week, and you'd never pay it any mind. But if a doctor told you that a medicine you were taking might cause dizziness, you would notice it. So to this extent, a placebo (or nocebo) effect can be accounted for with absolutely no "mind over matter" style physiological change whatsoever. It is plausible that some specific placebo effects like reduction/increase of pain response, anxiety, and mood could actually be real psychological effects involving suggestion. But if you hear of a placebo doing something and you think "how could a belief in a placebo possibly have that kind of effect", it's very likely that you are at least partly seeing mere measurement error. [1] http://en.wikipedia.org/wiki/N-rays http://en.wikipedia.org/wiki/N-rays
- sp332 14y ago
  That's interesting but I'm sure it doesn't explain everything. For example pain is actually experienced differently (confirmed by watching nerve pathways light up on fMRI scans) depending on people's expectations. http://www.ninds.nih.gov/news_and_events/news_articles/news_article_pain_perception.htm http://www.ninds.nih.gov/news_and_events/news_articles/news_...
  - mistercow 14y ago
    I did actually cover that in my last paragraph. There are certain effects that are known to be highly subjective and therefore it is not implausible that a real effect from placebos could be seen, even accounting for biases.
vishaldpatel 14y ago
Chalk one up for thinking positively.
rafski 14y ago
I always wondered to what extent the official warnings on cigarette packs contributed to the illnesses presented on them actually materializing.
AddictionMyth 14y ago
I think that drug addiction could be partly the nocebo effect. After all, we are told repeatedly as children: beware drugs, because you might find that once you start taking them, you are unable to stop. Then all sorts of terrible things will happen. So for some kids, this may seem like the perfect opportunity! http://AddictionMyth.com http://AddictionMyth.com

86 points by sew 14y ago

The last sentence: "Words are the most powerful tool a doctor possesses, but words, like a two-edged sword, can maim as well as heal." I would really like to get one of those swords that heal on one side and maim on the other. Think of the possibilities!

tzs 14y ago

Part of this I suspect is that people might already have the symptoms of the side effect but not know it. Almost all of us have random coughs and sniffles and aches and pains, but don't notice them. Think, for instance, of those times when you've heard a friend or co-worker cough several times over a few minutes and you ask if they are alright, and they have no idea what you are talking about because they were not aware that they had coughed. When you tell someone the pill they just took might have a side effect of making them cough, they are going to notice those random coughs that they normally ignore, and attribute them to the pill.

smashing 14y ago
In some strange way, the placebo effect has its own placebo effect. People will tend to not voice their issues because they wish to stay on track for their treatment, get out of the doctor's office and on with their life. After all, a guy isn't going to just blurt out erectile problems if he is led to believe by the expert through the error of omission that erectile problems aren't a side effect. Its just too embarrassing.

dag11 14y ago

The example of the suicide attempt with fake medication causing the subject's blood pressure to drop to dangerously low levels got me thinking. If the belief that (s)he would die was almost enough to actually kill him/her, would it be possible for someone to end their own life with just their thoughts alone?

tzs 14y ago
Through meditation, people have learned to exhibit some amazing control over things that were thought to be entirely outside of conscious control. Perhaps the best example of this is Wim Hof: http://en.wikipedia.org/wiki/Wim_Hof http://en.wikipedia.org/wiki/Wim_Hof That man can spend nearly two hours sitting nearly naked immersed (except for his head) in an ice bath, without his core temperature dropping to dangerous levels and without suffering frostbite. He has also done such insane things as run a marathon in a desert without water. Here's the pubmed link to a paper by some researchers who studied Hof to see what the hell was going on: http://www.ncbi.nlm.nih.gov/pubmed/22685240 http://www.ncbi.nlm.nih.gov/pubmed/22685240 It certainly seems plausible to me that there are probably many more things that we currently think are not consciously controllable this way that will turn out to be. It would not at all be surprising if one or more of those turn out to be things that you could use to kill yourself.
ChrisNorstrom 14y ago
That's some deep stuff. Let's go further... If one gave sugar pills to 100 dreadfully depressed patients at their lowest point and claimed it would make their heart stop beating within a few hours. Would any of the patients actually die from believing it? And if an autopsy confirmed the dead patients died from heart failure would the death be ruled a murder, assisted suicide, or suicide?
mistercow 14y ago
There really isn't enough information in that anecdotal retelling to make heads or tails of it, but from that limited information, I'd say that person probably just had a panic attack. Panic attacks cause a spike in blood pressure for most people, but for some people the opposite will sometimes happen. I used to have them from needles, and in high school I went to the ER for suspected meningitis. They had me hooked up to monitor my vitals, and when a nurse stuck me with an IV, the room suddenly filled up with panicking medical personnel because my blood pressure hit the floor. So my guess would be the subject in question took a bunch of pills, freaked out and went to the ER, and then had a panic attack because they thought they were going to die. But to answer your question, I think that if you can, by panicking, alter your blood pressure (up or down) enough to kill yourself, that just means you had some pretty messed up cardiovascular issues. You wouldn't call that "killing yourself by thought alone"; you'd call it "dying of cardiovascular disease".

typpo 14y ago

The nocebo effect is quite powerful. I'm 22 years old and was in chronic pain for a year. I had trouble doing simple things like opening doors. Understanding nocebos helped me cure my carpal/cubital tunnel and thoracic outlet problems. After wasting a lot of money on ergonomic setups and doctors I read Aaron Iba's post on how he cured his RSI [1]. One of my takeaways from subsequent reading and research was that the nocebo effect played a huge role in how I associated computer usage and programming with pain. When you expect an autonomic symptom, you are much more likely to experience it. Since treating myself with this in mind, along with other techniques such as those outlined by Aaron, it's been a couple months since I've been in pain from using a computer. http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-pain.html http://aaroniba.net/articles/tmp/how-i-cured-my-rsi-pain.htm...

mistercow 14y ago

One really important point about the placebo effect that a lot of people miss is that a lot of it is not a real physiological change caused by the placebo, but is a result of bias in both the subject and the experimenter. Over any period of time, a person will have a great many variations in mood, pain, etc. (which a subject is able to self-examine), and a great many variations of biological function (which a researcher is able to measure). When those variations correspond to effects that a subject or researcher has been primed to expect, the subject or researcher is more likely to notice that effect. This is simple confirmation bias. If you think trained scientists couldn't possibly stumble on that kind of pitfall, you should read about N-rays[1]. This is just as likely to be true for the "nocebo" effect as for the placebo effect. Dizziness, for example, is a very common symptom for people to experience for myriad benign reasons. Orthostatic hypotension (head rush) is a common cause of dizziness, and it is affected by a lot of minor factors like hydration, vasodilation, how long you've been sedentary, how fast you stand up, etc. This may happen to you three times in a week, and you'd never pay it any mind. But if a doctor told you that a medicine you were taking might cause dizziness, you would notice it. So to this extent, a placebo (or nocebo) effect can be accounted for with absolutely no "mind over matter" style physiological change whatsoever. It is plausible that some specific placebo effects like reduction/increase of pain response, anxiety, and mood could actually be real psychological effects involving suggestion. But if you hear of a placebo doing something and you think "how could a belief in a placebo possibly have that kind of effect", it's very likely that you are at least partly seeing mere measurement error. [1] http://en.wikipedia.org/wiki/N-rays http://en.wikipedia.org/wiki/N-rays

sp332 14y ago
That's interesting but I'm sure it doesn't explain everything. For example pain is actually experienced differently (confirmed by watching nerve pathways light up on fMRI scans) depending on people's expectations. http://www.ninds.nih.gov/news_and_events/news_articles/news_article_pain_perception.htm http://www.ninds.nih.gov/news_and_events/news_articles/news_...
- mistercow 14y ago
  I did actually cover that in my last paragraph. There are certain effects that are known to be highly subjective and therefore it is not implausible that a real effect from placebos could be seen, even accounting for biases.

vishaldpatel 14y ago

Chalk one up for thinking positively.

rafski 14y ago

I always wondered to what extent the official warnings on cigarette packs contributed to the illnesses presented on them actually materializing.

AddictionMyth 14y ago

I think that drug addiction could be partly the nocebo effect. After all, we are told repeatedly as children: beware drugs, because you might find that once you start taking them, you are unable to stop. Then all sorts of terrible things will happen. So for some kids, this may seem like the perfect opportunity! http://AddictionMyth.com http://AddictionMyth.com