The Nocebo Effect

Early last month a Time Magazine article appeared on my homepage.  “Your Doctor’s Words Could Make You Sick.”  Of course I clicked on it.

The article, by Charlotte Blease and several others who wrote the book The Nocebo Effect:  When Words Make You Sick, addresses the harm that occurs due to negative expectations.  As the placebo effect’s “evil twin,” nocebo effects occur when we expect to feel worse.  I interpreted their article to be one of placing the blame for the “side effects” people experienced from the COVID jab on the shoulders of medical professionals administering the shots and forewarning of pain or flu-like symptoms.  You may see it differently. 

I sensed that they were trying to downplay the seriousness of the effects of the COVID jabs while at the same time trying to condition people to listen to their doctors more (and prepare them for jabs that will be needed for future “pandemics”).

I didn’t like anything about that article.  However, I was curious about the nocebo effect.  So I went to the National Center for Biotechnology Information, an official website of the US government.  (I really need a sarcasm emoji here.)  Fortunately, the NCBI posts articles from scientific journals from around the world.  And lately, there have been a whole lot of articles on the topic.

One article suggested that the nocebo effect may be responsible for patient-reported statin intolerance, and that true statin intolerance may indeed be much less than the 5-30% that patients report.[1]  Another article, one that is actually a review of dozens of studies, found that all of the people a patient interacts with affect the patient’s outcome—receptionists, nurses, doctors, and even healthcare staff that the patient doesn’t see like managers and cleaning staff.  Basically, the amount of time and personal attention paid—helping the patient feel like he is being treated well and listened to—facilitate the road to recovery (the placebo effect).  On the other hand, managers that limit the amount of time a doctor can spend with a patient ore receptionists that don’t prioritize a needy patient (and receptionists are often unqualified to triage patients) contribute to a patient’s nocebo response.[2]

Some doctors lament that the nocebo effect raises its head when patients read their records and research the drugs they are prescribed.  Because often the nocebo effect “causes” negative responses in patients and these patients cease taking prescribed medications for their chronic conditions.  They estimate this results in 100,000 preventable deaths and $100 billion in costs annually.[3]

Many articles noted the dilemma healthcare professionals face when determining how much information to share with a patient, knowing the need to inform patients of potential side effects while at the same time hoping to avoid a nocebo effect that “creates” side effects.[4]  Along the same lines, some researchers suggest that conspiracy theories, mostly regarding COVID, and sensationalist news articles, especially those regarding food safety and the spread of contagious diseases, contribute to the nocebo effect.  They go on to blame the nocebo effect and conspiracy theories for many people refusing to get a second COVID jab.[5]

The following excerpt from the Time article highlights the core issue in the nocebo dilemma for me.

In 2010, Dr. Dirk Varelmann, a specialist in anesthesia and pain management at Beth Israel Deaconess Medical Center in Boston, wanted to explore whether the way in which a local anesthetic injection was described to patients would influence pain. Varelmann led a study where one group was told, “You will feel a big bee sting; this is the worst part;” the other group was informed, “We are going to give you a local anesthetic that will numb the area, and you will be comfortable during the procedure.” Those who were told they would feel a sting—that is, the patients receiving a negative suggestion—reported significantly more pain after the injection even though both groups got the same anesthetic. Varelmann’s conclusion was that, “using gentler, more reassuring words” could improve patients’ experience during invasive medical procedures.

If I’m informed that I’ll feel “a big bee sting,” I at least feel that person is being honest with me, about what is coming.  “Using gentler, more reassuring words” might make me trust the person less.  Like many others, I no longer trust the reassuring words of our government and the healthcare industry.  They treated us like garbage and showed zero concern for the health of the citizens of this country and continue down this path while simultaneously telling us, “All is well.” 

As the authors of the Time article conclude, “Knowledge is power, but it’s as equally important to remember that words matter.” 

Knowledge is power.  Words do matter. 

Knowing that the placebo and nocebo effects are real, we must remember that how we treat our loved ones, friends, or others we hope to help heal is foundational to their recovery.  Sincerely listening to their concerns and informing them of potential side effects of treatment—having an open and honest conversation—takes time.  We have to be honest.  Because when trust is lost, the nocebo effect takes hold, potentially negating any progress made in healing.  We don’t have the time or resources to waste.

Links to related posts:

The Placebo Effect  

“A Pious Fraud” More on the Placebo Effect  

References:

https://time.com/6963052/nocebo-effect-essay/

For further information:

https://pubmed.ncbi.nlm.nih.gov/38709490/

https://pubmed.ncbi.nlm.nih.gov/38699574/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11061517/

https://pubmed.ncbi.nlm.nih.gov/38726093/

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[1] https://pubmed.ncbi.nlm.nih.gov/38712783/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11061517/

[3] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777857

[4] https://pubmed.ncbi.nlm.nih.gov/38557480/                                              

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863677/