The placebo effect is many things but one interpretation has been the healing power of intention and expectation (tapping into the body’s own potent self-healing potential).
But there is also a lesser-known phenomenon called the “nocebo” effect, where poor patient expectations actually lead to poorer health outcomes.
For example, when patients in a clinical drug trial are informed about all the possible “side effects” of a treatment, they may actually experience them—even if they’re given the placebo rather than the actual drug.
Research recently conducted in Germany revealed that this nocebo effect occurred in 31 different clinical drug trials.
In fact, many patients actually drop out of studies due to the nocebo effect—11% of the placebo group in one recent fibromyalgia study. In statin trials, “nocebo”-related dropout rates ranged from 4 to 26%.
A doctor’s choice of words also makes an important difference. I’ve mentioned Bernard Lown in prior Dispatches. Dr. Lown was the pioneer of non-surgical treatments for heart disease and the originator of the concept of “Avoidable Care.”
He says: “ Words are the most powerful tool a doctor possesses, but words, like a two-edged sword, can maim as well as heal.”
When given pain-reliving injections prior to surgery, patients felt better when told it would make the procedure go better. But they felt worse when warned that the injection would hurt.
In these days of risk management and informed consent, patients are recited a long litany of everything that could possibly go wrong and all the negative side effects they might feel. And simply telling them makes them feel worse. So, informing patients about side effects increases the likelihood that they will actually experience them—which has a net negative effect on quality of care. This, of course, poses an ethical dilemma. Don’t worry, though, your hospital probably has a professional “medical ethicist” on staff now (as I described in the previous Dispatch “Step right up”).
But there’s a simple solution to this dilemma—not to mention the side effects (real or perceived).
Just say “nocebo.”
And, instead, choose any of the many natural therapies available that work as effectively—or more effectively and safely—than drugs or surgery. (And, as a side benefit, natural health practitioners generally score higher on communicating with the patient as well.)
“Nocebo Phenomena in Medicine: Their Relevance in Everyday Clinical Practice,” Dtsch Arztebl Int 2012; 109(26): 459–465