Thursday, 15 January 2015

Nocebo: 'To Do Harm'

Please take as directed

Most folk are aware of the placebo effect. Tis a confounding bias in drug studies. Simply stated if you believe a drug is beneficial then sometimes there is a demonstrable positive therapeutic effect, even though the 'drug' has no intrinsic therapeutic merit. This has been known for sometime. Drug trials, in order to determine if a certain drug has medical benefits, divides the participants into groups and each receives a different treatment. In some trials, but not all, the recipients are divided into two cohorts. One cohort receives the drug, while the other receives a placebo, which is generally a sugar pill or a therapeutically neutral compound. Those taking the placebo often exhibit medical benefits which can only be explained by the patient's positive expectation. Not only can this be psychological in nature but can actually transfer to the physiological. Thus is the power of the mind. But the placebo effect has a darker, evil twin, called nocebo, the Latin name for ‘doing harm’.   

Several studies have shown that where there is an expectation or a suggestion of an adverse reaction to a 'drug' or treatment, which the medics know to be innocuous or beneficial, there is a negative response in a significant number of the recipients. I don't intend to outline these studies however, for those who like to see the fruits of Dr Death's research feel free to follow the link:

The nocebo response is vastly understudied in comparison to the placebo effect. A simple audit of the published literature reveals that there are more than 160,000 publications on 'placebo' whilst there are less than 200 on 'nocebo'. The reason is not hard to fathom. To conduct nocebo studies doctors need to inflict subjective 'pain'. Clearly this does not sit well with medics, or medical regulation bodies and is counter the fundamental ethos of medicine, of 'do no harm'. Research workers interested in this field of study often have difficulty in convincing medical ethical committees. This is a shame as there is a real need to study this topic and not just because of scientific curiosity. Consider the implications of telling patients about drug side effects. Most drugs have adverse side effects, but how many of these negative reactions, and to what degree, are due to expectation and anticipation by the patient.

Perhaps the nocebo response is behind documented cases of the Voodoo hex, or 'pointing of the bones' when a Shaman or Witch Doctor wills a person to die through ritual and cursing. Hex victims have been reported to lose their will to live, and even though there is no physical illness, undergo a physical decline eventually resulting in death.

Anyway, the nocebo effect seems a fascinating area of study and well worthy of further study and research. Surely it will throw light on the subtle and not so subtle influences of suggestion on the mind and how this manifests into real physiological and ultimately  physical responses. We just have to find a way to  circumvent those pesky ethics committees. And what ever you do, don't tell that well known Witch Doctor, Mr Mumbojumbo Mugumbo. He might get upset and point his bony finger...... You  have been warned.          

Mr Mumbojumbo Mugumbo being discombobulated

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