After all these years working in the emergency department I have learned one thing: beware the patient that tells you they think they are about to die. They are probably right.
The powerful physical effects that can be produced by placebos is now well documented. So powerful, that there may even be an emerging problem with placebo addicts flooding into the health system.
But all levity aside, what is less known, less examined, and probably just as significant,Â are the effects of the nocebo (meaning â€œI will harmâ€).
New Scientist has an interesting article on the effects ofÂ the nocebo, where negative expectations, and the power of suggestion can produce measurable negative effects.
Take Sam Shoeman, who was diagnosed with end-stage liver cancer in the 1970s and given just months to live. Shoeman duly died in the allotted time frame – yet the autopsy revealed that his doctors had got it wrong. The tumour was tiny and had not spread. “He didn’t die from cancer, but from believing he was dying of cancer,” says Meador. “If everyone treats you as if you are dying, you buy into it. Everything in your whole being becomes about dying.”
He didn’t die from cancer but from believing he was dying of cancer
Cases such as Shoeman’s may be extreme examples of a far more widespread phenomenon. Many patients who suffer harmful side effects, for instance, may do so only because they have been told to expect them. What’s more, people who believe they have a high risk of certain diseases are more likely to get them than people with the same risk factors who believe they have a low risk.
:: New Scientist::
One study of women found a fourfold increase in death from coronary symptoms amongst those who believed they were going to have a heart attack compared to others with the same risk factors.
In Many clinical trials, those in the control group being administered pharmacologically inert substancesÂ will actually develop the negative side effects of the real therapies.
And in a retrospective study of 15 trials involving thousands of patients prescribed either beta blockers or a control, it was found that both groups reported comparable levels of side effects, including fatigue, depressive symptoms and sexual dysfunction. A similar number had to withdraw from the studies because of them.
Nocebo effect on smokers.
Which raises an interesting possibility.
In Australia, as in many other countries, all our cigarette packets now carry a mandatory ‘Smoking Kills’ warning including explicit, graphic pictures of smoking related illness. The warnings must cover 30% of the front and 90% of the back of the cigarette package.
This is combined with frequent runs of graphic advertising campaigns,Â intended to be both powerful and disturbing.
Without doubt these programs have been effective. Today, Australia ranks with Sweden, Canada and the USA as having achieved the largest falls in daily smoking prevalence of any nation. And there is a strong push for increased use of these ‘shock’ tactics due to this very success.
There is absolutely no doubt regarding the terrible suffering that smoking inflicts on people. And the positive impact that these campaigns has had on countless lives as well as the massive savings to the health system are indisputable.
But could constant exposure to all this negative psychologicalÂ imprinting be producing aÂ nocebo effect, and actuallyÂ increasing the incidence of smoking related illness and even the death rate amongst those who have been unable to give up smoking?
Unable or unwilling to give up, do many smokers actually develop a belief that they are going to suffer lung cancer, or heart disease, or stroke? What effect would such belief have on their health?
Or do they just become de-sensitised to the whole thing?