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We're all familiar with the concept known as the "placebo effect" in drug testing. But look at this:
Usually, randomised controlled trials are ‘double-blind’ in nature, which means neither the researchers nor the study participants know whether an individual patient is getting the active treatment or placebo. In other words, individuals taking a placebo will usually not know that, and will believe that they have (usually) a 50:50 chance of being on the active treatment. In randomised controlled trials, an individual’s belief that they might be on the active treatment might contribute considerably to the placebo response. In theory, if an individual knew they were on placebo only, we wouldn’t expect much of a placebo response.
This concept was tested in a study which was published recently in the on-line journal PLoS ONE. In this study, individuals with irritable bowel syndrome were treated with a placebo, and told that’s exactly what they were taking. The bottle holding the placebos they were given even had the word ‘placebo’ written on them. Another group of patients with IBS were given no treatment for comparison.
After 3 weeks, 39 per cent of the group receiving nothing reported an improvement in their symptoms. In the placebo group, this figure was 59 per cent. This difference was statistically significant. The authors describe the effect as “clinically meaningful”.
Clearly, people associate pills with benefits, even when they know that the pills are worthless. I find this absolutely amazing, but extremely interesting, of course. This clearly demonstrates how much power the pharmaceutical industry holds over us. In the eyes of Big Pharma, we are the equivalent of Pavlov's dogs.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
It's similar to making a doctor's appointment when you are sick and immediately feeling better. Or those new electronic cigarettes for people trying to quit smoking. You think you are doing something when you aren't, really. It's another example of how our minds can exert more power over our bodies than we have been taught and many in the medical establishment believe.
Marliss Bombardier
Dum spiro, spero -- While I breathe, I hope
Psoriasis - the dark ages
Hashimoto's Thyroiditis - Dec 2001
Collagenous Colitis - Sept 2010
Granuloma Annulare - June 2011
I learned a new one recently - the "nocebo" effect. It's the opposite of placebo - and occurs when something ineffective causes ill health. I guess it's another part of the power of suggestion. The good news is that positive thinking can make a HUGE difference in our health outcomes (and maybe even life span).
Nocebo and Nocebo effect
Research has...shown that the nocebo effect can reverse the body's response to true medical treatment from positive to negative. (Root-Bernstein 1998)
A nocebo (Latin for "I will harm") is something that should be ineffective but which causes symptoms of ill health. A nocebo effect is an ill effect caused by the suggestion or belief that something is harmful. The term 'nocebo' became popular in the 1990s. Prior to that, both pleasant and harmful effects thought to be due to the power of suggestion were usually referred to as being due to the placebo effect.
Because of ethical concerns, nocebos are not commonly used in medical practice or research. Thus, it is not unexpected that the nocebo effect is not well-established in the scientific literature. However, there are some anecdotes and some studies that are commonly appealed to in the literature to support its validity.
More than two-thirds of 34 college students developed headaches when told that a non-existent electrical current passing through their heads could produce a headache.
"Japanese researchers tested 57 high school boys for their sensitivity to allergens. The boys filled out questionnaires about past experiences with plants, including lacquer trees, which can cause itchy rashes much as poison oak and poison ivy do. Boys who reported having severe reactions to the poisonous trees were blindfolded. Researchers brushed one arm with leaves from a lacquer tree but told the boys they were chestnut tree leaves. The scientists stroked the other arm with chestnut tree leaves but said the foliage came from a lacquer tree. Within minutes the arm the boys believed to have been exposed to the poisonous tree began to react, turning red and developing a bumpy, itchy rash. In most cases the arm that had contact with the actual poison did not react." (Gardiner Morse, "The nocebo effect," Hippocrates, November 1999, Hippocrates.com)
In the Framingham Heart Study, women who believed they are prone to heart disease were nearly four times as likely to die as women with similar risk factors who didn't believe.* (Voelker, Rebecca. "Nocebos Contribute to a Host of Ills." Journal of the American Medical Association 275 no. 5 (1996): 345-47. ) [Of course, one might argue that the women in both groups had good intuitions. The objective risk factors may have been the same, but subjectively the women knew their bodies better than the objective tests could reveal.]
C. K. Meador claimed that people who believe in voodoo may actually get sick and die because of their belief ("Hex Death: Voodoo Magic or Persuasion?" Southern Medical Journal 85, no. 3 (1992): 244-47).
"In one experiment, asthmatic patients breathed in a vapor that researchers told them was a chemical irritant or allergen. Nearly half of the patients experienced breathing problems, with a dozen developing full-blown attacks. They were “treated” with a substance they believed to be a bronchodilating medicine, and recovered immediately. In actuality, both the “irritant” and the “medicine” were a nebulized saltwater solution."*
Arthur Barsky, a psychiatrist at Boston's Brigham and Women's Hospital, found in a recent review of the nocebo literature that patient expectation of adverse effects of treatment or of possible harmful side-effects of a drug, played a significant role in the outcome of treatment (Barsky et al. 2002).
Since patients' beliefs and fears may be generated by just about anything they come in contact with, it may well be that many things that are unattended to by many if not most physicians, such as the color of the pills they give, the type of uniform they wear, the words they use to give the patient information, the kind of room they place a patient in for recovery, etc., may be imbued with rich meaning for the patient and have profound effects for good or for ill on their response to treatment.
Love,
Polly
Blessed are they who can laugh at themselves, for they shall never cease to be amused.
Amazing stuff! I knew about the placebo effect but not the nocebo effect.
Had to laugh because I have been drinking Promised Land Egg Nog (full fat version) since before Thanksgiving ... expecting "bad results" and it has not happened..LOL
grannyh
Promised Land Egg Nog? That must be some potent stuff. Good for you for surviving that "test".
Polly wrote:Since patients' beliefs and fears may be generated by just about anything they come in contact with, it may well be that many things that are unattended to by many if not most physicians, such as the color of the pills they give, the type of uniform they wear, the words they use to give the patient information, the kind of room they place a patient in for recovery, etc., may be imbued with rich meaning for the patient and have profound effects for good or for ill on their response to treatment.
You know, I never gave much thought to this topic, but thinking about it now, I have a hunch that such things may be much more important than we realize. Last February, when I was in the ER with the bleeding emergency, and they told me that they were going to move me to an ICU room, (after they stabilized my condition), I naturally pictured a room with little stalls, filled with people in various stages of dying, (which didn't seem particularly appealing at the time, of course). I was kind of surprised when they rolled me into a private room, instead. It had all the ICU hookups, and constant nurse surveillance, of course, but it was bright, cheerful, and sparkling clean, with all the amenities, (if I wanted to watch tv, for example). IOW, to me, it appeared to be a place for a living patient, (as opposed to a place for a dying patient). I have no doubt that it helped to keep my spirits up, and I most definitely agree with you that attitude has everything to do with surviving and healing.
Thanks for the insight.
Love,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Another situation where the nocebo effect has a very adverse influence is connected with the tendency of increasingly-sensitive medical tests to detect cysts, benign growths, and cancers which may never be a problem. Certain types of cancer are very slow-growing, and previously, they were rarely discovered, except in autopsies. Prostate cancer is an example of this - some are aggressive, but most are not, and in many cases, the patient is better off not even being aware of them, because the nocebo effect almost surely has an undesirable influence on the patient's attitude, quality of life, and probably health in general. Needless hours are spent worrying, and this has to have a negative effect on one's overall health.
One of the biggest problems with the mammogram screening program is the high rate of false positive results caused by cysts or other benign tissues. For every valid diagnosis of breast cancer, there are many false positive findings, that result in countless hours of worry and wasted time and money. Suddenly, quality of life goes out the window, and many, many millions of dollars are wasted in followup exams which usually verify that the original test result was simply a false alarm. I'm not saying that mammograms are necessarily a bad thing, I'm just saying that if such screening tests are to be used, they need to be replaced with a more accurate/reliable test, in order to cut down on all the needless worry, and wasted money. I could be wrong, but I have a hunch that self-examination has a much better track record for detecting breast cancer, than mammograms. Mammograms excel at detecting benign cysts, and causing unnecessary worry. Somehow, I can't see mammograms being discontinued, though, unless a more expensive exam is available as a replacement, because this exam is a great revenue generator for clinics and doctors, and all the followup visits generate additional profit, of course.
Anyway, the point is, this is an area where the nocebo effect can be at it's worst, obviously.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Proof that insurance companies don't care if a test is valid or not - the main consideration for them is cost.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I read in that prestigious medical journal Reader's Digest that mammograms really don't cut down on breast cancer deaths, that it is a nice but unnecessary diagnostic test. Although the article said the same thing about colonoscopies, and if I had not had a colonoscopy in September I would not have known that I had a precancerous polyp. I have no history of colon cancer in my family--that is one cancer that we don't have, and if a dear friend had not died of colon cancer two days before my ob/gyn put the screws to me to have a colonoscopy I would not have had one.
Speaking of my ob/gyn, she is fine with women like me who have "breast awareness" rather than doing the self-exams or having yearly mammograms.[/i]
Marliss Bombardier
Dum spiro, spero -- While I breathe, I hope
Psoriasis - the dark ages
Hashimoto's Thyroiditis - Dec 2001
Collagenous Colitis - Sept 2010
Granuloma Annulare - June 2011
Has anyone looked at the dates on the "machines" used to test us? This year I tried.. but the date was missing on the mammogram machine.. next I looked for the last date it was calibrated.. missing too.. supposed to be there. Makes one wonder if they are using old machines long since paid for and probably way out of date as to the ability to find anything....
grannyh
Maybe there are no laws requiring regular recalibration of hospital lab or testing equipment.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hmmmmmmmm. I guess that's the medical equivalent of forgetting to get a vehicle inspected when the window sticker expires.
Kinda worrisome, though, since so much rides on those test results, (as far as the patients are concerned, though not the doctors, of course).
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Visit the Microscopic Colitis Foundation Website
